Athletic heart Atrial fibrillation Cycling Wed General Cardiology

CW: My Athlete’s Heart Podcast

I recently had the pleasure of doing a podcast with Rob Orman, an ER doctor and fellow cyclocross racer from Oregon. As Dr. Orman says, we discuss the broad intersection of sports and Cardiology. Of course they intersect; there shall be no sport without a good heart.

In the 35 minute conversation, we discussed the following topics.

  • Are marathons bad for you?
  • Sudden death in sports
  • How should you counsel patients before they start a fitness program?
  • What are the important things to watch for on a sports physical?
  • Early repolarization: harbinger of death or no big deal
  • Managing atrial fibrillation in the athlete

Though our chat was geared to medical peeps, there may be something there that interests you.

And I was delighted to see this… on iTunes

Here is the link: The Athlete’s Heart at



P.S. I am especially grateful to Dr. Orman–for he labeled me an electrophysiologist, cyclist and drum roll… a philosopher? That’s a good one. Huge Grin.

3 replies on “CW: My Athlete’s Heart Podcast”

And the grin is because……….? You are a philosopher . AARON darn fine one too. i have incorporated you into my daily reading.

Hi John. EXCELLENT 35-minute discussion on ERCast. It was easy from itunes to download this mp3 recording onto a CD that I could play in the car. A couple of thoughts I’d add to your insightful discussion:

i) The cost of an ECG in the office is not $25 anymore as you indicated. At the time I retired from academic primary care practice (July, 2010) – it was at least 3 times that amount (not to mention interpretation fees that are sometimes added on).

ii) Great points you make about various QT interval durations (that clearly anything over 500 msec should be investigated). At least in my primary care experience – it was rare indeed for me to see a QT anything close to that in an otherwise healthy, young athletic population not on meds (ergo, rare as a screening test in someone without positive family history that you’ll see a QT approaching that duration).

iii) Given the pros and cons for anticoagulating (or not) a young adult athlete who is otherwise healthy – Shouldn’t this be an informed consent decision that the athlete himself/herself makes once told of the pros and cons? I’m no longer in my 40’s – but I do not think I would opt for anticoagulation if I truly had “lone AFib” – given the hassles of becoming a “patient” (with need for frequent doctor visits) and the potential for not insignificant side effects from longterm anticoagulation. Newer anticoagulants (like Dabigatran) was extremely expensive (potentially an important issue- depending on one’s coverage) – and don’t have an “antidote” if bleeding does occur …

iv) Wouldn’t use of Echo be appropriate for that young athlete with AFib on the fence about anticoagulation or not – by providing another way to assess if the heart is truly “normal” (perhaps there was previously undetected cardiomyopathy or LA enlargement that would be enough to suggest definite need for anticoagulating that individual?)

v) In your experience – is intermittent (= paroxysmal = PAF) much more common than persistent AFib when AFib does occur in young adult athletes? My impression has always been that it is frequency and especially likely duration of AFib episodes in individuals with PAF that determines likelihood of stroke – so might not ambulatory monitoring in addition to Echo be yet another way to truly assess relative likelihood of stroke (and therefore the need for anticoagulation). If YOUR 2 AFib episodes were truly all you had – and if those 2 episodes were short and self-limiting – Wouldn’t your stroke risk be truly very, very low? (that said with full acknowledgement that the vast majority of AFib episodes are asymptomatic …. ergo my suggestion for additional ambulatory monitoring to assess this).

vi) You bring up an EXCELLENT point about Dabigatran – namely the inability of the medical provider to KNOW if the patient is taking the medication (since there is no way of monitoring drug levels). IF the new test you allude to for Dabigatran monitoring does come through – Won’t the addition of “Dabigatran monitoring” cancel out what was to have otherwise been one of the major “pros” for using that class of drugs (namely that monitoring would no longer be needed). Absence of monitoring of course makes it extremely difficult to know the “true event rate” on these new anticoagulating drugs, because investigators can’t be sure if the patient is truly taking the drugs?

vii) You ARE a “philosopher” – and I LOVE it!

viii) GREAT recording you made!!! It is a LUXURY for us to have ready access for tapping into your wonderful clinical insights! Keep up the superb work – : ) Ken

A couple of of bitter cyclists beating up on us marathoners.

Thanks for the motivation. Flying Pig next week!!

See you (limping) in Boston,


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