Tests and Diagnosis

Late June 2009
So, I have a heart murmur. Lots of people have heart murmurs. I really wasn't very concerned and continued with training for Vineman 70.3 (a 1/2 iron distance triathlon) scheduled on July 19th. On June 13th I did my longest training run for 2009, 10 miles in 1 hour 33 minutes. That's a pace of about one mile every 9 minutes and 20 seconds. I was pleased, not quite thrilled with my time. At the end of the workout my heart rate was 156, fairly typical for me for this type of workout. On June 17th I visited my primary care physician who confirmed that I had a heart murmur and gave me a referral into cardiology. My doctor said I could continue to exercise. Sutter Cardiology scheduled me for an appointment on July 5. On July 3, I did my longest brick (that's a bike/run combination workout). I cycled for just under 3 hours (about 47 miles) and then ran 7.5 miles in 1 hour and 7 minutes. I was very pleased with my run time which was faster than earlier long runs.

Seeing the Cardiologist
On July 5, I saw my cardiologist, Dr. M. After listening with his stethoscope, he said that he could hear either "substantial" or "significant" regurgitation (I can't remember his exact words, but it was one or the other). Essentially, regurgitation is blood flowing backwards within the heart that results in turbulence which can be heard via the stethoscope. Just from listening he believed that there was a significant leak in my aortic valve (blood leaking backward from the aorta into the left ventricle). He also said that I might need valve replacement surgery, probably sooner rather than later. I was stunned. I was training hard and feeling good. I was only 47. Everyone in the waiting room was much older!!! This made no sense to me. Dr. M said the next step was an echocardiogram (essentially a sonogram of the heart) to confirm his diagnosis. I asked if I could continue to train. He said yes, but to listen to my body. If my heart started to race or felt odd, I should stop the training. Still not really believing this was happening, I worked with the very helpful cardiology scheduler who got me in the next day for an echocardiogram after learning of a cancellation. This test takes about a half hour. The practitioner puts some lubricant on your chest and moves the wand over your chest at different angles. They take lots of measurements on the viewing screen. It's painless and easy.

The News
On July 7 I did my usual swim of 1300 yards at the gym, followed by a spin class workout of about 45 minutes. On July 8 I ran five miles in the morning before work. At 9:00 I received a call from Dr. M's nurse. She said that I had an ascending aortic aneurysm and that I should stop triathlon training. Again, I was stunned. I did a lot of googling that morning trying to figure out what all that meant. In a nutshell, the aorta is main artery leaving the heart from the left ventricle and bringing blood to the rest of the body. The aorta heads upward at first (the ascending aorta) and then makes a u turn (the aortic arch) and then heads down toward the legs (the descending aorta). My aneurysm was in the ascending portion just after leaving the heart. An aneurysm is a dilation of any blood vessel caused by disease or weakening of the vessel wall. Fortunately I had an appointment the very next day with Dr. M to go over these results.