The Haywire Heart: How too much exercise can kill you, and what you can do to...

I almost docked the book for its shortcomings and because people might read a 4 star over a 5 star review but in the end felt like the authors' effort deserved 5 stars even if the final work had a few holes and editorial choices that made it less than a full 5 stars. Chief among these is not having a real clear idea about what an "endurance" athlete is. (actually, the sensationalist "too much exercise can kill you" is the worst sin, but I digress). Back to the issue, the authors seem to imply that it is the sustained red-lining type of exercise over a long period of time that brings the risk, and it would be nice to know, as another reviewer complained, what kinds of practical limits fall into the safer range. Impossible to know, for example, if staying in Zone 2 keeps you safe, or if occasional (not constant) interval sessions, with appropriate rest days fall into the safe area. In their defense, there is no research on this, so nobody knows, but it does seem that the majority of case studies were definitely the over-achievers category. I did not mind the deep dive into the heart physiology that got pretty technical, but I do wonder if space devoted to that might not have been better used. I think the book is definitely best for those who are already symptomatic versus trying to be preventive, but those are the ones with the most needs. Totally agree with another reviewer that this should be required reading for the cardio docs themselves. I'm late 50s now and although asymptomatic, I do have high cholesterol and poor calcium test and my doc did his best to take me seriously but any look at his waiting room made you understand why they tend to filter more for the other more common risk factors for heart disease instead of the too much hard exercise types like me who can pass a stress test with no problems. Anyway, definitely a good and mostly easy read given the material and a much-needed resource.

I have been VERY active my entire life. I am a 60 year old male. I played ice hockey and lacrosse, mobile positions, wing and crease attack and middy respectively from age 8 to 18. I always have been a very avid bodysurfer. I consider myself extreme in this regard, at it 9 out of 12 months, bodysurfing big hurricane surf sometimes up to 8-10 feet, when such surf occurs here on Long Island. This is MAJOR aerobic activity, maybe more so than Tri. I competed in triathlons for 20 years winning my age group in Clydesdale division in every race I entered except one second place finish. In races not offering a Clydesdale division I would finish in top 5th of my age group. I would guess I completed about 60- 75 sprint length tris with never a DNF. I mention this to convey that I was a competitive Triathlete, not merely a event T-shirt collector type participant or a once or twice participant. I was a competitive runner for over 36 years, 6 days a week year round with almost no running injuries and therefore almost no time off. Most months, year round I competed in at least 2 events bike races, ocean swims, runs. Some months I would race three weekends out off the four. About 6 years ago I was diagnosed with atrial flutters and underwent a cardio conversion. This was around the time of major life stress. This was followed up with a atrial flutter ablation about 4 years ago and a atrial fibrillation ablation 3 weeks ago. I stopped competing in running races and Tris about 5 years ago due to other health issues, prostate cancer and other surgeries but I’m still active cycling, swimming and bodysurfing. Just finished the Haywire Heart. The HH is revelatory, dispelling many ideas. Read this fantastic book even if you are not a sufferer of these heart issues if only as a guide to your activity level. Dr. Mandrola explains, in his clear and concise style, complex issues of cardiac and exercise physiology. Perhaps the main takeaway is the explanation that, to your doctor, you are probably a seldom seen anomaly with an activity level they very rarely see and often misunderstand. Dr. Mandrola cites example of Cardiologists and Electrophysiologists failing to interpret data and test results correctly due to biases and lack of specific experience with our rarer test results. The case studies of athletes including that of Ironman god Dave Scott are a wealth of information. Everyone who seriously competes in any endurance sport, especially Tri, will benefit immensely from reading this book. The correlation between stress as result of competing and training and other life stress is eye opening. Kudos to Dr. Mandrola! You have filled a giant void with your effort. Have fun out there but be forewarned! Reply

I am an endurance athlete (marathoner) and was diagnosed with idiopathic cardiomyopathy a few months ago. I bought the book to explore answers to the idiopathic part of my diagnosis, especially as an athlete and vegan, which is perplexing but also intriguing my cardiologist enough to seek answers for me too. I like that the book takes time to do what my cardiologist did which is explain the heart--the foundation and electrical makeup--in laymen's terms but nonetheless thoroughly. I skimmed that part and find the case studies especially instructive, or better yet, relatable. While I have not found an answer to my own "idiopathic" diagnosis in this text, I think this might have been good for me to have read when I used to deny overtraining! I also think it is useful to me as distance running coach to share with clients. And lastly, I wish cardiologists would read it so that they can have better insight into the athlete mind and behavior instead of lumping every heart patient/athlete into a homogeneous pile of the former, tossing out some meds, and leaving us to our devices. Good read.

This is a book about heart problems that occur in endurance athletes. It has to thread a difficult needle between discouraging folks from exercising and defining how much exercise is too much. Go to any mall in America and look around. Too much exercise doesn't seem to be a big problem, and indeed this book is not about the average American, but is intended for the life-long, hard-driving, endurance athlete. The authors do a good job in defining this focus and certainly wouldn't want the casual cover reader to conclude that moderate exercise is bad. But like anything, too much of a good thing can be bad, and the book is full of real-life stories of athletes who drove themselves so hard that their hearts suffered serious consequences. The other audience of this book is physicians, particularly cardiologists and electrophysiologists who deal from time to time with endurance athletes. Their normals are not the same normals as the average patient, and they benefit from seeing doctors experiences in their problems. I was surprised how much data there is associating multiple cardiac problems with endurance athleticism. It does give one pause (not that I'm at risk), and I would think this data and the patient stories in this book might indeed cause an "exercise addict" to moderate his or her ways. My colleague and friend Dr. John Mandrola's chapters on the medical evidence of the effects of extreme exercise, as well as modern diagnostic and treatment modalities are very clear and would be of benefit to any patient with rhythm problems. Reading his advice for patients on how to prepare for a doctor's visit strikes so close to home: I wish all patient's would heed his advice! My only minor quibble is with the final chapter, The Takeaway. This seems to be a bit of a hodgepodge, containing advice on supplements (I think the bane of the fitness industry), bystander CPR and ICDs, rather than a real summary of the book. The Epilogue of the book better serves that function. Advice to take garlic, or stating the Japanese have a high iodine intake and also a low incidence of heart disease seems less scientific than the rest of the book and maybe out of place. But, overall this is an excellent book on a little-known subject, directed at athletes but containing lots of good information for doctors who take care of them.

A must read for any endurance athlete. It was written by Doctor John Mandrola, in conjunction with Velonews technical writer Lennard Zinn, and cycling journalist Chris Case. The book is a follow up to this a Velonews article that was inspired by Zinn's mid life heart issue - multifocal atrial tachycardia. I've been commenting for a good 15-20 years about what I call the Jim Fixx syndrome - seemingly fit athletes who drop dead, usually around age 55. The good news is that fatalities like this are pretty rare. However, the bad news is that it appears our predilection for endurance sports makes us considerably more likely to develop other heart issues - mostly electrical in nature, which even if not fatal, can suddenly turn our athletic lives upside down. A couple of highlights stuck with me. One is that time matters. The more time spent at high heart rates, the great the chance of developing a problem. And intensity matters. They say there are three things you need to do to be faster; intervals, intervals, and more intervals. Unfortunately, that can lead to issues later on. And size matters. The bigger they are, the harder they fall. Women tend to have fewer problems than men, but they think that may simply be related to women's statistically smaller size. However, as with heart attacks, women who do have issues have a much harder time getting a proper diagnosis, so they need to be much more insistent on getting the proper treatment. Another curious tidbit was that people with heart issues tend to be irritable. A cycling buddy noticed this about himself, before he die at age 52 of an enlarged heart. It was also interesting to read that while intense training can bring on a variety of heart issues, de-training can often also resolve them. For many, ablation surgery can cure the underlying issue with arrhythmias, although it may take several tries. And while drugs, like beta blockers, are not typically a good solution for most athletes, it was surprising to read that some athletes can actually tolerate them without a reduction in maximum hr. For myself, I now believe I have had two instances of atrial flutter, both occurring when I did that one extra bonus climb at the end of an already epic ride on a hot day. I did not draw the correlation until I read the book. So while I haven't worn a hr strap in many years - just too uncomfortable for me, I did buy an ANT compatible arm strap. I'm guessing there are a lot of other endurance athletes out there that will find this book equally as valuable as I did.

I bought this book because I wanted to know if the level of endurance activity I was doing in my seventies was damaging my heart, what I got was way to much information on how the heart works ..."membrane potential of a muscle cell relative to its surroundings is measured in millivolts and is always a negative charge ...) and too little information on exactly what I should be doing to minimize damage to the heart through exercise. The stories are the best part of the book but there was the potential for a very good book if they could have simplified the anatomy, reduced the detail, and provided "if this, then that" information.

Six weeks ago, I had a vasovagal attack donating plasma at the Red Cross and lost consciousness, so I was taken by ambulance to Caualty at the local hospital. An ECG showed minor changes consistent with an athlete's heart (I'm a retired marathon runner, who is still physically active in a gym). An echocardiogram was advised, which showed severe left atrial dilatation, which I accept is due to damage resulting from excessive training training for marathons (it's well described in the book). So, I was referred to a cardiologist, who noted that I have a resting heart rate of 40 bpm (sinus bradycardia, not heart block), so he advised me to have an artificial pacemaker. This book was very useful in providing alternative advice. My resting heart occasionally drops to 34 bpm (anything above 30 bpm is acceptable as normal in athletes) with no symptoms and a completely normal unchanged blood pressure. Most of the book on arrhythmias doesn't appear to apply to me - I'm never aware of my heart beat or have shortness of breath exercising or at other times. And the chapter advising supplements to me just appears to be junk science. I'm still being investigated. The next step is to have a Holter monitor, which might provide some useful information. Or not. I think the vasovagal attack was due to jet lag (I'd flown from Munich to Perth 2 days earlier - a 17 hour flight with a 6 hour time zone change, so there was probably some tiredness involved). And the Red Cross had recently changed their procedure for plasma donations, not replacing the 900 ml of plasma donated with a litre of saline till the end, so there was probably some low blood volume involved too. I don't think I need to worry much. I'm retired from the heavy marathon training, so that's not a problem. I'm currently doing cardio' workouts in a gym, which are comfortable, to maintain fitness. The book has provided me good reasons for declining a pacemaker.

I have run for 50 years and was diagnosed with 2nd degree heart block and intermittent atrial flutter several years ago. When the flutter kicks in it definitely interferes with exercise: running, hiking, biking -- any aerobic activity. This book was recommended by a neighbor -- a mountain climber and long-distance masters bicycle racer. It was a much appreciated recommendation and provided a good deal of context and background that helped me better understand the nature and potential fixes to my condition. I should say that often the book focused on heart conditions and arrhythmias other than those of direct, personal interest to me. The segment on atrial flutter was relatively brief but quite informative; the book made almost no mention of heart block. The Haywire Heart was a useful and informative read. It seemed well researched, rational, and balanced. Its illustrations were also useful. While I might have quibbled a bit with its organization and coverage, I would definitely recommend it for anyone seeking knowledge and perspective on (aerobic) exercise and risks to heart health.