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Why doctors misdiagnose heart conditions in athletes

Editor’s note: This article is an excerpt from “The Haywire Heart,” by Dr. John Mandrola, Lennard Zinn, and Chris Case. It is the first book to explore heart conditions in athletes.

One of the drawbacks you may face in meeting with a doctor about a possible heart condition is the fact that most doctors have little experience with a full-fledged endurance athlete. If you have trained for hours on hours, months on months, years on years, or if you compete in races, you are special. Your heart and body and mind have undergone adaptations that most doctors don’t regularly see.

We mentioned training-related adaptations when it came to ECG patterns, but athletes present more than just variable patterns on an electrical record of the heart. A competitive endurance athlete lives a different kind of life than most people who seek out the services of a doctor. At least in most Western countries, the vast majority of people who go to the doctor have diseases acquired from too little exercise, not too much.

Read more about heart health and cycling >>

Here is an outlandish example of what I mean: One of my colleagues, an experienced private-practice cardiologist, once remarked to me, “John, it’s not as if riding a bike is that hard. My gosh, it’s not like weight lifting or football or hockey.” He was serious. His view of bike riding was that of the beach cruiser: When you are tired, you slow down.

Most doctors don’t know the sensation of being in a road race, criterium, or time trial. They’ve never been in the gutter because of a crosswind, saying to themselves, 10 more pedal strokes, just do it for 10 more pedal strokes. Hold that wheel! Don’t let go!

Most doctors don’t know the effort it takes to bridge across to a breakaway. When normal people feel the sensation that a curtain is closing in on their peripheral vision, they turn the tension down on the exercise bike or reduce the speed of the treadmill. They pull the plug on the pain. They are normal. Competitive athletes are not.

Even doctors who run marathons don’t quite get the intensity thing. Marathons are a different sort of affair. There is no question that they are hard, but they generally have an even pace and don’t involve the competitive crises that flare up repeatedly in a bicycle race or a cross-country ski race or a triathlon.

But it isn’t just the intensity of the efforts that most doctors don’t get; the demands of training remain unfathomable. When normal people are tired or sick or busy with life, they don’t go ride or run for hours. Exercise for normal people is expendable. Yes, it is true that many normal people exercise on a schedule, but they typically walk, jog, or do yoga.

Here is the key difference between “normal” exercise and training. In normal exercise, it’s clear that when one is finished with the activity, it gave more life force than it took away. Tell me that’s the case after a four-hour training ride in intense heat. It’s not. Most doctors don’t know that training can break people down. They think exercise builds people up. If you are an athlete, or live with one, you know differently.

Another aspect of the training life that most doctors don’t get is the mental aspect. That you would worry about missing a breakaway in next weekend’s criterium — worry about it on a Monday! — is utterly foreign. They see you as a professional with a job, wife, and family, but they do not get your focus on increasing threshold power by 10 watts in the next month. Little do they know the means you will take to get to those ends.

These gaps in knowledge set the stage for both overdiagnosis and underdiagnosis of heart conditions in athletes and it’s why it’s so important that you prepare properly for your appointment. “The Haywire Heart” offers a detailed guide on how to prepare to meet with your doctor about a possible heart condition.

Read about four warning signs that might indicate a heart condition >>

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