The 6 Warning Signs of Heart Disease in Endurance Athletes—with Dr. Larry Creswell – EP94

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We know that exercise is good for our hearts, yet we hear story after story of endurance athletes dying suddenly—almost always due to heart disease that has gone undetected. Just how common are fatalities at endurance races? What are the warning signs of heart disease? And what can we do to keep our hearts healthy and prevent any kind of cardiovascular event?




Dr. Larry Creswell is a thoracic surgeon affiliated with the University of Mississippi School of Medicine in Jackson. Dr. Larry received his medical training at Johns Hopkins University, and he has been practicing for 20-plus years. He is also an endurance athlete, currently training to swim the English Channel in 2019. Dr. Larry specializes in helping recreational athletes with heart issues, and he regularly shares content online through his blog, Athlete’s Heart.

Today, Dr. Larry joins us to share the warning signs of heart disease in endurance athletes. He explains the different types of heart arrythmias, offering his take on why atrial fibrillation is more common in athletes than the general population. Dr. Larry offers advice on maintaining heart health, covering the one-time tests he recommends, the best diet for cardiovascular health, and strategies for preventing heart disease. Listen in for Dr. Larry’s insight on taking care of your heart and putting yourself in a position to help others should they experience a cardiac event.

Topics Covered

[1:02] Dr. Larry’s interest in athletics and the heart

  • Decision to be active at age 40 (swimming, triathlon)
  • Questions about heart in people healthy and fit
[3:43] How Dr. Larry is training to swim the English Channel

  • 5 days/week with long swim on weekends
  • Travel to venues with similar temperature
[5:14] The details around swimming the English Channel

  • 21 miles across, average of 14 hours
  • 60 degrees without wetsuit
[5:54] Heart fatalities at endurance sporting events

  • Uncommon but startling to witness
  • Almost always unrecognized heart disease
[7:19] Dr. Larry’s 6 warning signs of heart disease

  1. Chest pain, tightness during exertion
  2. Unusual shortness of breath
  3. Palpitations or pounding in chest
  4. Light-headedness during exercise
  5. Fatigue out of proportion
  6. Decrease in performance
[11:28] The value of HRV tracking in heart health

  • Identify abnormally high heartrate when not exercising
  • Indicative of arrythmia
[13:04] The different types of arrythmia

  • Bradycardia = <60 bpm
  • Tachycardia = >100 bpm
  • Atrial fibrillation = irregular
[16:17] Why atrial fibrillation is more common in athletes

  • Heart responds to exercise by growing
  • May cause disorganized electrical activity
[18:14] The treatment options for atrial fibrillation

  • Take aspirin or blood thinner
  • Medication (occur less often, less severe)
  • Ablation procedure
[19:33] How symptoms differ in men and women

  • Men experience crushing pain in chest
  • Women’s pain subtler (i.e.: tightness)
[21:10] What to do if you experience the warning signs

  • Discussion with doctor
  • Specific tests based on symptoms
[22:18] Dr. Larry’s advice on maintaining heart health

  • Visit doctor for physical exam on annual basis
  • One-time EKG to ensure normal electrical activity
  • One-time echocardiogram to view heart structure
[25:10] Dr. Larry’s insight on calcification around the heart

  • Occurs when develop plaque around arteries
  • No clear correlation with athletes
[27:34] How to prevent heart problems

  • Exercise on regular basis
  • Eat well and don’t smoke
  • Be honest about warning signs
  • Seek help when necessary
[28:55] The family history factors to watch

  • Early coronary heart disease in family tree
  • Relatives die suddenly without explanation
  • Inherited problems cause sudden death (e.g.: long QT syndrome)
[31:04] The best diet for heart health

  • Real food like lean proteins, fruits and vegetables
  • Avoid processed foods with more than 5 ingredients
  • Limit sodium intake (season food with alternatives)
[36:10] How to identify and help someone having a heart attack

  • Fall to ground, pulseless and not breathing
  • Perform CPR promptly and get defibrillator
[41:57] The effectiveness of CPR in cardiac arrest

  • 15% survival rate outside hospital setting
  • Up to 30% if access to defibrillator, CPR
[43:09] Dr. Larry’s take on excessive training and heart health

  • Skeptical that exercise is detrimental to heart
  • Professional cyclists have higher longevity than gen pop
[45:24] Dr. Larry’s recommendations around minimum exercise

  • 150 minutes aerobic training per week
  • 30 minutes of resistance training
[50:03] Dr. Larry’s #1 piece of advice

  • Take care of heart best you can
  • Be in position to help others

Learn More About Dr. Larry Creswell

Athlete’s Heart

Athlete’s Heart on Facebook

Athlete’s Heart on Twitter


AHA Recommendations for Physical Activity

CDC Physical Activity Guidelines

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