Facts You Should Know About Cardiovascular Disease According to 1997 estimates, 59,700,000 Americans have one or more forms of cardiovascular disease (CVD). In the United States, all cardiovascular diseases combined claim the lives of nearly 504,000 females annually while all forms of cancer combine to kill about 259,000 females. Breast cancer claims the lives of about 41,700 females each year; lung cancer claims about 64,500. About one sixth of all people killed by CVD are under age 65. In 50 percent of men who died suddenly of coronary heart disease (CHD), there were no previous symptoms of this disease. About 84 percent of cardiovascular disease deaths occur in people age 65 and older. Source: American Heart Association Signs You Are Having a Heart Attack Oppressive chest pain in middle or left of chest, radiating to jaw or arm Shortness of breath Breaking into a sweat Dizziness, light-headedness, nausea Split/race times getting worse Symptoms that occur during exercise but abate with rest **As soon as you experience ANY of these symptoms, stop running, go home, and see a doctor immediately. Do not run until you've had your condition assessed. Source: Dr. Kenneth L. Baughman, Chief of Cardiology, Johns Hopkins Hospital Rules for Returning to the Road Get a maximal exercise stress test to make sure your body can handle the rigors of running seriously. If your stress test is still positive, have a catheterization to determine amount of artery blockage. Use stress tests regularly to see if you are ready to move to the next level of training. Give your heart time to heal-it can take 6 weeks for scar tissue to be healed over. Slowly increase intensity of training-like any injury, it takes time to return to your pre-injury performance level. Monitor your risk factors carefully to maintain healthy heart after any procedure. **If you have a bypass, you are as safe as, if not safer than, most middle-aged runners who may not even know they are at risk. Source: Dr. Kenneth L. Baugman, Chief of Cardiology, Johns Hopkins Hospital

back on track

A Runner's Return From Heart Surgery to Heartbreak Hill

As I rounded the corner onto Boylston Street the noise from the crowd seem to roll over me like a tidal wave. The finish was in sight and I started to relax, knowing that I was about to complete not only the marathon, but also a journey that started a year ago. I allowed myself to enjoy the moment, taking in every sight and sound. As I neared the finish, I searched desperately among the crowd for the one face that had taken every step of this journey with me. Finally I saw the face of my wife, tears rolling down her cheeks, and that smile that had brightened up so many dark days of the previous year. As I covered the final steps to the finish line my heartbeat was strong and steady. I was comforted by its rhythmic pounding. Then the reality set in. Although I have had this dream each and every day since I left the hospital a year ago, it has yet to come true.

In February 2000 while training for my 14th Boston Marathon, I ran a half marathon in Williamsburg, Virginia. Several weeks prior to this race, I had started to have some difficulty breathing whenever I did any interval or tempo runs. However, being a lifelong runner with a health-conscious lifestyle, I saw no need to be overly concerned. Sure, I wasn't running as fast as I had been two years ago when I won the 50-54 age group in all 15 races I ran, but who was? I attributed it to "getting old." About 6 miles into the race I felt the breathing difficulties return. As I worked to maintain a pace that should have been easy, I thought to myself, "I'll get this checked out when I get a chance." Making the final turn and heading up a slight hill, I felt a tightness in my chest, along with the breathing difficulties, and for the first time I got scared. This was not the type of shortness of breath I had experienced so many times before as I made the final dash to pass another runner or to set an elusive PR.

I shared with my wife what I had experienced and she agreed that it was time to see what the problem was. Blinded by my lifestyle, neither one of us imagined this was a heart-related problem. Ten years ago I had taken an exercise stress test and had done very well. There was no indication of heart disease. I guess the important lesson to be learned here is that periodic checks are the best thing we can do for ourselves.

After other tests proved negative, a treadmill test was scheduled. Needless to say I was a little nervous about the outcome. As the speed of the treadmill increased and the elevation was raised, I went from an easy walk to a slow jog. With each completed phase I became confident that my heart was fine and things would be okay. Then it happened. The nurse practitioner asked me how I was doing and if I felt anything unusual. I was to find out later that she had noticed changes in my EKG. She allowed me to continue but now showed more concern about how I was feeling than she had earlier. After one more level the nurse again asked me how I was feeling. The tightness that I had experienced during the half marathon had returned. The nurse immediately lowered the treadmill and stopped the test.

The next words she spoke hit me harder than the 20th mile of a bad marathon. "You just had a positive stress test." At this point I looked around the room to see whom she was talking to, knowing full well that we were the only ones there. How could this be? I had always lived a healthy lifestyle. I had controlled all the modifiable risk factors for most of my life. I've been a competitive runner since high school. I've never smoked. I keep my diet low in fat, cholesterol and sodium. More than 20 years ago I eliminated caffeine and alcohol from my diet. My blood pressure was normal and my resting heart rate was about 46. That left one thing, genetics: About 7 years ago my mom had cardiac bypass surgery.

My immediate thought was, "What does this mean for my running?" A cardiologist was called in and laid out my options. I could be given medications and be followed, have additional non-invasive tests or go straight to a heart catheterization. Catheterization is a procedure whereby a long thin tube is inserted into the femoral artery and guided up to the heart where a dye is injected into the coronary arteries. The procedure allows the cardiologist to see if any blockages exist. Although there are risks with this procedure, as there are with any invasive technique, I opted for the cardiac catheterization, as it would give me the most accurate information in the shortest amount of time. The examination revealed that I had three blocked arteries. With a 70 percent occlusion of the left main coronary artery, a.k.a. the "Widow Maker," my preferred treatment option became triple bypass surgery.

The surgery went very well and within 24 hours I was up "walking." The survival shuffle at the end of a very grueling marathon would be a sprint compared to my first post-surgery walk. Cardiac rehabilitation started about six weeks after surgery. Walking at 3 miles per hour on a treadmill and riding the exercise bike for 20 minutes at a very low intensity was a long way from running 26.2 miles. Before long I was allowed to jog at 13-minute mile pace. Despite this progress, at times I was very discouraged and thought I would never get back to running. Then I would look around the room at those who were just starting their rehab and realize how far I had come. Having been in excellent condition prior to surgery surely aided in my recovery and shortened my rehab time.

After 8 weeks of supervised rehab, I was on my own. With the approval of my cardiologist, I set out on my journey to train for Boston 2001. Finding no resources to guide me, I set out to write a training program that would get me from heart surgery to Heartbreak Hill*. My run-walk regimen was gradually replaced by all running. Over time, the distance lengthened and the pace quickened.

As my training progressed and I was able to complete 18-mile runs with ease, I gained confidence that my dream of running the 2001 Boston Marathon would come true. It was not to be. An Achilles tendon injury in the weeks prior to the race sidelined me and shattered any hope I had of fulfilling my dream-this year. In spite of this, I know that if I continue to train with all my heart, one day my dream of again running Heartbreak Hill will be realized.

*Heartbreak Hill is mile 20-21 of the Boston Marathon-a focal point for the race spectators who are eager to witness runners struggling to conquer the most challenging part of the course. The "Hill" was named by late Boston Globe sportswriter Jerry Nason who coined the term "Heartbreak Hill" after writing a story in 1936 describing defending champion Johnny Kelley's bitter defeat by Ellison Brown.

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Herb Tolbert, 54, has been running for more than 35 years and is a member of the Montgomery County Road Runners Club and of the National Capital Track Club known as the GNATS. He and his wife, Nadine, live in Montgomery Village, MD.