The heart - your single point of failure. And other pleasant thoughts

I may be slightly obsessed but it is a subject close to my, umm, heart. Yes, it's cardiac function and exercise. If you don't exercise then you don't get the benefits of exercise, right? You get fat, you lose muscle and bone mass, you lose "condition". Yet if you exercise too much, ie too strenuously or for too long, you risk damage. And if you get wrapped up in what is too-often the "boy's club" that is competitive sport then you are often driven to do exactly that - damage.

Basically what you really want to do is moderate exercise within the bounds of your abilities. Alas, that won't win you a bike race, will it? Well, not a big one, anyway. Trouble is, the commitment you need to make to competitive sport is OTT. Everything about it is wrong, yet it's addictive and feels so good. Given that you are probably going to do it anyway, you may as well read up on the downsides - the risks. If you want to "succeed" then at least do it fully informed.

Effects of Intermittent Exercise on Cardiac Troponin I and Creatine Kinase-MB

Strenuous physical activity is destructive for cardiac function causing an increased risk of myocardial infarction during and one hour after the exercise bout.¹ Cardiac fatigue is exercise-induced cardiac dysfunction in the absence of underlying cardiovascular diseases with a large number of symptoms and an unclear etiology.

Reflections on training and aging

Well we all do it - age, I mean.

One moment I'm learning to ride my dad's huge old Alcon and the next I've got 3 kids of my own. Let me reflect on this for a moment.

It was too big for me, the Alcon. It had a fixed sprocket on one side of the back wheel and a single freewheel on the other. Once I figured out that the faster you went, the better, I was OK. And this one idea - go faster - has propelled me throughout my cycling career. Go faster. It's better.

It was at Centennial Park that I found my forte. Laps, lots of them. Each one a fresh challenge. Each lap urging me onward, ever faster. Every rider in front of me a target to be caught. And at Heffron Park it was the same - but better. Wait for the last lap, the bell, and then - just go faster! Catch me if you can!

It seemed that "go faster" was indeed the key to it all. And the maxim held true also at Camperdown, bumpy, steep and forbidding that it was, where going slow was to tempt pedal-clipping fate. Going faster was, once again, the way forward.

Inevitably though life has its rough patches. The big fall. The glandular fever. The heart attack. The lay-offs, the come-backs. It's always the same, but always different. You get older and it all takes a little longer.

The falls took their toll both physically and mentally. I'm still paying for that big one at Heffron in '88. I never quite got back on terms with A-grade after that and never again took the "brave route" through the bunch. I lost trust. I backed off when I sensed trouble. I let others have the win. I lost that "animal" urge, perhaps. I mellowed.

And of course the heart attack was a real surprise. How can I ride every day and still get a blocked artery? Well there you go, you can. And the after effects linger. That question hangs over you, floating at the back of your mind - should I push a bit harder, or back off? How's the heart going?

So here I am, 14 months later. Back to 100kms a week. Well I have been here before, even after the heart attack. But I may have rushed my comeback, as you do. And I fell back into a deep hole. It's been over 6 months since I last rode a 100km week. But I've done it. And the sensations are good, again.

Let me run through the process.

Almost 6 months off the bike and I feel breathless, the quads hurt and sundry bits - like tendons, knees and the contact points - complain for days afterwards. But it was better than I expected. Maybe a comeback is possible?

A few rides later and all hope is lost. I'm not improving. I'm puffing, panting, weak and tired. Finishing is a struggle. Perhaps I should stop?

I persist and after a few weeks I notice that I'm going a bit further and occasionally a bit faster. But still I'm at a loss. It wasn't like this when I was 25. (Yes, well, I'm 57 now.) I'm not exactly jumping out of my skin, I lack zip and I'm wasted after every pathetically short ride. But I can't stop now.

Remembering how I over-did it last year I take it steady and build gradually. I don't want to relapse. I start to feel some good sensations when I hit the 80-km-a-week mark. The legs, heart and lungs occasionally work together. Hope springs eternal.

And cautiously I hit 100km-a-week. Finally the legs have some zip and I can maintain a steady, decent pace throughout the ride. I'm not dying at the half-way point and limping home. Instead I'm accelerating almost - almost - at will over the whole ride. OK, I can't attack a hill like "normal" but I don't think that's too far away. I can see the tunnel now and I suspect there's a light at the end of it. We shall see. 

100km in a single week? Here's the proof:

 Oh well, it's (yet another) start.

BMC's Lodewyck sidelined with cardiac arrhythmia - it can happen to anyone

Triggered by a crash and associated trauma? Brought on by subsequent medication? Or just going to happen one day anyway? We are only guessing.

The BMC Racing Team today announced that it has removed its Belgian rider Klaas Lodewyck from competition after he experienced irregular heart rhythms during racing and training.

"He had been experiencing some irregular heart rhythm during racing and training," team doctor Max Testa said. "We have been investigating it, first by having him evaluated by sports cardiologists in Belgium. The common decision between a specialist there and the BMC Racing Team's
medical staff is to rest Klaas for an undetermined amount of time while a thorough investigation is performed."  BMC's Lodewyck sidelined with cardiac arrhythmia | Cyclingnews.com


Point is, it can happen anytime, to anyone. Cyclingnews lists a few more...

Lodewyck is not the only rider to suffer from cardiac arrhythmia - former cyclo-cross world champion Niels Albert was forced to retire prematurely because of heart problems, and Belkin's Robert Gesink stopped racing in June to have an arrhythmia treated. Other riders who have had cardiac issues in recent years include Nick Nuyens, Haimar Zubeldia, Nicolas Vogondy, Nicolas Portal and Kim Kirchen.

Not surprisingly they didn't mention me. Whilst I can't speak for any of the above-named, I can of course speak for myself. I have ridden over 300,000km in racing and training, a very small amount of it at state "open" level but mostly at all levels of club racing. I never imagined that my heart would ever give me trouble. Even when I started to get the odd 'feeling' I dismissed it. And whilst I pushed myself pretty hard - as hard as my limited training time allowed - I rarely felt as though I had pushed "too" hard. Maybe sometimes, but isn't that what you are supposed to do? I always trained 'properly' before racing. I did my base miles. I even ate well, mostly, and hardly ever drank alcohol.

I guess I managed pretty well what I could control. Or so I thought. (Hypertension and stress might be things that I could have controlled a bit better, though.) The other factors - those out of my control - included my genetic predisposition. And in hindsight that's a pretty big one. Cardiac issues on both sides of my family should have given me a hint.

Coupled with starting a family a bit later than most and juggling racing, training, work and that growing family, I was probably cutting things a little fine. And when I then started at university intending to pick up a mature-age degree or two, I noticed that my health was going a little awry... aren't warning signs wonderful?

Only if you read them right! Naturally I thought, "it's stress" and decided to make things better by cranking up the pace - let's get this degree thing over and done with sooner rather than later. Probably not the right choice, but it was the choice I made. And thus an "unexpected" illness arrived in my life, coupled with medication that did nothing positive for my existing, if somewhat hidden, cardiac risk factors.

Of course I didn't ask for a heart attack. Indeed I thought that riding and racing would protect me from such a thing. But I was wrong. It doesn't have to be an outright ischaemia, it can be a mild arrhythmia. But with only one heart allocation per person it's better to listen carefully to your body and assess all of the factors involved. Life is a balance of positives and negatives. Striking the right balance is vital.  

Update on recovery from ischaemia

Well as you may already know I had a heart attack on January 1 this year. To be perfectly honest, upon reflection, it was fairly minor as far as ischaemic events go - but ignoring it wasn't an option. Well 60-odd years ago ignoring it was probably the only option. I remember one of my grandfathers (who 'survived' in some senses service in 2 world wars) took 'angina tablets' when the pain came on. He probably had a blocked artery or 2 but there was little you could realistically - or affordably - do about it back then. Whereas in my case they simply inserted a few stents and inflated them, unblocking the blocked artery. It took 45 minutes (if you discount failed attempt number 1, an ambulance trip and brief stays in 2 hospitals). Fixed!

Well, mostly fixed. I'm not exactly the same as I was, psychologically or physically. I am unblocked,  with a renewed blood supply to the organ in question, but said heart now has muscle tissue damage, some of it irreparable, if to a minor degree. Nevertheless my heart beats strongly and regularly, and after almost 3 months of training on the bike (half on the trainer and half on the road) I am back to where I was in December last year - doing at least 200km a week on the road. Mostly flat and only 60% intensity, though. And just a few intervals at 80% or so. And no long, hard climbs for now.

Yet there remains a small, disquieting fear that the heart will be weakened, unable to cope with "normal" training (let alone racing) loads. And statistically that is borne out by those who have repeat heart attacks after their first. So I'm tentative, still. A new clot could form over the stents themselves, for example. But with each passing mile I get more confident that I'm OK. Indeed I feel "better" in many ways. Whereas I was grinding it out for the previous few months (before the attack) I am now refreshed and eager. My body is responding positively if slowly to the training load, whereas it was only slowing down and going backwards before.

Another realisation is that heart attacks can be - indeed often are - "silent". You may not notice you are having one. The one I had, whilst distinctive, was dull and incapacitating for a couple of hours, like dragging a heavy weight around, rather than endlessly sharp and totally, unavoidably crippling, if you can see the distinction. Indeed I began to feel "better" after about 3 hours of this crushing bore of a monumental chest and arm pain. I could see a way out. But by then I was in hospital, which is the best place to be if you want to get "fixed".

Still, I could see how ignoring it and just avoiding strenuous exercise forevermore may - in some cases - work out. But for me I wanted to ride again, and I didn't want to risk the statistically significant attack number 2, the one that would sneak up on me and do me in for good. And it made me ask, 'ok, this is different, it's really bad - but have I had one of these before, just milder?'. And my answer would be "yes". This was just a new level of pain and injury.

Hindsight is a wonderful thing but the last 3 months of training pre-attack, sometimes in terrible heat, often had me thinking 'what's wrong?'. And whilst I could do it, I could finish the rides - and the occasional races - I didn't push to my old limits. I backed off. I let the bunch go on the last lap. I gave in to the "pain" of the effort. Whilst it wasn't that distinctive full-on crushing pain, I now recognise that what I thought was "not enough training" or "just old age" was probably a very mild form of heart attack. I have no firm evidence, no blood tests or angiograms to back that up, but it's what I suspect. Whilst my heart attack represents a certain event, the rupturing of some plaque and for a time the complete blockage of a coronary artery, in truth that artery was significantly narrowed for years.

My heart was under attack from reduced blood flow for a long time. I just didn't read the signs.   
      

Heart problems bring Kaisen's career to a premature end : SBS Cycling Central

Timely indeed, given my own situation. This is Lotto Belisol's Olivier Kaisen on his heart problem:

"At training camp in December I was able to train in perfect circumstances without any problem. Now I think my moderate season in 2013 might be caused by it." Kaisen first noticed the problem during the Tour Down Under in January."After the second stage at the Tour Down Under I didn't feel well. It had been a very tiring and extremely hot day and I had ridden much at the head of the bunch for André Greipel. I did start the next stage, but immediately after the start of the third stage I felt something was wrong. I was scared and together with sports director Herman Frison I decided to quit. He said I couldn't take any risk.



The thing is, and I know this from hindsight more than any analytical brilliance, as you tend to grow into your body over time, it so rarely surprises you. You simply get used to its quirks. After all, you don't get to experience what other hearts are like, although you may still realise that there's a huge diversity in what are "normal" rhythms and rates of beating. Some are fast, some are slow and some are all over the shop. Yet they "do the job". Mostly. So you get "used" to your own quirks and they fade into the background... until one day...


And if you race - or even train hard - you are putting a hefty load on that single point of failure. That load can be extreme in a race, especially if you are dehydrated or have some other variation from the "norm" that one day may create that "perfect storm" that is ischaemia. Now hindsight is a wonderful thing and I don't want to put anyone off cycling to their full potential - far from it - but we can't see into our bodies as we go about our daily lives (well, not without some help, anyway). We have to go by feel. And that's why we need to look after ourselves, eat, rest and train right, and keep a look-out for anything that feels 'unusual'. It could be a sign that shouldn't be ignored.