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

Gender Differences in Sports-Related Sudden Cardiac Death


A Research Letter was published in last week’s Journal of the American Medical Association that provided updated information about the French experience with sports-related sudden cardiac death (SCD) in the general population.  I’ve talked here at the blog previously about reporting by this group of investigators on their comprehensive study from 2011.

Last week’s report focused on the time period from 2005 to 2010.  The investigators identified cases of SCD during moderate to vigorous exercise among athletes who were primarily recreational, rather than competitive, athletes.  Overall, 775 incidents of SCD were identified.

The incidence of sports-related SCD per million participants per year was:

2.96 for athletes aged 15-34
6.63 for athletes aged 35-54
7.51 for athletes aged 55-75.


5.45 for all athletes, overall.

But looking at gender, the incidence of sports-related SCD per million participants per year was:

10.07 for men

and only

0.51 for women.

During the study period, the 3 most common sports activities for women were cycling, jogging, and swimming.  For those sports, the incidence of sports-related SCD per million participants per year were all  less than 0.5.  In contrast, the incidence of SCD for men in those sports was 6.5, 4.7, and 0.9, respectively.


There are at least a couple possible explanations.  First, there may just be something different about men and women when it comes to predisposition to SCD.  One obvious difference is the greater prevalence of coronary artery disease in adult men compared to women, but there may be other such differences as well.  Another possibility is that, on a population basis, the intensity of exertion during participation might be different for men and women.

Regardless of the explanation, though, there is an implication with respect to screening.  One of the criticisms of routine cardiac screening for young competitive athletes–yet alone, for recreational athletes–has been the limited resources and associated costs of physical examinations and diagnostic tests such as EKG’s or echocardiograms.  Knowing that the risk of sports-related SCD may be 10+ times greater for men than for women and several-fold greater for athletes older (rather than younger) than 35 years might help us focus our screening efforts on the portion of the recreational athlete population that is at greatest risk.