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Red60
October 14th, 2006, 11:05 PM
I am not yet a Masters swimmer, but I hope to get involved in the next year or two. In the meantime, I work out on my own. About 15 months ago, at the age of 44, I had a heart attack. They put four stents in my heart. I have susequently been checked out via catheterization, and my coronary arteries are clear. I now take a variety of medications.

Once upon a time, I was an okay freestyle sprinter. My cardiologist tells me I should work out at "moderate intensity" which I find hard to do. But I warm up slowly and cool down slowly, too. In between I am doing pretty modest intervals (100s on 1:30, 200s on 3:05, 400s on 6:10) and am feeling encouraged because I am getting stronger. That said, sometimes I feel my limits and cut the workout a bit short. (I go around 3000 yards a workout approximately 4 times a week.)

Here is my question: is there anybody out there who knows enough about coronary heart disease and competitive swimming to give me any guidance? Can I keep pushing to go a little harder, or should I back off? I would really like to compete again. Thoughts? Many thanks!

Red60

gull
October 15th, 2006, 09:23 AM
Great question. First let me say that, although I am a cardiologist, I don't know the specific details of your condition and treatment. The short answer is that there is evidence of an increased risk of heart attack and sudden death with vigorous exercise in patients with CAD. Your individual risk depends in part on the results of your stress test as well as your heart function (ejection fraction). I have copied a link to recent guidelines from our literature on this subject. The best advice is to consult with your cardiologist, take your medications (which should include a statin, a beta blocker and of course aspirin and Plavix), and listen to your body. An adequate warm up and cool down is essential.



http://content.onlinejacc.org/cgi/content/short/45/8/1348

geochuck
October 15th, 2006, 10:22 AM
A fiend had a heartattack at 32 years of age during a marathon running race. He then started light jogging and at age 75 he still runs the marathon. He gradually built up his stamina so he could compete again.

Red60
October 16th, 2006, 12:21 PM
Many thanks for your reply, Craig. I have reviewed the material, and somewhat hard pressed to identify good news in it. I don't know my ejection fraction, but seemingly I am in the "mildly increased risk" group. So here's a follow up: are there training approaches and specific events/distances that would be more appropriate for someone in my position? I do not have discomfort when exercising. I enjoy IM and freestyle workouts, and seem to achieve the best equilibrium of effort and efficiency doing sets of 200s, as opposed to 100s. Intuitively, I don't seem inclined to really sprint in workouts. I have wondered if this is my body speaking.

gull
October 16th, 2006, 12:36 PM
The take home message is that there is some increased risk (which is impossible to quantify) associated with vigorous (as opposed to moderate) exercise and competitive sports in patients with CAD. That is not to say you shouldn't do it. If your ejection fraction (a measure of the strength of the heart) is OK, and you pass a maximal stress test, you just have to decide if you want to accept that risk. Think of it this way: you at least know that you have heart disease, while there are many in our ranks who have it but have yet to be diagnosed. You might ask your cardiologist if he has any recommendations regarding maximum heart rate during training.

A final thought. Quality of life is important. If this is something you really enjoy doing, then the benefits likely outweigh the risks. And while 10% of heart attacks may be associated with strenuous activity, 17% have been linked to anger/emotional stress.

scyfreestyler
October 16th, 2006, 01:59 PM
Question...

Let's assume that a person has a heart attack and undergoes coronary bypass surgery to correct the bloodflow problem. This person assumes an active role of maintaining their health through diet and exercise and winds up with ideal lipid numbers and blood pressure measurements. Is that person still at a higher risk of heart attack in the future than somebody who caught their problem before having a heart attack? Does it depend on the amount of cardiac muscle destroyed during the initial heart attack? Does the cardiac muscle not regenerate itself?

gull
October 16th, 2006, 02:26 PM
The prognosis is heavily dependent upon the heart function (ejection fraction). Keep in mind that bypass surgery is not a cure, consequently patients remain at risk for future heart attacks. That risk can be lowered (but not eliminated) with diet, medications (including aspirin, a statin, and a beta blocker), management of diabetes and hypertension, smoking cessation, and moderate exercise. And no, heart muscle does not regenerate itself (hence the need for stem cell research).

scyfreestyler
October 16th, 2006, 05:36 PM
Thanks for the information. For some reason I thought that cardiac muscle could repair itself...guess not.

Red60
October 16th, 2006, 09:05 PM
The take home message is that there is some increased risk (which is impossible to quantify) associated with vigorous (as opposed to moderate) exercise and competitive sports in patients with CAD. That is not to say you shouldn't do it. If your ejection fraction (a measure of the strength of the heart) is OK, and you pass a maximal stress test, you just have to decide if you want to accept that risk. Think of it this way: you at least know that you have heart disease, while there are many in our ranks who have it but have yet to be diagnosed. You might ask your cardiologist if he has any recommendations regarding maximum heart rate during training.

A final thought. Quality of life is important. If this is something you really enjoy doing, then the benefits likely outweigh the risks. And while 10% of heart attacks may be associated with strenuous activity, 17% have been linked to anger/emotional stress.
Thanks for the insight and perspective. Wise words. I have already decided that I won't worry too much about whether I am swimming "moderately," so I think I've crossed the line into not being too worried about it in general. I'll keep at it and put off the question of competition for awhile, since I am in no hurry, and I'm enjoying the workouts on their own terms. With luck, I'll be competing within the next several years.

Again, thanks for the information and context.

gull
October 17th, 2006, 10:03 AM
Life is full of risks. We take risks when we board an airplane, drive a car, step off the curb. There are Masters swimmers with CAD who compete; Trip Hedrick underwent bypass surgery and competes at an "elite" level. Perhaps you could contact him.