The Haywire Heart: How too much exercise can kill you, and what you can do to protect your heart Hardcover – January 5, 2017

I hope I read this book in time. I am a 74-year-old bike racer with premature ventricular contractions (PVCs, often felt as skipped heartbeats) that have been diagnosed as benign following a stress ultrasound examination. Until I read this book, my instinct was to push harder. I thought if I just did enough interval training and hard hill climbs, I would get past these PVCs. To some extent, that has worked. However, after reading this book, I now believe that the PVCs may be an early warning of heart problems to come if I keep on pushing as hard as I have been.I am going to continue riding my bike, and I am still going to push hard at times, perhaps even race again, but most of my riding is going to be at a slower pace.An anecdote: a fellow bike racer won a criterium (a hard circuit race) in the 80-to-84-year-old age group last year. Our team had put on the race, so I had the pleasure of presenting him with his trophy. A few days later, he passed away from what was described as a heart attack. He had appeared to be in excellent health when I saw him. I can't help but wonder if he wouldn't still be alive if he hadn't pushed himself so hard.I think any endurance athlete who frequently pushes his or her heart rate to its maximum and who is middle-aged or older should read this book to know the risks as well as the benefits of hard exercise. Backing off a bit on the workouts doesn't mean the end of exercise or even necessarily of competition, but it may mean the difference between being fit five or ten years from now or being impaired by a heart condition.

I had a miserable few years lately trying to figure out the ups and downs of my cycling ability. Setting age group Strava records (65-70) one day, can’t get out of bed a few days later, and then lather, rinse repeat. Made no sense. After waiting long months for appointments with a series of cardiologist appointments, Holter studies, MRI, blood tests and copays out the yin-yang only to be treated like I was crazy, faking it. Told I was wrong, depressed, getting too old, stop riding, blah de blah. Read this book and was so immediately po’d at all these doctors with wrong/incomplete info. Buy this book. Save yourself the hassle and learn from a doctor who knows his shifters. And Lenny Zinn, too. Less than the copay for one office visit.

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.

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.

Having recently been diagnosed with AF I wanted to learn much more about the condition. The British Heart Foundation and some hospital websites like Royal Brompton have some good info and are a good starting point but I wanted a more comprehensive understanding. I am a masters lifelong endurance athlete. I chose three books, two from having read Amazon reviews and the third I had ironically learnt about shortly before the diagnosis. I am reviewing them all together as I like reviews where other books are highlighted, particularly if they are better or have something different to say. One word of warning whether typical of books on AF or not all three can be pretty demoralising for the newly diagnosed particularly the early chapters which explain the how’s and why’s and can make it sound as if nearly everything can be a possible trigger for AF. The first book is ‘Your Complete Guide to Afib’ (2020) by Dr Percy Morales. This is a short (119 pages) book dealing with definitions, causes, triggers, drugs and treatments. Factual, no case studies, and will probably satisfy most people’s quest to find out more about the condition. I give the book four stars as, from my perspective, not much on endurance athletes and the author, genuinely I hope, offers his weight loss course which I don’t think needs to be within the text. The second book is ‘The Afib Cure’ (2021) by John Day and T. Jared Bunch. The publication date should mean the book is completely up to date being one of the reasons I chose it. Their definition of cure might only be remission for some. It is more comprehensive than the first book, with case studies (not too flowery) and the first half is probably more demoralising too. It has a good chapter on ablation and has a comprehensive note section on the research reports the authors refer to and quote should you wish to go even deeper into subjects. I would have given this book four and half stars, with the loss of half a star as I would have liked a separate section on cardioversion, being an early initial procedure for many, which is dealt with but in a number of different paragraphs and not fully. Also, the book does have a small number of helpful paragraphs on endurance athletes with AF but again I would have like a dedicated section. The latter point (as with the first book) is that much of the self-help measures revolve around improving life style choices – diet, exercise, no smoking, but for athletes’ life style is likely to fairly well optimised already so much of these sections in the book are not really applicable. The third book is ‘The Haywire Heart’ (2018) by Chris Case, John Mandrola and Lennard Zinn. Whilst the book does deal with AF it also deals with other heart arrhythmias so not completely dedicated to AF. It has a comprehensive layman section on how the heart works and heart conditions and pulls together evidence and research on how extreme exercise can damage your heart. Again, pretty sobering if you are reading the book post diagnoses or a cautionary tale if not. The case studies are there to show there is life after training/racing. The chapter on treatment options is shorter that the second book but does provide a slightly different take more applicable to athletes. There is also a notes section on the research papers referred to. Again 4 stars as it does fill in some of the gaps in the other two books.

It's a really interesting book, if a little niche. There are a growing number of endurance athletes in their 40s and 50s, (me amongst them) who despite being apparently very healthy have developed cardiac arrhythmias. At first this was seen by the medical world as simply bad luck, but these authors pull together the evidence that it's likely that prolonged hard training can actually cause heart problems and they explain why. I had already arrived at similar conclusions myself. Looking back I was training far too hard and my body tried to tell me so! The authors know what they are talking about and who they are talking to as they are keen sportsmen themselves, and John Mandrola is a cardiac electrophysiologist, so specialises in heart rhythm problems. It is a giant adjustment to make from seeing yourself as super-fit to realising you have a heart problem, and it's an adjustment that probably a lot of people are going to have to make unless people get a better understanding of what hard training can do to them. This book should help both the people doing the adjusting and the process of creating a better understanding. I am grateful to the authors for putting it together. They will never make a fortune from it, so they have written it to help other people.

There is apparently an emerging theory (backed up by a growing body of evidence) that excessive high-level exercise can cause abnormal heart rhythms. This fed through into the community in a Velo News article by the authors of this book in 2015.This book explains that theory - beginning with a case study (and with other case studies scattered throughout the work) - going on to explain how the heart works and how exercise affects the heart and how the heart can be damaged (specifically by or contributed to by high level, high volume exercise). The authors acknowledge that the theory is not 'nailed on' and that there is much work to do to understand how arrythmias develop and whether the link with exercise is indisputable.What the work does is identify the issue, explores it, offers some insight and advice about 'best practice' to perhaps avoid damaging your heart 'just in case'.To a degree, I have to say that the book could cause alarm and concern and I recommend also reading the online blog of Dr Larry Cresswell who is a little less alarmist (in my opinion) and whilst he doesn't dismiss the link with exercise, he offers a more conservative view.I thoroughly recommend the book for what the insights it gives, the quality of the writing and the depth.I should emphasise that this is an exceptional work that is perfectly suitable for the lay person; i.e. not requiring any or any detailed medical knowledge.

This book deserves wide readership amongst the endurance athlete community. It reviews the latest evidence on heart problems caused by persistent endurance training and competition, outlining the risks to heart health as far as they are understood. There is a timely warning on overtraining, wise advice on spotting symptoms, discussion of compounding risk factors and guidance on seeking medical support. Particularly, if you are beasting yourself day in day out without serous attention to letting your body recover, it would be a good idea to think again. Beyond that, having raised the spectre of heart damage, it has no real answer to the critical question which any athlete might have i.e. given my genes, age, training history and lifestyle - is my endurance schedule putting my health at risk? The book makes clear that "many athletes - probably most - do not develop heart disease". "Why these afflictions strike some and not others is still unknown". This is not really a criticism of the book - it tells us as much as is known - but I suspect it will leave many, like me, with a heightened recognition of the risk but unable to calibrate how the risk applies to me.

If you have any concerns about irregular heart rhythms etc brought on by too much endurance sport (guilty) then this is just what you need. It's encyclopedic in it's coverage of the issue and is written by experts who have personal experience.One word of warning though, it's not dumbed down and isn't an easy read. It's like reading a medical textbook, and doesn't sugar coat everything so be prepared.