Dying to Run, Episode 6: “Heart Trouble”

Matt Fitzgerald has been a runner for almost his entire life, but his running days ended abruptly in 2020 when he developed long COVID, a post-viral chronic illness that makes it almost impossible to exercise. “Dying to Run” chronicles Matt’s quest for closure in the form of one last finish line.

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Have I mentioned I have heart disease? It’s no big deal. Lots of people with long COVID are diagnosed with heart ailments. In some cases, the problem was preexisting and might have gone undetected if not for the barrage of tests long-haulers frequently endure in the medical quest to find a neat-and-tidy explanation for their symptoms. In other cases, COVID-19 and its aftermath create a problem that wasn’t there before. I’ll never know whether my coronary arteries clogged before or after 2020. What I do know is that they’re pretty clogged.

The first indication that something was wrong with my ticker came from heart rate data collected during my runs. One day my pulse would be maxed out at 181 beats per minute at a jog, the next day I couldn’t get it above 110 beats per minute no matter how fast I ran. Puzzled, I began to monitor my heart throughout the day and noticed more strange behaviors. I’d go from sitting to standing and see my pulse jump thirty beats, or pause my morning walk with Nataki to admire a neighbor’s garden and observe my heart rate creeping upward when it ought to have done the opposite. These red flags had nothing to do with atherosclerosis, I now know, and everything to do with long COVID-related dysautonomia, but it’s not uncommon for symptoms of one condition to lead to the discovery of an entirely separate condition, and that’s what happened in my case.

Eventually. But like a badly played game of twenty questions, it took a while. I went in for bloodwork, which came back normal. I then did a lung function test: also normal. Chest x-ray, EKG, echocardiogram: normal, normal, normal.

Next up was a cardiac stress test, where the patient walks or runs on a canted treadmill wearing electrodes. Now three months into my chronic illness, I hadn’t yet pulled the plug on my training, and being whom I am, I approached the test as if it were the Boston Marathon. Whereas a normal person would have worried about what the test might find, all I cared about was posting a good score.

I showed up clad in color-coordinated Adidas apparel, buzzing from a high-carb breakfast. Final instructions were given by a masked technician who might as well have been a megaphone-holding race announcer. Making special note of the part about “progressing to failure,” I hopped aboard a surprisingly cheap-looking treadmill with an eagerness that, judging by the tech’s own body language, was not appropriate to the occasion. It was all I could do to ask for the number to beat. Had I done so, and had the tech obliged, the number she gave me would have been a metabolic equivalent, or MET, which is the unit of measure doctors use to measure fitness in heart patients. One MET equals your metabolic rate at rest. At a slow walk, your body’s probably burning calories at twice the resting rate: 2 METs. The average heart patient taps out at 6 METs. I was still going strong at 17 METs when, without warning, the masked technician stopped the machine and told me I was done.

“What! Why?” I protested. “You said I could go to failure!”

Ignoring my outburst, the tech asked me if I’d been experiencing chest pains. The answer was yes, but that didn’t matter.

“I wasn’t even tired!” I raved. “You didn’t let me finish!”

“Mr. Fitzgerald,” the tech pressed, “your test results are  . . . abnormal. You need to stop exercising. Immediately. That means no more running. I don’t want you even mowing the lawn.”

“But—”

“You will start taking children’s aspirin. One a day. We’ll schedule you for a cardiac angiograph as soon as possible. In the meantime, if you experience any chest pains, call nine-one-one right away.”

The angiograph happened a week later. Have you had one? They’re fun. I lay face-up on a padded table with a catheter in my arm, staring up at a large cylindrical contraption called a fluoroscope. A special glow-in-the-dark die flooded my bloodstream, allowing the scope to capture X-ray images of my arteries. For the better part of an hour, I held my breath whenever the piped-in voice of the cardiologist told me to, my athlete’s intuition somehow knowing already the news was bad.

Yet I almost laughed when the cardiologist joined me in the waiting area, looking Baffled. Baffled! Of the many emotions you don’t want to see on the face of your cardiologist, bafflement has to be near the top of the list. Never before had this poor fellow seen an angiograph failed so spectacularly by a patient who boasted a resting heart rate of 41 BPM, cranked out 18 METs in a stress test, and had perfect blood lipids. My calcium score came back at 363, which means (according to a helpful resource I found online), “You have heart disease and plaque may be blocking an artery. Your chance of having a heart attack is moderate to high.”

Like I said, I’ll never know how healthy my heart was or wasn’t before I got sick, but it’s certain it wasn’t helped by COVID-19 and its aftermath, which are known to inflame the endothelial cells that line the inside of arteries. At the same time, they turn the blood into sludge through the formation of microclots. The combination of these two changes greatly accelerates the growth of arterial plaques, a process that could be further hastened by, say, doing large amounts of high-intensity exercise while in this vulnerable state, as I did during the six months between my recovery from COVID-19 and the onset of long COVID.

Neither of these preexisting conditions was documented in my medical records, however, and the cardiologist was found himself at a complete loss as to what to do with me. He couldn’t tell me to start exercising or to clean up my diet because I’d exercised my entire life and authored several books on healthy eating. In the end he prescribed statin therapy, which was absurd, for as he already knew, my cholesterol levels were ideal. I took one pill, maybe two, and tossed the bottle.

What I really needed, I decided, was a second opinion from someone who knew more than zero about running, and I knew just the person: Amy Fiedler, a cardiac surgeon at UCSF who, when she isn’t stenting the arteries of sedentary fast-food addicts, competes in triathlons and ultramarathons. Through the miracle of social media, I was able to get her on the phone and ask how I might better assess the riskiness of continuing to run. Without hesitation, she told me to get myself a coronary catheterization, a mildly invasive procedure that could determine the severity of any blockages I might have. “Depending on the outcome,” she said, “you’ll come away with either peace of mind or a basis for pursuing further treatments.”

“Let’s say there are no blockages,” I said. “If I’m understanding you, this tells me it’s safe run now. But if running contributed to my plaques, won’t more running just keep making them worse until I do have a blockage?”

“That’s a good question,” Dr. Fiedler said, “and I don’t know the answer to it. And I don’t think anyone does.”

I should note that, by the time this call took place, worsening malaise had prompted me to pull the plug on running, so I made no immediate effort to act on Dr. Fiedler’s advice. But if there was ever a time to determine exactly how dangerous it is for me to do things like train for ultramarathons, it’s now that I’m training for an ultramarathon. Yet I keep putting it off—not because I fear hearing more bad news but because, frankly, it wouldn’t make any difference one way or the other.

I never ran for my health. I ran because it made me feel alive. I never felt more alive than I did in the last mile of the 2020 Atlanta Marathon. Photos show my face contorted into a mask of pain, but on the other side of that mask I am experiencing the most sublime joy, a feeling of absolute completeness and perfection, and wishing it would never end. It’s a well-known fact that running a marathon temporarily suppresses the immune system, enabling opportunistic viruses to gain a foothold. I can’t prove it, but I like to think I got COVID-19 and then long COVID because I ran that marathon, but if I had the chance I’d do it again.

Some years ago I debated a physician who defined “health” as “resilience against threats.” What a sad little view of health! So reactive. So fearful. Adding days to my life is not a goal I can get excited about. Adding life to my days? Now you’re talking! For me, the only life worth living is a life of maximal intensity and fervency, even if it kills me. That feeling I had in the last mile of the 2020 Atlanta Marathon, a race I’ll never fully recover from: that’s what I call health. And if it’s not health, I prefer it to health.

Here’s where I stand today: If I go through with the Javelina Jundred, I might die of a heart attack. But if I play it safe, I’m already dead.