Cycling v Heart Attack

[David_G]

I was talking to guy on my Saturday group ride who I han't seen for awhile.

It turns out that he had a heart attack on a group ride several weeks previously. He complained about feeling I'll and left the ride early. He rode home which took about an hour. When he got home his wife told him he looked awful and took him to the doctor.

Tests revealed that one of his arteries was 70% blocked. His cardiologist said that if it wasn't for his high level of fitness he would have probably died.

After several weeks off the bike he is back on it and trying to regain some lost fitness.

I can beat that, one of my coronary arteries was 97% blocked and it's only 3mm wide to start with. I've got the pictures from the angiogram and you can see the narrowing.
The goss I got was that you don't feel any pain at all until you get to 70% blocked.
I didn't have a heart attack, but I was that 3% away from one. They put some things called stents in there which opened the artery up and my cardiologist gave me the all clear to go for it at the gym and ride my bike as much as I wanted about 3 months later.
That was in 2003 so all is going to plan so far.


*EDIT*
The moral of the story is : If you're feeling woozy, have chest pain, numbness in your arm or any of that..Stop what you're doing and call an Ambulance IMMEDIATELY. They don't mind if it's a false alarm and if it's not they're the best one to drive you to the ED.

[Ken Ho]

Linky: How much is too much

As the article explains, there is a gap between what medical science has proven and what endurance athletes anecdotal evidence suggests. Empfield offers some tentative theories on what might underlie it, but we probably need someone to do more definitive research.

"Heart Tired" is a terrible term! One that misleads people. As indicated in the article, heart can not get tired, and the likely candidate being that of the external neuro-hormonal factors that control the heart. Heart muscles are better than Duracell batteries.

I kinda like the term. It's like "shock" or "stroke". Not terribly accurate, but gets the message across.
He didn't say that the heart cannot get tired, he said that it does not let you know inthe same way as skeletal muscle.
It was more a suggestion of long term fatigue and damge too, as opposed to MI, which is what most people consider to be a "heart attack"., of course.
It's just food for thought.

[sogood]

I kinda like the term. It's like "shock" or "stroke". Not terribly accurate, but gets the message across.
He didn't say that the heart cannot get tired, he said that it does not let you know inthe same way as skeletal muscle.
It was more a suggestion of long term fatigue and damge too, as opposed to MI, which is what most people consider to be a "heart attack"., of course.

There's no evidence of damage. And even when "heart tired" is in place, I am sure the heart can still go into the various tachycardic states, indicating the heart muscles can still be triggered to beat at far higher rates. It just makes no sense to make those purported claims on the heart. A bit of pseudo-science when general body alteration under excessive stress and existing neuro-endocrine regulation of the heart are far more likely to be the mechanism for the observations. As for the Germans (esp the East Germans), well, they used some pretty amazing pharmacological agents in those days.

[winstonw]

I agree "heart tired" is a dodgy term.

While reading Empfield's article I found myself saying that's familiar. I'm 52, but have not got my HR above 155 in the last few months of wearing a HRM regularly. Even when I've absolutely thrashed myself on climbs, all out sprints, or 10 and 20 minute TTs, it won't go higher.

My GP thinks it is most likely totally attributable to a thrashed thyroid. I had an acute high spike of TSH with normal T3 and T4 some months ago, but the TSH has settled down to just above normal levels. (He did three tests to check whether it was just an acute thing). I'll be having another test in 4 months. I must say though, in alignment with thrashed thyroid, I've also felt more tired than usual and hungrier, and am probably clinically bradycardic (current HR just sitting at the desk 42, BP 123:66) which are different symptoms to those mentioned by Empfield.

I think there's heaps we still don't know about the brain and its regulation of the neuroendocrine axis; and how stress, infection, and the immune system can mess with it.

[Ken Ho]

I kinda like the term. It's like "shock" or "stroke". Not terribly accurate, but gets the message across.
He didn't say that the heart cannot get tired, he said that it does not let you know inthe same way as skeletal muscle.
It was more a suggestion of long term fatigue and damge too, as opposed to MI, which is what most people consider to be a "heart attack"., of course.

There's no evidence of damage. And even when "heart tired" is in place, I am sure the heart can still go into the various tachycardic states, indicating the heart muscles can still be triggered to beat at far higher rates. It just makes no sense to make those purported claims on the heart. A bit of pseudo-science when general body alteration under excessive stress and existing neuro-endocrine regulation of the heart are far more likely to be the mechanism for the observations. As for the Germans (esp the East Germans), well, they used some pretty amazing pharmacological agents in those days.

..sigh...

Lack of evidence is not evidence of lack.
I did meet a bloke recently who had a heart transplant for cardiomyopathy developed during intense training for some marathon in the desert.
I'm not saying that Empfield is right, just offering it as food for thought.
It's barely more than 20 years since the mechanism of thrombotic MI was elucidated, and less than 20 since we started treating unstable angina as a pre-MI state and less again since the ACS concept became accepted. I've seen the whole evolution of that in my career.
There is still much we do not know.

[sogood]

Lack of evidence is not evidence of lack.
...
There is still much we do not know.

But much reservation is required, especially when the concept is pushed formally without evidence. It's true that there's much we don't know, but there's a set of logic and process we consider new ideas. This guy hasn't presented any. Similarly, "food for thought" needs to be worthy food, or diarrhoea may result.

[Ken Ho]

Lack of evidence is not evidence of lack.
...
There is still much we do not know.

But much reservation is required, especially when the concept is pushed formally without evidence. It's true that there's much we don't know, but there's a set of logic and process we consider new ideas. This guy hasn't presented any. Similarly, "food for thought" needs to be worthy food, or diarrhoea may result.

Maybe we read a different essay. I didn't see anyone push anything formally, and I thought the food was reasonable.
It was presented as anecdotal, not research based. All he said was, have a little consideration for your heart.
Science always begins with a story. Science is the process of testing the stories to see which ones are true.
No stories, no science.
How many of the best findings have started with an idea that everyone else thought was mad at the time ?
Most of them, actually.

[wombatK]

Science always begins with a story. Science is the process of testing the stories to see which ones are true.
No stories, no science.
How many of the best findings have started with an idea that everyone else thought was mad at the time ?
Most of them, actually.

+1. I've always thought you've got to be just a wee bit mad to think you can get a PhD.

I thought the article was clearly pointing to the limits of science. Phrases like "tired heart" might not be
technically accurate. But many lay people will read "tired" as a synonym for "exhausted" - and will get the
drift of what it is suggesting. There are limits to everything - including how your heart can perform.

[sogood]

How many of the best findings have started with an idea that everyone else thought was mad at the time ?
Most of them, actually.

There can be thousands of stories, and it's illogical to start to take it seriously without any factual evidence. Religion is a classic story to explain away all observations.

[Ken Ho]

How many of the best findings have started with an idea that everyone else thought was mad at the time ?
Most of them, actually.

There can be thousands of stories, and it's illogical to start to take it seriously without any factual evidence. Religion is a classic story to explain away all observations.

OK, I agree that just dreaming up fantastic possibilities is not the best way to start the scientific process. (Like cold dark matter, for example)
However, in this case, the anecdotal observation of unexpected heart disease in people who had led super-fit healthy lives is the basis for the hypothesis.
Hopefully someone will post the quote about the 3 stages of truth soon.

[sogood]

OK, I agree that just dreaming up fantastic possibilities is not the best way to start the scientific process. (Like cold dark matter, for example)
However, in this case, the anecdotal observation of unexpected heart disease in people who had led super-fit healthy lives is the basis for the hypothesis.
Hopefully someone will post the quote about the 3 stages of truth soon.

3 stages of truth is telling when a story has been proven. However, it is not a reason to not apply rigorous scientific questioning. In any case, this is not a question of ridiculing a story, but justifiably seeking at least some evidence before given consideration. Otherwise it's no longer hard science, but wild speculative science fiction. Yes, many enjoy science fictions.

[Ken Ho]

OK, I agree that just dreaming up fantastic possibilities is not the best way to start the scientific process. (Like cold dark matter, for example)
However, in this case, the anecdotal observation of unexpected heart disease in people who had led super-fit healthy lives is the basis for the hypothesis.
Hopefully someone will post the quote about the 3 stages of truth soon.

3 stages of truth is telling when a story has been proven. However, it is not a reason to not apply rigorous scientific questioning. In any case, this is not a question of ridiculing a story, but justifiably seeking at least some evidence before given consideration. Otherwise it's no longer hard science, but wild speculative science fiction. Yes, many enjoy science fictions.

No, it's anecdotal reporting. Wild speculative sic-fi is time travel, or worm-travel, or sub-space communication.
I'm happy to consider things before utter proof exists, and I have to say, that sometimes pop culture leads the way, and the scientific community las behind. Low-carb diets, for example.

[sogood]

...I have to say, that sometimes pop culture leads the way, and the scientific community las behind. Low-carb diets, for example.

There's no shame in proper scientific process and associated rigorousness. It's there for a reason. Away from low-carb diet, how much more money has people wasted on wildly promoted dietary supplements and plans?

[ColinOldnCranky]

One's ticker can just as easily go during or post bed exercises, if the exertion level is "right". Cycling is not the issue but safe exertion level for the underlying health state is.

That is a fair explanation as a first response, but it may still not be right. When I was a serious squash player a researcher in Scotland stumbled across an alarming correlation between squash players and fatal heart attacks recorded at scottish hospitals. The number of people who died on court or within one hour of finishing a session of squash. No-one previously had ever noticed the correlation because no-one had ever looked for it. I wonder if anyone has looked for it with cyclists.

Within a year or two of this being published one of the worlds leading players died on court at the Tee Tree Gully international squash tournament in South Oz. (http://en.wikipedia.org/wiki/Torsam_Khan).

Some years later a friend of mine who, with his whole family, matched the fit and serious active sports person died at aged forty with his keys in the front door after jogging from the court to home.

I am talking in both cases of supremely fit and serious players. By themselves two instances would not mean much but, in view of the scottish data, ...

I understand that trading off fast cadence with pressing harder in a higher gear makes for extra restrictions in blood flow, so taxing the system with a higher blood pressure than otherwise. Sorta inducing something like hypertension.

[Ken Ho]

...I have to say, that sometimes pop culture leads the way, and the scientific community las behind. Low-carb diets, for example.

There's no shame in proper scientific process and associated rigorousness. It's there for a reason. Away from low-carb diet, how much more money has people wasted on wildly promoted dietary supplements and plans?

You seem to be trying to imply that I have a problem with science.
I dont. I'm a freaking doctor.
I just accept that science needs to be preceded by an anecdote.
I would be interested to see a study to check the story. It would make a good study for a cardiology reg.
Follow a cohort of triathletes for a few decades. The Kona group would make a nice captive cohort as many of them keep doing it.
Its true that people waste a lot of money on supplements. I don't.
Anyway, I'm out now. This discussion is getting too personal.