The Delusion of Fitness

When I teach about risk factors associated with coronary artery

disease (CAD), I start out by asking the group, “Who is at risk for

heart disease?” to which I get an interesting mix of answers. What I go on to point out is that – if you have a heart you are at risk for heart disease – which really seems to astonish people because we don’t think of the young, the fit, the diet disciplined, as ever having heart problems – except they do, and this delusion often leads to some truly devastating consequences.

The stories we all hear about young athletes dropping lifelessly to the field, court, or ice,

are becoming all too common. Just recently many of us witnessed NFL star, Damar Hamlin’s

cardiac arrest on Monday Night Football. In my role as a cardiac rehab nurse, I have

encountered many professional athletes, amateur marathon runners, sports enthusiasts, or

otherwise “fit” people, who also survived a heart attack or cardiac arrest. The sad thing is,

many of these individuals may have avoided damaging trauma if they were not under the false

impression that their high level of fitness automatically protected them from heart disease. I

remember a patient who cardiac arrested on the finish line of his triathlon saying, “maybe I

should have stopped during the swim”. This means that, even though he didn’t feel right while

he was swimming, he finished the swim, biked 25 miles, and ran 6 miles until his heart finally

gave out.

A couple of weeks ago I met a lovely 25-year-old woman who, for no apparent reason,

developed cardiomyopathy while traveling in Italy with her family. She led a healthy lifestyle of

regular exercise and eating right and was surprised when she developed such weakness and

fatigue that she couldn’t keep up with the rest of the family while touring Italy. She couldn’t

imagine that when she finally sought medical care upon arriving home she would be going on

the Heart Transplant list. Thankfully, and miraculously, she received a donor heart one week

after they knew she needed one and is doing well. I hate to think what might have happened if

she had delayed seeking medical help.

I read an article recently about a notable Cape Cod doctor who disregarded his many

serious cardiac symptoms because of his fitness and healthy lifestyle. He was a sports

enthusiast – skiing, fishing, playing hockey, and kept a very demanding exercise routine. He

was serious about his plant-based diet in order to be fit enough to be active with his young

family as well as his career as a world-renowned neurosurgeon. When he would develop classic

cardiac symptoms (chest pain, jaw pain, arm pain with shortness of breath) while exercising, he

denied the obvious cause thinking someone as fit as he couldn’t be having a heart problem. He

also ignored indications of high blood pressure which probably led to his worsening coronary

artery disease. When he finally did go to the doctor, he needed a stent to a blocked artery.

While praising the skill of the cardiac team and care he got at Cape Cod Hospital, delaying

treatment certainly put him at risk for heart muscle damage which could drastically affect his

active lifestyle.

The point is, no matter how fit you are or how disciplined the diet, YOU TOO could have

coronary artery disease or another dangerous condition of the heart such as cardiomyopathy

(damage or inflammation of the heart muscle) or a tear in a coronary artery known as

dissection or SCAD (sudden coronary artery dissection).

Another example of underlying heart disease in a very fit person is Dave McGillivray

who, among his many professional and fitness accomplishments, is the lifelong director of the

Boston Marathon and the New Balance Falmouth Road Race. In a wonderful article written by

Bill Higgins for the Cape Cod Health News, Dave talks about discovering his need for triple by-

pass surgery despite his many feats of endurance in cross country running. After this

experience, he changed his mission from encouraging and inspiring people to win a foot race, to

win at life by recognizing that “Just because you are fit doesn’t mean you are healthy. If you

feel something, do something. Take action because it could save your life.” He very aptly

points out that people at high levels of fitness should recognize when there is a significant

change in how they feel during exercise. If you suddenly find an exercise that was once easy for

you becomes difficult, or you begin to have many “off” days during workouts, you need to pay

attention and get checked out. Certainly, if you develop chest tightness, pressure, arm or jaw

discomfort, especially if associated with extreme fatigue or shortness of breath, don’t deny that

something serious could be wrong – call your doctor right away. If these symptoms are severe,

don’t think your fitness overrides a cardiac cause, call 911. Because you are fit, you may not

experience these signs as intensely as the average person but don’t be in denial – YOU TOO

could have a heart problem.

The moral of the story is – ANYONE can have a heart problem – no matter how perfect

or healthy the lifestyle. There is no magic bullet that prevents heart disease, so enjoy the many

benefits of fitness, but don’t be in denial if you have symptoms or begin to struggle with your

regular routines. Recognizing the delusion of fitness could save your life for real.