When Athletes Have Heart Attacks

By August 20, 2015 December 9th, 2016 Athletic Performance, Exercise, Lifestyle & Stress
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Tragic events underscore need to understand balance between fitness and health

The recent death of a 55-year-old competitive mountain biker in the popular Leadville Trail 100 MTB in Colorado has garnered the attention once again of a media obsessed with pointing out the irony of highly trained — and seemingly healthy — endurance athletes who die suddenly while racing or training.

The cyclist died of an apparent heart attack in the last miles of the high-altitude 100-mile ultra mountain biking race; it would have been his 19th time completing the event. While the story is truly sad and we send out condolences to friends and family, it also underscores a need for the entire athletic community to have a more serious discussion about the real cause of sudden deaths in athletes. The most common cause is a heart attack, and many of these tragedies are the result of athletes being willing to sacrifice their health — sometimes unknowingly — while following no-pain, no-gain programs in a futile attempt to gain more more fitness.

This story is not new. Our modern-day marathon is based upon the story of the ancient Greek runner Pheidippides, who died after running from Marathon to Athens, Greece, to deliver news of a military victory against the Persians in the Battle of Marathon. So in fact the marathon event itself is based upon the death of an athlete.

The scenario has repeated itself throughout the ages, including the highly publicized death of Jim Fixx, author of The Complete Book of Running who died of a heart attack while running at the age of 52, to more recently the death of 58-year-old ultramarathon running icon Micah True, central figure in Christopher McDougall’s New York Times Bestseller Born to Run.

While these athletes’ stories have drawn quite a bit of attention, there have been many others who have had heart attacks and died while pursuing their athletic passion in a variety of sports, and many of them at a much younger age — some of them even teenagers. Others die during training, and even during sleep, and these deaths are often unreported. Still other athletes survive a heart attack or other coronary event — consider the stories of legendary marathoner Alberto Salazar, who won both the Boston and New York City marathons, cycling icon Leonard Zinn, and Boston Marathon race director Dave McGillivary.

And while this is the subject of news and magazine articles, and even scientific studies, few are willing to discuss the real underlying cause. We have been sold for years on the notion that fitness and health are one in the same. And often following these tragedies so-called experts point to genetics and family history. While it may be difficult for some to accept, and the subject might prompt an emotional response especially from those who have lost a loved one, there are three important parts of the issue that are almost never discussed. In almost all cases:

  • Cardiovascular disease does not occur in a healthy body.
  • Cardiovascular disease is preventable through a healthy lifestyle.
  • Cardiovascular disease is usually accompanied by abnormal signs and symptoms.

While many people have been conditioned to equate fitness with health, these two conditions clearly are not the same. It is possible to be healthy and not that fit. It is also possible to be very fit, while quite unhealthy. Even the fittest ultra-endurance athletes are not immune to heart disease, just as they are not immune to injuries, ill health, depression, high body fat, and other unhealthy conditions.

The key to the optimal human experience and long-term performance is to find the balance between fitness and health.

The truth is some athletes are unhealthy because of lifestyle and dietary choices, or nutritional deficiencies. Another very common problem is many athletes compromise their health at the expense of getting fit — typically by overtraining, which can include too much volume and not enough rest, but more typically involves too much high-intensity training. This regimen can produce a deadly combination of stress, inflammation and free-radical oxidation.

Additionally, it’s well known that too many athletes who die of preventable conditions ignore the abnormal signs and symptoms of cardiovascular disease (see below), or ignore a health professional’s advice based on tests.

The myth that exercise makes athletes immortal sprung out of the story of Clarence DeMar, who won the Boston Marathon several times and won a medal at the 1924 Paris Olympics despite a previously diagnosed heart murmur. DeMar died of cancer in 1958 at the age of 70, and an autopsy revealed a healthy cardiovascular system with no signs of atherosclerosis. This helped fuel the notion that marathoners were invincible, as well as adding momentum to the running boom that was just taking off.

However, by 1977, the medical journals were already reporting that running did not create an immunity to heart disease, including a study published by Dr. Timothy Noakes entitled, Coronary Heart Disease in Marathon Runners.

In my own practice I was already seeing the ill effects from training in many marathon runners. I made many copies of Noakes’ study to give to disgruntled runners, especially health professionals, in an attempt to impress upon them that exercise itself was not protective against disease. Still later, I began to realize that is some athletes extreme exercise might even promote heart disease.

Avoiding heart disease, regardless of how fit you may be, means taking a careful assessment of many facets of your life, not just your training and racing. This includes managing stress levels, monitoring inflammation, and paying particular attention to diet, nutrition and training.

Much of my program, including my books and articles on this site, are aimed at helping people strike this balance and achieve optimum performance without diminishing health. Only by doing this can you set yourself up for a lifetime of healthy activity while reducing your chances of becoming another heart disease statistic.

Signs & Symptoms

Your body’s trying to tell you something

Heart disease can sneak up on you, and death is too often the first sign. Yet, there are often earlier signs and symptoms that provide clues ahead of time. Just before a heart attack, indications of an impending problem include chest pain or pressure, especially down the arm and worsened by exertion. Others include shortness of breath, high blood pressure (above 120/80), and a family history of heart disease.

Even earlier, often years or decades before a major cardiac event, subtle signs and symptoms may include:

  • Anxiety and stress, fatigue, nausea, pain in other parts of body, irregular heart rate, shortness of breath, sweating, swelling.
  • Above normal levels of body fat. In particular, a bigger belly. It’s usually obvious — if your waist size has been getting bigger, it’s an even bigger clue.
  • Blood sugar problems.
  • High levels of triglycerides — fats in the blood that the body produces from dietary carbohydrates.


  • Brian says:

    For those that think they have it all figured out, I have to chuckle. I have raced bicycles for over 20 years and at age 49, I had a Widow Maker heart attack. Before you start hypothesizing as to why it occurred, keep in mind the following:
    1. For over 20 years, I have maintained a healthy diet. It included plenty nutrient-rich foods. A few of them to mention are: seeds, nuts, whole plant-based foods, foods with low or no saturated fats. Most meats in my diet were lean, and predominantly fish. I could go on and on since nutrition has been top of mind for me — for the majority of my life.
    2. Early in my racing career, I worked with a coach. The importance of rest and dangers of over-training were noted and observed throughout my career.
    3. I had recently undergone blood tests to stay on top of things. My triglycerides were incredibly low, along with a healthy LDL reading of 35.
    4. Following the event, I underwent other tests involving cholesterol (i.e. particle count, etc). All came back with exceedingly good readings.

    I find the proclamation that “Cardiovascular disease does not occur in a healthy body.” laughable.

    The cardiologists have ZERO CLUE why I experienced the event. They chalk it up to genetics, yet none of my family members have experienced heart attacks.

    My point: you can tell yourself you have it all figured out. Doctors love to do this. The truth is no one has all the answers and all we can do is “attempt” to prevent CAD and cardiac events. By the grace of God, I survived my heart attack and subsequent near-fatal heart rhythms.

    If you have an explanation, I’d love to hear it. Otherwise, I’d be careful about what you say in these settings and giving people false assurances.

    • Steve says:

      Hi, I’m glad you survived and hope you’re doing well. One clue regarding your history are references given in a talk by Joel Wallach ND. When athletes train a lot they sweat out minerals. Many of these minerals are deficient in most soils and thus we suffer ailments from these deficiencies. For example, magnesium & selenium deficiencies have been connected to heart arrhythmias & cardiomyopathies respectively. Orthodox MDs don’t know this because there isn’t a pharmaceutical to treat it. Who funds research – follow the money..
      Mineral/nutrient education & supplementation have helped me a lot in getting over a bad case of atrial fib. Cholesterol hype only sells statins.

      Take care.

  • matt says:

    Curious as to why most to all the athletes that die of heart attacks just happen to be in sports that involve high level of sweating?
    Because sweat contains many minerals such as sodium, potassium, calcium, magnesium, copper, iron, chromium, nickel and many other less abundant trace minerals (such as selenium which will cause a heart attack when your body is deficient in). For example high blood pressure is due to a deficiency in magnesium and calcium.

  • Katen says:

    Good lessons to learn here. Thanks for sharing. What kinds of test should I ask my doctor at my next visit? Echocardiogram is one that I see here. I’m 49, female and have no family history of heart disease. I’m vegan and training for my first 50 miler. In my 30k races, I tend to go all out at the last 5k. I did one today and got home and felt something on my chest that I’ve never felt before—very slight tightening. Thinking of getting checked but don’t know how to start. Will start wearing my HR monitor on long runs. Thank you.

    • Hello Katen,

      The very best advice I can give you is to go to a heart doctor if you think there might be an issue. It’s always best to get checked out by a health professional who can do an in-person physical exam.

    • Rich says:

      Problem with the echo is it’s only 10 seconds of what’s happening at that exact time. Echo stress is a much better test it is real time with you exerting effort on your heart

  • Peter Deacon says:

    I had shortness of breath for over 3 years, and was treated for Asthma and had many tests, and was told my heart and Arteries were ok ..But 6 months ago I had a heart attack, and spent 2 weeks in hospital before they found I had a blocked artery and a nearly blocked one they offered me stents but I went for a double bypass ..now my breathing is ok .

  • Valentino shembilu says:

    Its abad disease I have ever seen

  • Joe says:

    I just read this article after trying to do a typical google ‘self-diagnosis’. I’m 38 years old and started getting back into shape with more intensity over the last few months. Running, weight-lifting and cycling. I have never had good stamina and although very active and fast all these years, I never typically ran long distances. I went cycling this week intending to do 25 miles which I have done previously and midway got so exhausted, short of breath with chest tightness. Putting it off as plain exhaustion, I pushed through at a slower pace, then rested and carried on with no issues. Since then I tried running and could barely do a mile and my overall workouts have been short and lack of energy. I thought resting a day or two would help but this morning woke up and got dizzy a few times. I am scheduled for a check with my doctor but I know the usual ECG and blood pressure check is all they do, despite the fact that my family history includes a mom with heart disease and multiple strokes. This is some scary stuff not to be taken lightly.

    • Craig says:

      Hi Joe,
      I hope you have had a total health check up, be persistant and make sure you are 100%certain you do not have coronry/cardiovascular heart disease.
      I had identical symptoms to yours a rapid loss of fitness in just a month or so but thought I would not suffer a heart attack at 48. I exercise everyday and eat clean healthy non processed foods this is how I convinced myself it would never happen to me.
      I kept up my exercise but it got more and more dificult.
      Last week I hit the deck 4 times in 24 hours, massive crippling chest pressure that got worse every episode but Dr Google had me convinced it was indergestion.
      What was actually happening was a 100% blokage of a coronry arterie backing up for up to 5 or 6 mins then my strong heart muscle would push the blokage free and I would instantly feel fine.
      Anyhow after the 4th episode a friend came by and straight away asked what was wrong, I said why and she said I looked grey and pale and I needed to call an ambulance.
      I refused an ambulance but drove straight to hospital, (stupedist thing I have ever did, what if what happened next was before I got to hospital, I would have been dead and maybe an innocent bystander) they put me on a heart monitor @the hospital and checked my BP and heart beat.
      Strong heart beat 55min, ok BP good rythym.
      I was about to get up and walk out and an episode came on, they hooked me up to an ecg and got a print out.
      This was my worst episode.
      Turns out MASSIVE heart attack, was in surgery within minutes.
      99%blokage coronry arterie, 2 stents fitted.
      Soooo lucky, minor if any heart muscle damage up and walking within 48 hours.
      If I was not in hospital when this episode happened over 90%chance I would have died or at best irreprible damage to my heart muscle.
      Thats not good odds.
      I had all the signs, rapid decline in physical fitness, depression, anxiety, lethargy, pressure.
      I ignored it for weeks, self diagnosing, everything but heart disease, what a fool, I ended up minutes from death.
      Take note, never ignore the symptoms, it can happen to anybody…

  • Paula says:

    The fact is that in some countries have obligatory ecg stress tests to participate in competitive sporting events. It has been branded in the uk and the USA as impracticable but that is simply not the case. In Italy for example if you are under 40 you have a ecg under stress and if you are over 40 you must also have an echocardiogram. It’s no bother to do this once or twice a year to take part in events.

  • Bert says:

    Your brief discussion highlights lifestyle and cardiovascular risk factors all people should minimize. Not discussed or even suggested, however, are the often not yet discovered, thus diagnosed, congenital cardiac anomalies that may only manifest for the first time during the stress of physical workload. As a paramedic I have had patients with hypertrophic cardiomyopathy or Brugada syndrome found on ECG only because of their signs and symptoms manifesting during competitive sporting activities.

    I have run regularly for 33 years now, my first marathon at 19 years old. Jim Fixx’s book was my first running guide. Your reference to Jim does not include his own awareness of a congenital anomaly of which, I believe, he and his father both died of but his father at an earlier age.

    You are correct in pointing out, especially in ultra athletes it seems, the diffuse belief that with the high number of calories burnt during a long training run of 30-80k a higher fat meal makes for wise calorie replacement. I have enjoyed a lower fat lifestyle since years of road running and comfortably maintain that now into ultra running. I perhaps could at times increase my fat intake for caloric need but not through the highly saturated fatty foods often the fare at social or event gatherings.

  • Álvaro says:

    What do you think about this study?

    Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

    • Alvaro:

      I absolutely agree, noting the presence of the words “potential” and “excessive.” As long as the endurance exercise is not “excessive,” there are very few “potential” adverse cardiovascular effects.

      The MAF Test is explicitly designed to show you when endurance exercise (and training volume generally) has become excessive. If your MAF speed plateaus for more than 2-3 months, or it starts to drop, then you’ve reached “excessive” endurance training.

  • Natasha says:

    I was a competitive runner and cyclist. Last year at age 39 I suffered fainting spells during my runs. Then I suffered close to a cardiac arrest during a long run. Never before had I exhibited signs of any problems, ever. I was found to have a deadly arrhythmia. EP study, MRI, cardiac catherization all done on me. EKG abnormal and everything else normal. I have heart damage but from what, docs do not know. I now have an ICD and on beta blockers. I can continue to run, and I do. But no where near the intensity I did before. But I am grateful and happy to be out there at all. Hard to know if this is going to happen to you if you have not exhibited problems in the past. But I am lucky to be alive. My HR now when I run stays in the low 130’s and I am about a minute per mile slower than I used to be.

    • Gary says:


      Similar to you, I was a competitive endurance athlete and triathlete. At age 49 I started to encounter episodes of a-fib. These episodes become more frequent and lasted longer. I already knew I had an inverted T-wave on my EKG .. this was randomly discovered years earlier and a cardiologist referred to this as an “athletes heart”. In an attempt to discover why I was experiencing a-fib as well as other related symptoms, I had an MRI study. It showed a thickening of the apex of my left ventricle .. a condition known as apical hypotrophic cordiomyopathy. The research of the condition suggests the risk factor is “sudden cardiac death”. In other words .. it’s an electrical issue rather than a plumbing issue. I refused the beta blockers and ablation procedure the cardiologist suggested and learned how to managed this condition on my own. That was 4 years ago. Today I am able to mountain bike (4 mile ascent up a mountain, 1 hour climb) and trail run and do the things I want to do, but I always wear a heart rate monitor and I keep my HR below 170. I no longer race .. but I still “participate” in some of the local events. I discovered that hydration with the proper balance of electrolytes was critical. Before, during and after any athletic endeavor, I always hydrate and add an electrolyte tab to my water. I rarely feel a-fib anymore .. if I even feel an irregular heart beat I reach for the hydration. I hope this helps. Thanks for posting your story.

    • Bob Reeves says:

      Arrhythmias often are the result of magnesium deficiencies. Magnesium is part of the ATP energy cycle that fuels our ability to run. ATP are the energy molecules of the body produced in mitochondria via the Krebs cycle, where 6 of the 8 steps require magnesium. The full designation of ATP is ATP-Mg.

  • sergio says:

    muy buena nota, espero seguir leyendo cosas así, ya que soy un atleta amateur , que corre y corre bicicleta. muchas gracias y saludos sergio

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