This article was originally published in the Nov./Dec. 2013 issue of Inside Triathlon magazine.
In June 2009, I called it quits. I announced my retirement with a news release headlined, “Danish Xpress Stopped by Heart Malfunction.” The irony was that what had made me successful as an athlete, my strong heart, was the very thing that ended my 18-year career as a professional triathlete, which included a podium finish at the 2007 Ironman World Championship and two ITU Long Distance World Championship titles in 2004 and 2006. Prior to the announcement, my family and I had lived through two of the most difficult months in our lives dealing with far more important issues than whether or not I could swim, bike or run.
During the Wildflower Long Course Triathlon in early May of 2009, I felt an uncharacteristic gradual fatigue during the bike. In the final miles I could barely hold a heart rate of 110 beats per minute despite pushing the pedals as hard as I could. My arms and lips were tingling, my vision was blurred and I had to really focus just to get down that last steep hill into T2. As I got off the bike, my breath was out of control, and I sat down near the fence that surrounded the transition area. I was hyperventilating, my tongue was in spasms and I was scared. Really scared. It went on for several minutes while volunteers and paramedics rushed to help. I slowly got my breath under control and was put on a stretcher in the medical tent. After being checked by the doctors and resting for a good half hour, I could finally stand up. I talked to my wife, Mette, and my coaches back in Denmark and drove to my race accommodation. Something inside me changed. I did not know what, how or why, but something was not right.
Four years prior, in 2005, I experienced chest pain during a hard swim workout. I jumped out of the pool scared and managed to get an appointment with a cardiologist the following day. During the examination he found nothing that could cause the pain, but he did find a congenital anomaly called a bicuspid aortic valve. We later found out that the chest pain stemmed from a thoracic vertebra that was slightly out of place, which was easily adjusted by a chiropractor.
A bicuspid aortic valve is the most common heart condition, found in 1 to 2 percent of all people. It means that you have two leaflets instead of three in the valve that opens the blood flow from the heart out into the body. In addition, I had a minor leak at the valve and a slightly enlarged aorta, which is common for people with this condition. The leak meant that 5 to 10 percent of the blood pumped with each heartbeat would return back into the heart. So my heart basically had to work 5 to 10 percent harder than a normal heart. It was used to this, though, and overall very strong. A bicuspid aortic valve can also be associated with enlargement of the aorta, the blood vessel that carries blood away from the heart, but the size of my aorta was normal in 2005.
Despite the discovery of the condition, my doctors felt it was OK for me to train and race as a professional as long as my heart, the leak or the aortic diameter did not start to grow. I had checkups every year and before my last Wildflower, in February 2009, my heart showed no signs of what was about to happen. Before that race I felt amazing. I had just clocked some of my best splits ever in training. But the race did not go as planned, and after an extensive medical evaluation, I was forced to retire.
My story is not unusual, at least among top endurance athletes. Other professional triathletes have gone through similar or worse scenarios. The most prominent were Greg Welch and Emma Carney, both of whom ended their careers in the early 2000s due to a dangerous arrhythmia called ventricular tachycardia. Welch went through an incredible nine heart surgeries to stabilize his condition, but lives and blesses the sport with his ever-positive spirit to this day. Chris Legh discovered a hole in his heart in 2003, but still competes at age 41 and this year came a mind-blowing fifth at the stacked Ironman Melbourne. And finally you may recall that two years ago two-time Ironman world champion Normann Stadler was rushed through valve repair and aortic replacement surgery because of an aortic diameter of 70 millimeters (nearly twice the norm) and a big leak at his valve. He has a similar condition to what I have, but did not discover it in time. In addition, hundreds if not thousands of age groupers have lived through similar conditions.
Obviously, many of them have asked themselves whether their heart problems are caused by the extreme demands we put on this vital organ as endurance athletes. Is it dangerous for us to train hard for 10, 20 or 30 hours a week, year in and year out? Is it dangerous to put our hearts through the demands of a grueling eight- or 17-hour Ironman? Is there a risk of dying suddenly when you push your limits?
To answer those questions requires a bit of knowledge about various heart conditions and their causes, as well as the anatomy of the heart.