Two Stories, Two Endings
by Larry Creswell, M.D.
Sadly, Fixx went for a run through the Vermont countryside on July 20, 1984, and was later found alongside the road, dead at age 52. An autopsy showed that he had severe blockage in all of his coronary arteries and almost certainly suffered a fatal heart attack or arrhythmia. It turns out that despite his long history of obesity, smoking, and a family history of heart problems, Fixx didn’t have a doctor and hadn’t had a physical examination in years.
I supported the suggestion of his athlete friends that he get checked out. He had a stress test that was abnormal, which prompted a cardiac catheterization -- a test in which dye is injected into the coronary arteries (the arteries that supply the heart itself) and motion picture x-rays are made. This test showed two blockages in the right coronary artery (see the first image below; click to blow it up). Each was treated successfully with a coronary stent (second image). He has made a good recovery after the procedure and reports that he is feeling great.
This is the story of one of us -- an avid triathlete who’s part of the Endurance Corner family. In just my short time getting to know the EC folks, this is the second story just like this. Thankfully, each of the EC stories has had a happy ending. But it really hits home.
The Problem of Coronary Artery Disease (CAD)
The heart muscle uses a tremendous amount of oxygen, especially during exercise. That oxygen is supplied by the coronary arteries -- a left and right coronary artery that carry blood flow to the heart muscle itself. These arteries are the first branches of the aorta, the large blood vessel that carries blood from the heart to the rest of the body.
We use the term CAD to refer to the progressive development of narrowing in the coronary arteries. This process, also known as atherosclerosis, begins with fatty streaks on the inside of the coronary arteries and progresses to more severe, space-occupying blockages due to the deposition of fatty materials in the walls of the blood vessels. When the arteries become narrowed to 25-50% of their original diameter, the resulting reduction in blood flow can produce symptoms. The typical symptoms are chest discomfort (angina) that occurs with exertion (or later, at rest) and/or unusual shortness of breath. In a previous column, I included these two symptoms as warning signs that should never be ignored by athletes.
Over the years, much attention has been paid to the issue of “who gets CAD?” We’ve learned that there are several risk factors that are indicators of the likelihood that an individual will have -- or will develop -- CAD. Some of these risk factors cannot be changed (such as your age), but others can be modified to reduce your chance of developing CAD in the future.
Risk Factors You Cannot Change
Risk Factors You Can Modify
I’ll bet that most of the readers here at EC are already physically active and I’ll also bet that most of the readers here are already hard at work on the other modifiable risk factors as well. A periodic visit to the doctor will help with keeping track of the blood pressure, blood cholesterol levels and the possibility of diabetes.
Diagnosis and Treatment
For the Athlete
Larry Creswell, M.D., is a cardiac surgeon and Associate Professor of Surgery at the University of Mississippi Medical Center in Jackson, Mississippi. You can contact him at firstname.lastname@example.org. You can also learn about Larry in his recent Endurance Corner athlete profile.