Runner Down

No one knows if George Spears experienced a heaviness in his chest, an ache through the shoulders and down an arm, or difficulty breathing while running the final six miles of his life. His wife says she worried only about his sore hip. Later, she objected to a medical examiner employee’s suggestion that “lifestyle” may have played a part in his death, saying his careful diet, rejection of tobacco, and rigorous exercise regime were living arguments to the contrary. The cause of death on his death certificate says only “arteriosclerotic heart disease.”

Brad Huckle’s doctors told him that a 90 percent blockage of one of his coronary arteries had precipitated his heart attack. He remembers nothing about that day except a few seconds aboard the shuttle bus taking him from his parked car to the starting area and possibly—he’s really not sure—telling somebody, moments after his collapse, that he was not OK. He must rely entirely on other people and his previous experiences to recreate the event. Nearly three months later—a few days after he celebrated his forty-eighth birthday—he looks as though he’s the fittest, healthiest man in the world and ten years younger than his age. It’s easy to understand why he sounds like a man who can’t believe what happened to him.

“Aside from the short prep time between the [Wisconsin] Ironman and the marathon, there was absolutely nothing unusual about this event,” he says matter-of-factly. “The weather, or so I understand, was decent. I was an experienced runner, having taken part in close to fifty races in the past four years. I know how to monitor my body. I know how to hydrate. I wasn’t even trying to beat my PR. A guy I ran next to for seventeen miles said I looked fine and that I didn’t say anything about symptoms. I passed other people who said I looked good and one person on Summit Avenue who said I was flying. Now it’s conceivable that I glanced at my watch when I got up toward the top of Summit and saw I was off my desired pace, and I put on the afterburners. But even so, I wouldn’t have done anything I hadn’t done many times before.”

His short-term memory was sketchy for a couple of days afterward, but had pretty much returned by the time he left the hospital five days after his collapse. His recollection of race day may be gone for good, however—the result perhaps of an interruption of blood flow to the brain during the few minutes between his collapse and resuscitation.

Huckle, with no personal or family history of cardiac disease, insists he had never thought about a heart attack. Apparently, he says, when you successfully complete enough marathons and triathlons, “there’s a bit of the Superman syndrome that creeps into your mentality.” It’s part, he says, of your competitive spirit. “If you’re full of fear and self-doubt, you’re probably not going to sign up for an ironman or a marathon. If anything, you want to block bad things like that from your mind. You’re not interested in the what-ifs.”

So what if he had felt unfamiliar discomfort during his last run?

“Honestly,” he replies, “I probably would have attributed it to a poor nutrition plan, lack of hydration, maybe something that had carried over from Wisconsin. I don’t know what it feels like to have a heart attack. I guess I would have kept pushing, at least until something became very, very obvious. That’s what competitive people usually do—push on. My competitive nature, my experience as a runner, and the fact that it was race day would have all worked against me.” But, without cogent memories of the event, he doesn’t know if he had symptoms, much less how he responded or didn’t respond. Hypotheticals aside, he says, “I don’t know what I would have done differently. I had no reason not to do what I did, what I’d always done. I’d had a stress test. I’d seen a doctor.” He pauses and smiles. “Heart attacks happen, sure. I just never thought it would happen to me.”

He wonders how long he’d had that arterial blockage—and why it hadn’t brought him down while swimming, biking, or running in the ironman three weeks before the marathon. He says he has only a layperson’s understanding of what might have happened in his case. He had read with predictable interest the Times story exploring the possible connection between heart attacks and marathons, and speaks vaguely about a “possible perfect storm” of internal developments that may have laid him low.  But neither he nor his doctors can say for certain.

Huckle, like most survivors, sounds more grateful about being here than rueful about almost not. He has suffered permanent heart damage, he says. He’s in cardiac rehab and on multiple medications he will probably take the rest of his life. He will probably never run competitively again. He thinks often, he says, about George Spears and his heart attack, but is back to work at his Roseville bank, enjoying life with his son and his family, and even thinking about starting a little recreational jogging. “I’m glad to be alive,” he says softly. “I start from that point. Anything else, you feel you’re being greedy.”

Huckle acknowledges the irony and curiosities that infuse his and similar cases. The first person to reach him after he fell was a firefighter who was running a few moments behind him and was proficient with the specific make of AED that’s positioned along the course for just such an emergency. Interestingly, the runner who stopped to minister to George Spears was a registered nurse who worked in a cardiac unit. And in the Times story, following close on the heels of the surviving Marine Corps heart attack victim was a cardiologist. Which speaks to, if nothing else, the attraction of competitive running to persons with an interest in health and survival and adds credence to Bill Roberts’s observation that the “most likely person to respond first to a downed runner is another runner.”

And, unlike the legendary but ultimately luckless Jim Fixx, Brad Huckle had the good fortune to have his heart attack at a large urban marathon, not on a lonely country road. Why that didn’t matter for George Spears is another mystery of the heart.

“I know it sounds weird,” Huckle says, “but if I’d had that heart attack three months or years later, while I was running by myself in the woods or maybe shoveling snow, I could have simply fallen and died. Having that heart attack where and when I did saved my life.” 

Heart Attack: Changing Perceptions of a Potent Killer Heart attacks may be anomalous among marathoners, but they’re a frequent killer in the general population. More than a million Americans will experience a myocardial infarction this year, and half of those will be fatal. “Still,” says Jay Cohn, a University of Minnesota cardiologist and director of the Rasmussen Center for Cardiovascular Disease Prevention, “a heart attack is no longer an automatic death sentence.” The key, Cohn says, is what it’s always been—swift, appropriate medical attention, ideally in a hospital within an hour of the onset of symptoms, before the heart muscle can sustain permanent damage from the restriction of the blood supply. Besides a speedy response, changes in our understanding of heart attacks have improved victims’ outcomes. “The management of acute myocardial infarction is dramatically different from what it was thirty years ago,” says Cohn, an innovator in the diagnosis and treatment of heart disease during a fifty-year career. “It used to be, when people would make it to the hospital after having a heart attack, we’d put them to bed and let them recover slowly. They’d spend maybe four weeks in the hospital. Now they come in, are sent to the [catheter] lab, and have their artery opened with an angioplasty and stent. They’re often home again in as little as two days, and the survival rate is 95 percent instead of 80.” The change, Cohn says, reflects the updated understanding that most heart attacks are caused by the obstruction of a coronary artery by a clot. Also in flux is our recognition of who is having heart attacks. That cardiovascular disease, not cancer, is the leading cause of death in women still comes as a surprise to many people, including women. Women have as many heart attacks as men, according to cardiologist Anne Taylor, director of the U of M’s Women’s Heart Clinic, but generally they have them later in life. “You don’t see heart attacks appearing in women so much until about ten years after menopause—that is, in women in their late fifties and sixties and seventies,” says Taylor. That helps explain the relatively few reports of MIs among female runners, who now make up about 40 percent of a typical marathon field. The risk factors leading to heart disease and attacks remain the usual suspects—high blood pressure, elevated cholesterol, smoking, diabetes, obesity, genetic factors—but the relative impact of those factors differs between the sexes. Diabetes, for instance, increases the incidence of coronary artery disease, precursor of most heart attacks, by about five times in women, compared with about two and a half times in men. In addition, heart attack symptoms are often “more subtle” in women than in men. Instead of the crushing chest pain often reported by men, Taylor says, symptoms in women often include sleep disturbances, shortness of breath, and excessive fatigue. Perhaps the most dramatic change, however, is the growing belief among many doctors and scientists that heart attacks can be prevented entirely in all but the most elderly. “We now know that if we can detect the risk of atherosclerosis at an early age and start appropriate therapy,” says Cohn, “we can strikingly reduce the risk of having a heart attack. If we can identify a risk in a person twenty years before a heart attack is likely to occur and intervene with drugs to lower cholesterol and blood pressure, we could slow the atherosclerosis progression and thus prevent a heart attack during the most productive period of a person’s life.” Cohn concedes that this view is controversial. But the Rasmussen Center he established at the U of M six years ago offers a battery of ten noninvasive screening tests “that we think,” he says, “can pick up nearly everyone who is likely, in the next twenty years, to have a heart attack, so we can intervene and prevent it.” Most of the more than 2,000 men and women who have come in for the center’s tests have family histories rife with heart problems, though they themselves don’t have symptoms. “We call them the ‘worried well,’ ” says Cohn, who concedes that definitive proof of this approach will show only in long-term follow-up studies, which won’t be available for several years. While not everybody is as optimistic as Cohn, everybody seems to agree that many causes of heart disease leading to heart attack are obvious right now. Twin Cities Marathon medical director William Roberts runs down the list: “Smoking and secondary smoke, poor diets, inactivity—those are all weapons of mass destruction.” Roberts agrees that early detection and intervention have great potential to save people’s lives, but, in the meantime, “we can do a lot by changing people’s habits.” As last fall’s TCM made perfectly clear, anyone can have a heart attack. “But,” says Roberts, “that doesn’t mean that people shouldn’t run. A person who trains regularly is at much less risk than somebody who is inactive.”  —W. S.

Senior editor William Swanson’s Dial M: The Murder of Carol Thompson has been nominated for a 2007 Minnesota Book Award.