Book Review: Haywire Heart









Check out the recently published “The Haywire Heart” by Chris Case, John Mandrola, MD, and Lennard Zinn.  The book is available at Amazon and other outlets.

You may recall that Case, Mandrola, and Zinn authored an article in VeloNews, entitled “Cycling to Extremes:  Are endurance athletes hurting their hearts by repeatedly pushing beyond what is normal?”  This was a terrific read.  I wrote a previous blog post sharing my thoughts about the article and about the issue of arrhythmias and endurance sport, more generally.  Their article generated much discussion in the cycling and broader endurance sports communities and the interest of readers served as the motivation for their new book.

This is a book about electrical problems in the heart–the various arrhythmias.  Case, Mandrola, and Zinn are in a unique position to bring this topic to life because each has dealt personally with some form of arrhythmia.  And as long time cyclists (and perhaps with some triathlon experience as well), they’re able fashion the discussion to the avid endurance athlete.  From the medical perspective, the field of arrhythmias is rather complicated, both in terms of the underlying mechanisms of disease and the evaluation and treatment of affected patients, but here the authors have found a writing style that is captivating and accessible to the non-medical reader, while retaining much medical detail that will be of interest.  I give them credit because this is hard to do!

I love the title.  With an arrhythmia, the heart is truly “haywire.”  Ignore the line on the cover, though, about “How too much exercise can kill you.”  That’s unlikely to happen and there’s little in the book about that particular issue.  Instead, focus on “what you can do to protect your heart.”  That’s where the value lies here.

The book is organized into 9 chapters.  In Chapters 1-3, the authors describe in detail how the normal heart works, outline how the heart adapts over time to endurance exercise, and introduce the medical aspects of heart attack and arrhythmias, especially for the endurance athlete.  These sections are well-illustrated and are a great primer for any athlete interested in learning more about the heart.

Chapters 4-6 focus on the evidence of a link between long-time endurance exercise and arrhythmias, what to look for in yourself, and what it’s like to receive the diagnosis of an arrhythmia.  Here, the authors speak from personal experience and their observations and advice are valuable.

Chapter 7 deals with the issue of exercise addiction.  We know that exercise is generally healthy, but most of the benefits of exercise accrue with the first few hours per week.  Why, then, do athletes exercise more?  When does one become addicted?  What are the implications?  This is an interesting and pertinent discussion and might provoke some warranted introspection.

Chapter 8 covers the various treatment options for athletes with various arrhythmia problems.  For athletes who don’t have trouble with arrhythmias, the discussion is educational in a broad sense.  For those who do have arrhthymias, though, there is ample detail here to become educated and be better engaged with your doctor(s) as you sort out the best treatment for you.

Finally, in Chapter 9, the authors wrap up with their “takeaway” on how we might prevent arrhythmia problems.

One of my favorite aspects of the book is the inclusion of Case Studies sprinkled throughout the text, where the authors illustrate their points in a side bar with the personal account of an athlete.  These stories bring us the human side of arrhythmias and show how difficult these problems can sometimes be.

This book is for….

  • the athlete with an arrhythmia problem.  There’s a lot of familiar territory here as well as the opportunity to learn more.  An educated patient is the ideal patient.
  • the athlete with simply an interest in the heart.  I can’t think of a better resource to become educated about the workings of the heart, particularly as they relate to the endurance athlete.
  • the athlete (or the athlete’s spouse or parent) who’s afraid of causing harm to the heart through exercise.  Be forewarned and be vigilant.


Related Posts:

  1. Heart to Start, by James Beckerman, MD
  2. The Exercise Cure, by Jordan Metzl, MD
  3. Cardiac Athletes, by Lars Andrews

Book Review: Cardiac Athletes

CardiacAthletesBookHot off the press is a new book by Lars Andrews, entitled simply, Cardiac Athletes.  I had a chance to read the book over the July 4th holiday weekend and I thought I’d share some details here at the blog.  I enjoyed the book and recommend it highly.

Lars Andrews is the founder of Cardiac Athletes, the worldwide support community for athletes with heart disease.  I’ve written previously here at the blog about the organization’s many activities.  You can find them online at their website and also on Facebook.  If you’re an athlete with heart disease, you’ll find an active online forum that helps athlete patients make useful connections with others in similar circumstances.  On the charitable front, the organization raises money to support donation of automatic external defibrillators (AEDs) to communities in need and to support cardiac screening programs for athletes.

This new book will be good reading for a variety of folks–athletes, of course, with heart disease; healthcare workers who care for these athlete patients; and pretty much anybody who enjoys reading inspirational personal stories from athletes.

Andrew LaGerche, MBBS, PhD, a physician-scientist, himself a talented endurance athlete, and with a long professional interest in athletes and heart disease, writes a great Foreword.  In the Preface, Andrews details the history and evolution of the Cardiac Athletes organization and sets the stage for the remainder of the book.  The Introduction features his take on 10 repeating themes that will be found in the athlete stories:  cardiac athletes are pioneers; we need sports cardiology centres; are we starting to see a post athletic epidemic?; would preschool screening be bad?, among others.

The bulk of the book is a collection of the personal stories from 17 athletes affected by heart disease.  Each athlete shares his/her journey from the discovery of their problem, through its diagnosis and treatment, and the long-term consequences.  In many cases, there are illustrations which bring clarity to the specific heart problem being described.  This is very helpful to non-medical readers who won’t be familiar with the details.  Each chapter is a rare, honest look at how these athletes approach sport in the context of heart disease.  These stories are just very real.

At the end is a useful glossary of terms that will make the book more accessible and also a useful reference, or reading list.

The book is currently available in print form for $14.98 from Create Space.  Proceeds from the book will go to the Cardiac Athletes Trust Fund to support the organization’s charitable activities.



Videos by Doc Mike Evans


This is just a short post to draw attention to the remarkable video series by Doc Mike Evans, a family physician at the University of Toronto.  Over the past couple years, he’s produced a growing collection of witty educational videos on topics ranging from concussions to flatulence to obesity.  In his words, he’s trying to create a “med school for the public.”  The collection of videos is available at his YouTube site.

Some of my favorites on the topic of exercise are:

Check out the videos and share them with a friend!

USAT Webinar: Heart Health and Endurance Sport

Last week I recorded a one-hour webinar entitled “Heart Health and Endurance Sport.”  You can download the webinar for free at the USA Triathlon (USAT) website.

The webinar is a consequence of my recent work with USAT regarding race safety.  At the conclusion of our work, we felt that USAT was in a position to provide some educational offerings to members of our triathlon community that might lead to safer training and competing for athletes and to better safety and event planning by race organizers.

Obviously the topic is broad and one hour is pretty short.  I decided to organize the discussion into 5 topics that I thought were most important:

1.  The heart and general health benefits of exercise.

2.  The heart’s adaptation to exercise and the “athlete’s heart.”

3.  Sports-related sudden cardiac death.

4.  Other potential adverse consequences of endurance sport.

5.  How to care for your heart for the long term.

Take a listen.  I hope there’s some useful information that might let you take better charge of your own heart health and train and race safely.  There’s a “homework” project at the end; I’d be happy to hear from you….and so would your athlete friends.

Related Posts:

1.  USAT Fatality Incidents Study
2.  Athletes, Sudden Death, and CPR
3.  Recent Safety Initiatives in Triathlon

An Index to All of My Posts and Articles (Through 2012)


Here’s an index or Table of Contents for the best 112 of my blog posts and online articles.  I’ll try to post an updated index each January.

Resources for the Athlete

Useful Website:  Recipe Blog
Ironheart Racing Team–An Organization with Heart
A Book Recommendation:  General Medical Conditions in the Athlete  An Online Patient Support Community
Book Recommendation:  Heart 411
10 Credible Online Health Resources
A Useful Resource:
Hypertrophic Cardiomyopathy Association
Interesting Facts:  Causes of Death

Heart Anatomy and Physiology

Cardiac Arrest?  Heart Attack?  Heart Failure?
The Triathlete’s Heart
Nine Interesting Facts About the Athlete’s Heart
Heart Rate and Recovery….and Heart Rate Recovery (HRR)
Does the Heart Get Tired?

Athlete’s Heart

In the Medical Journals:  Athlete’s Heart and Cardiovascular Care of the Athlete
Do You Have “Athlete’s Heart”?

Athletes and Preventive Care

Who Needs a Doctor?
How to Find a Doctor (For Athletes)
Six Tips for Athletes to Reduce the Cost of Preventive Medical Care
Who’s Got the Bacon?
What is Your Blood Telling You?
The Skinny on Your Cholesterol
Spring Check-Up
Some Thoughts on Ideal Heart Health
Five Questions for Your Doctor
Caution!  Five Warning Signs You Shouldn’t Ignore
More on Laboratory Screening in Athletes
In the News:  Get an EKG?
Some Useful Resolutions
What is Your Risk?
In the News:  Do Your Kids Have Heart Disease?
In the News:  Forecasting the Effects of Obesity and Smoking on U.S. Life Expectancy
Useful Article:  8 Ways to Prevent Heart Disease
In the News:  Cardiac Screening for High School Athletes
In the News:  Preparticipation Screening for Student Athletes

Medications and the Athlete

Viagra:  Does It Improve Athletic Performance?
Heart Medications, WADA, and the Athlete
A Primer on EPO
In the News:  Athletes and Vitamins
Think Twice About NSAIDs
Athletes and Statins
In the News:  NSAIDs and Cardiovascular Risk
An Aspirin a Day?

Exercise and the Heart

Exercise is Good!
The Athlete’s Cardiac Paradox
Inspirational Videos
Can Too Much Exercise Harm the Heart?
Do Cyclists (And Perhaps Triathletes) Live Longer?
Short-term and Long-term Injury to the Heart with Exercise
More on Long-term Cardiac Risks of Endurance Sport
Don’t Stop Running Yet!:
Ironman and Heart Health:  My Take on Things
In the News:  Aerobic Exercise Improves Memory
In the News:  Some Good News for Endurance Athletes
In the News:  Coronary Plaque Buildup in Marathoners
In the News:  Hidden Benefits of Exercise
In the News:  Why Do Athletes Live Longer?
In the News:  Acute Effects of Marathoning on the Heart

Specific Heart Problems and the Athlete

Hypertension (High Blood Pressure)
Aortic Stenosis and Bicuspid Aortic Valve
Hypertrophic Cardiomyopathy (HCM)
Syncope–Part 1
Syncope–Part 2
Atrial Fibrillation in Athletes (In a Nutshell)
Swimming Induced Pulmonary Edema (SIPE)
More on Swimming Induced Pulmonary Edema (SIPE)
Skip a Beat Lately?
Athletes and Atrial Septal Defect (ASD)
Two Stories, Two Endings
Athletes and Cardiac Pacemakers
Looking For Athletes With an ICD
Don’t Play If….Part 1
Don’t Play If….Part 2:  Heart Valve Problems
Cyclist’s Account of Atrial Fibrillation
Another Heart Transplant Triathlete
In the News:  Atrial Fibrillation in Cross Country Skiers
Athletes and High Blood Pressure
Coronary Artery Disease:  The Essentials

Sports-Related Sudden Cardiac Death and Event Safety Planning

Useful Information for Event Directors
Cardiac Arrest  During Long-distance Running Races:  A New Report
Race Safety and USA Triathlon
Recent Triathlon Deaths
In the Medical News:  Sports-related Sudden Death in the General Population
In the News:  Sudden Cardiac Death in NCAA Athletes
Commotio Cordis:  A Surprising Cause of Sudden Death in Athletes
Heart Attack at Tri Camp:  A Story for Camp Planners to Remember
Triathlon-Related Deaths–The Facts and What You Should Know
You Could Be the Hero!
Marathon Safety
Open Water Swim Safety:  Fran Crippen and Recommendations from USA Swimming
Pulmonary Embolism Kills Triathlete
USA Triathlon Fatality Incidents Study
Wrap-Up From USAT RD Symposium 2013
Triathlete Death During 2009 Ironman Canada
Athletes, Sudden Death, and CPR
Cold Weather and Sudden Death in Marathon
In the News:  Detroit Marathon Deaths
Follow-Up:  Detroit Marathon Deaths
In the News:  Preventing Sudden Death in Athletes

Vascular System

Everything I Know (and Don’t Know) About Compression Garments–Part 1
Everything I Know (and Don’t Know) About Compression Garments–Part 2
In the News:  Link Between Peripheral Arterial Disease (PAD) and Coronary Artery Disease

Famous Athletes with Heart Disease

Jack LaLanne, Fitness Enthusiast, 1914-2011
Gyorgy Kolonics, Sprint Canoer, 1972-2008
Fabrice Muamba, Soccer Player, 1988-
Micah True, Ultra-runner, 1954-2012
Normann Stadler, Heart Surgery, and You
Darryl Kile, Professional Baseball Player, 1968-2002
Reggie Lewis, NBA Player, 1965-2003
Jim Fixx, Runner, 1932-1984
Flora (“Flo”) Hyman, Volleyvall Player, 1954-1986
Ryan Shay, Marathoner, 1979-2007