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18 August 2022

It wasn’t surprising that after finishing the 42km run at the Gold Coast Marathon last month, this 64-year-old needed to lie down immediately. What was more concerning, I couldn’t get up.

People leaned down, asking if I was OK. I weakly nodded and finally struggled up, pausing at a nearby first-aid post expecting little more than a reassuring chat.

Fortunately, the paramedics knew better. There was something wrong with my heart’s erratic rhythms and frantic beat. I was rushed to the multi-bed triage area behind the scenes, covered with electrodes and given an electrocardiogram, among other tests.

I had completed the marathon in four hours and just under six minutes. I usually prefer to finish in just under four but was happy given my training, post Covid. I didn’t feel any different after this run. I had exerted myself but it was only after I lay down just after collecting a medal and finisher shirt – and couldn’t get up – that I figured something might be amiss.

An authoritative emergency doctor diagnosed a potentially serious but common cardiac condition I’d never heard of, atrial fibrillation or Afib. It occurs when the two upper heart chambers beat irregularly, and blood doesn’t flow well into the lower chambers called the ventricles. It can be episodic or permanent. According to one GP, who sees older men with the condition, the heart’s upper chambers or atria “are quivering like a bag of worms”.

The Baker Heart and Diabetes Institute in Melbourne says it’s the most common type of irregular heartbeat and can lead to clots in the atria and the risk of stroke.

The irony is while it mainly afflicts those who are older and less fit, Afib also can curse the more senior participants in endurance sports, especially men. Cardiologists have a lively debate about whether over-60s and marathon runners could be exercising too hard and elevating their risk of Afib and other cardiac conditions. A 2017 book called The Haywire Heart: How Too Much Exercise Can Kill You, and What You Can Do to Protect Your Heart highlighted the phenomenon.

I took up distance running only in the past five years. My father dropped dead from a sudden heart attack and I didn’t want to follow suit. Having knocked off my 10th marathon, I presumed I was pretty fit, but later imaging showed my atria were enlarged, perhaps through exercise.

“Participation in sport and exercise at all levels is clearly associated with greater longevity, lower rate of heart attacks, lower rate of strokes and a lower risk of cancer. You basically live better, and you live longer,” Baker Institute Associate Professor Andre La Gerche told me. “But there is the little sting in the tail, which is atrial fibrillation. It’s probably related partly to genetic predisposition, and that’s brought out by exercise, and partly the fact that exercise makes the heart bigger.”

One of the challenges of Afib is there may be no symptoms. My doctor in the Gold Coast Marathon medical wanted to admit me to the Southport Hospital emergency department as my heartbeat remained stubbornly high and erratic. Yet I felt fine and wanted to go home. My heart spontaneously reverted to what’s called its normal sinus rhythm and has stayed sweet since.

Wearable devices, such as an Apple Watch or a Fitbit, can measure for Afib. Their stored data suggested my episode was triggered at the finish line by the stress of running a distance. The effort, as legend holds, killed the first marathon runner Pheidippides in Athens in 490BC.

But is it a myth that challenging training and running marathons are not always good for you, and is my wife right in claiming they age rather than rejuvenate me? Research presented in June at the British Cardiovascular Society conference found endurance sports could stiffen men’s arteries and increase their vascular age. For unknown reasons, women enjoyed a benefit and their heart systems were up to six years younger than their actual age.

The calamities caused by undiagnosed heart conditions are one reason the medical set-up at the Gold Coast was so thorough. In a race director’s worst nightmare, in 2018 at the Cardiff half marathon two unrelated men aged 25 and 32 collapsed and died at the finishing line within three minutes of each other. The coroner ruled it was due to natural causes.

“One thing that’s absolutely true is that AF is not and never is associated with sudden death,” says La Gerche, who is also director of the National Centre for Sports Cardiology, researching Afib in former elite athletes.

“The people who read about a heart rhythm problem throw it all in the same bucket. While atrial fibrillation is a nuisance and is associated with an increased risk of stroke, it’s not something that causes a heart attack or a cardiac arrest.”

Kieron Blackmore is a Sydney-based Irish-born IT consultant aged 66 who, while always sporty, took up running seriously only in his 50s. He was then treated successfully after an undiagnosed hole-in-the-heart condition caused a ministroke. Just before the pandemic, he ran 13 marathons in one year. He sees his cardiologist once a year for a stress test. Blackmore says he will keep on with ultra-marathons if he gets the medical OK.

“If marathons do age us, it’s the type of ageing I like,” he says. “I have many friends in their 60s and even older who run plenty. There are lots of us old buggers around.

“My advice is to run within your limits and don’t try to beat the 25-year-olds.”

Bondi doctor Gillian Deakin, author of 101 Things Your GP Would Tell You If Only There was Time, says by far the most significant problem GPs face is patients who don’t move enough.

But there’s a small minority, and she has noticed far more men than women, who push their athleticism too hard in later years and suffer consequences such as Afib.

“We all know what happened to the first guy who ran the marathon; however, there are a lot of studies into excessive exercise, and generally the results are not great for health, such as a fall in immune function and a threefold increase in the risk of Afib.”

Another active Sydneysider in his mid-60s was recently diagnosed with Afib after a routine medical check-up. He is now destined for a lifetime of medication, including blood thinners, to reduce the stroke risk.

He feels an “old man stigma” about the condition and asks not to be identified. “I don’t want people to feel sorry for me or think I am older than I am or go easy on me in sport,” he says.

Despite suffering Afib for years, there’s nothing Alan Luckie, 63, likes more than cycling long distances and up and down steep hills in rural Victoria near his home in Albury-Wodonga.

But myriad medical interventions to correct the heart arrhythmias, including another recent trip to hospital emergency, means he’s finally slowing down a bit.

“If it gives you joy, you don’t want to stop doing it, but you’ve still got to do something,” he says. “It’s about modifying the goals and what you’re trying to achieve by doing it, but maybe not with quite the same vigour.”

My case is small potatoes compared with what can happen, but it was a wake-up call. I’m now more aware of the risk and the need to monitor for any symptoms.

La Gerche says although Afib is more common among sporty people, we don’t know if reducing or stopping such arduous exercise will prevent it from reoccurring.

I’m sanguine about it and will seek regular checks. At the time of writing, I have just run the hilly 14km of Sydney’s City2Surf with no sign of Afib.

The Sydney Marathon next month is three times longer, and I can’t resist giving it a go.

originally published by The Australian, 18 August 2022 (Author: Christopher Zinn)

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