… a report on a close call
By Bernd Schroeder (German Masters swimmer, age 56):
To say it up front: I did not have an infarction. But I was close to getting one. And I would like to pass on my experience to all of you, to improve your odds against such a mishap.
Some of you may remember my catastrophic performance in the 200-meters butterfly race in Innsbruck. I did a perfect two laps, was far ahead of my competitors, and all looked like a new record; but I got beaten in the end. That was certainly not a normal outcome, considering the good shape that I had been in.
And something else was not normal either: In July, a constricting pain had suddenly begun to appear in my chest during exercise, already at a heart rate as low as 100 bpm. Until shortly, I had figured all kinds of reasons for that pain, but now I went to see the cardiologist. The exercise ECG was unmistakeable: Narrowing of the coronary vessels, and risk of myocardial infarction (angina pectoris).
Let me explain: Two ramifying arteries supply the right and left portions of the heart. But deposits can partially obstruct those blood vessels. And if the blood path becomes too narrow, an infarct will eventually develop. Those portions of the heart that are downstream of the clogged artery section are deprived of their oxygen supply, they no longer function properly, and eventually undergo death. Performance of the heart decreases, total failure being the extreme, and the deficiency being the more severe, the closer the clogged section is to the upstream end of the supply path.
Instant aid can save your life, but a portion of heart muscle may remain dead. The situation is better if the hazard can be identified at an early stage. A narrowed section can be dilated before an infarct develops. And if the underlying cause of the narrowing can be identified too, then there is – statistically – a good chance for you to reach old age while maintaining a good performance capacity.
Potential hazards are: Smoking, a wrong diet (involving too much fat), hypertension, diabetes, not enough physical exercise and overweight, mental stress, genetic disposition. The following words are attributed to Barnard, reputed heart surgeon: "Good sauces can kill a man just as sure as strychnine. It only takes longer." Being a slim swimmer who does not smoke, who practices a lot, has low blood pressure, and is conscious of a proper diet, I considered myself not exposed to that kind of hazard. But I was mistaken.
Examination with a heart catheter, visualizing the coronary vessels, revealed a 95-per cent clogging at the root of one of the big coronary arteries. The risk of an infarction within the next few months was imminent. The surgical procedure applied was to dilate the narrowed bit by introducing and then pumping up a little bladder, and subsequently to stabilize the location with a tubular section of wire mesh (stent). The two x-rays show the result of the operation (of which my cardiologist was rather proud, having overcome a few unexpected complications).
What is hard to understand: One week before surgery, in the DMS preliminaries, I did a 1:06.01 in the 100 meters fly, which was faster than the (age group) world record (but I already felt that pain in my chest after the event). After the operation I began to increase the exercise level rather gently. And then, in the German Masters Swimming finals three weeks later, I did a 1:06.29, which exactly equalled the current world record.
What do we learn from this? Sport is no safeguard against heart problems, and even top performance is not necessarily a proof of perfect health. But a well-trained heart copes better with an operation and recovers more easily. Physical exercise can reveal latent problems, and it holds the chance of remedy at an early stage. Grab that chance as soon as you feel a problem arising. Have a wary eye on your cholesterol levels in your annual sports medical health check, and have those levels checked more frequently whenever deemed necessary.
Photo No 2 – Heart (Herz.tif)
A Brief Comment on the above
By T. Noerrenberg, MD (and Masters swimmer)
The symptoms of insufficient oxygen supply, resulting from a coronary heart disease (CHD), may be varied: Sometimes they are rather un-typical (e.g. nausea, or just general ill feeling), sometimes it's a pain in the chest and/or left arm, sometimes pain in the upper abdominal region, but sometimes there is no irritation felt at all.
At an early stage, CHD symptoms may become manifest during exercise only, or under mental stress, or in certain weather conditions.
An ergometric ECG can bring clarity, but the exercise levels should go close to the limit of the subject's performance capacity. A short test up to only 100 Watt and a few drops of sweat will not do!
Bernd Schroeder's 95-% obstruction of one of his coronary arteries seems to be the result of a long-term process that probably went on for many years, or even decades. The first symptoms usually do appear at that stage of obstruction. For a long time, even high-level exercise ECGs may show no abnormalities, nor may there be any noticeable irritations, because an endurance-trained athlete may have developed coronary artery by-passes before one of the main arteries becomes completely clogged. And often the athlete simply ignores (or mis-interprets) the symptoms for a considerable time (notice that Bernd says that he "…had figured all kinds of reasons for that pain…").
The exercise ECG is an indispensable diagnostic tool, and every health-conscious athlete should undergo this check annually.
Bernd's good 100-meters results are no criteria of his cardiac performance: The heart is not really needed in a short race of not much over one minute; the skeletal muscles dispose of sufficient anaerobic reserves to adequately perform for such a period of time (a 200-meter race, where aerobic supply is challenged, is a different matter). But Bernd's heart will have to make an extra effort during and after the event to eliminate the waste products that the intense anaerobic metabolism had generated in the short but exhaustive race.
The insertion of a stent (tubular wire mesh) is no absolute safeguard against a myocardial infarction: Other coronary vessels may become obstructed, and even the foreign material of the stent proper may induce a thrombosis and, hence, an obstruction (with subsequent infarction) at its very location.
Examinations at short and regular intervals are recommended, no matter whether symptoms are perceived or not.
Translated from German by Ernst Jager
Photo No. 1:Bernd Schroeder (left), victory ceremony European Masters Championships Innsbruck 1999, 200m Butterfly Age Group 55-59 (Derek Parr, UK, on the right).
Bernd Schroeder participated in the Short Course Yards Championships in Santa Clara, 1999. He comes from Berlin and has broken world records in 50/100m fly, 50m free.