Coronary CT Angio for Runners

The last few years post-pandemic has seen a spike in the number of incidents of heart attacks amongst amateur endurance athletes. We have had cases of sudden fatal collapses in the gym, to seasoned endurance athletes succumb to heart failures.

This had got many of us concerned. I did some asking around - my father in law who is a doctor, cardiologists in the family, opinions on podcasts (like the one on the-working-athlete-podcast). The consensus was - an elaborate investigation may not be necessary if there is no family history of coronary problems, but if you were to get one done, then the best one is CT Angio of the heart.

It is one of the tests that have a negative predictive value of close to 100%, which means that a person with a negative result on this test will not have the disease condition. The negative predictive value is somewhat similar to a false negative metric.

And so I began the search for a diagnostic center, my search parameters

1. Cost - provide a lower cost of testing
2. professional attention - ideally should have a cardiologist review the results
3. personalised - runners / endurance athletes can have some parameters different from the general populace and these have to be considered

I booked an appointment at Prima diagnostic in Jayanagar, Dr. Gururaj Rao was also from the family circle and was fully aware of my background and objective of doing this assessment.

Coronary CT Angio - the scan

On the appointed day, I was advised to go early in the day, with have fasted for at least 4 hours. I had booked a 8:30AM appointment. The CT scan involves observation of the heart when injected with a dye / contrast. The contrast can have adverse effect on the kidney. To rule this out, a Creatinine test is done to confirm kidney function via a blood draw.

I had to then change into the hospital overalls. In the preparation room, a drip needle is inserted into a view on the back of the palm. Initially, the nurse inserted this on my right hand.

I was told that the contrast / dye will be administered through this drip needle during the scan. The radiologist then taught me how to hold my breath.

The scan itself is for about 5-7mins - during certain times while the scan is going on, the radiologist speaking over the intercom will instruct the patient to hold his/her breath. During the breath hold, the heart rate should not vary by more than a few counts - this is crucial to get to get a good scan.

But the issue is - the final breath hold happens just after the dye is injected (during the scan) and the dye causes a burning sensation going from the palm to the shoulder, the entire torso and the groin area. To not squirm at this pain and cause the heart rate to go up is a challenge.

In my case, just before the scan, the nurse tried to flush the cannula by injecting saline via the drip needle. This supposedly harmless injection itself was very painful for me. Our option was to try to change to the left hand, I agreed and now had 2 IV cannulas on both palms!!

Thankfully, I was able to keep calm when the dye was injected and was told that the scan was good.
I spent the next 1 hour in the diagnostic center just resting up. After about 2 hours, Dr. Gururaj called me in to explain the results.
I am fortunate to have good genetics - there is no perceptible damage to my heart even after 20 years of moderate endurance exercises. The calcium score was 0 and there was no visible plaques or blockages.

The negative result from this analysis is valid for 5-6 years, which is about the time it takes for the plaques to form, I guess.

The test costs about 10-12k INR, almost the cost of a good running shoe these days, but some TLC for your heart once in a few years may be worth it.

The 2024 12h Stadium WALK

 "You don't have to be great to start, but you have to start to be great." - Joe Sabah

I never wanted to get to a starting line this year, just keep the focus on the recovery. The structural imbalance due to the revision ACL surgery is still very visible, a perceptible limp in the left leg when I am running slow paces.

But I had a great training block last month and was able to rake up miles, running over 100km per week for 4 weeks in June, in an attempt to top the leader board in some meaningless corporate event. If I could keep such high intensity, surely I could run an easy 12hour run. I signed up, yes, you don't have to be great to start!

I ran up from home to Nandi hills with about 3 weeks to the stadium run. It was the most beautiful run. I had run the first 40k during the first 4:10 during that self-supported solo. The weather in Bangalore was also encouraging - windy and cloudy.

I loved the build up to race day. It was good to feel the excitement as I focussed on not falling sick and getting good sleep. I decided against running a 40k training run in favour of keeping away from the incessant drizzles.

I was confident to keeping a 10km (or 25laps) per hour for the first few hours. My plan A was to get to 55k in 6hours.

2:xx min lap phase

I started well, keeping a consistent 2:10 to 2:20 per lap for the first 75 laps - 30kms in 3hours, I was on target and was feeling good, in general. I was in my favourite 2XU full pants (about 10yrs old) and Saucony Triumph shoes (about 6000kms old), the clouds were providing a good cover and the weather was perfect. Unlike my regular training runs which I run on empty, I began drinking electrolyte from the 50ml cups. I should have seen the deficit when I went for two pee breaks, but failed to notice anything amiss until...

3:xx min lap phase

...CRAMP!!! A cramp started developing in the inside lobe of the quad on the right leg. All the focus on trying to keep the left leg strong and steady (remember the surgery?), and the cramp creeped up in the right leg. And this, within 30kms of the run - it was shame. But, I have run enough ultras to know that these "phases" come and go! I was willing to wait it out.

But then came the huge self-deprecating inner voice, "get prepared to be mediocre in everything... yada, yada". It took me a few laps to get out the thoughts of quitting the race.

Welcome - run walk pattern. Jog about half a lap, walk the rest, till the muscle feels ok, then repeat!

First change I made was to change my portion size, moved from 50ml glass to chugg-from-the-jug. Second, I recruited Santosh, the coach of the Indian Ultra running team as my support crew and he helped me with changing to less fancy shorts and an even older Asics shoes after about 40k in 4h:24m. Third, I also visited the physio tent and got them to stretch my cramp out. Nice try! I hit 125laps in about 5h:50m, about 3k behind my target, but slowing down by the lap.

And so began the long run-walk and even longer conversations with my cramp, till I hit about 140laps /56km in 7hours.

4:xx min lap phase

Around this time, it also got pretty hot and out came a sun that we hadn't seen in weeks! Caps, water sprays, ice, cold water sponges appeared on the track. I decided to wait it out until it got more cooler or my cramp eased off, neither happened for the next 3 hours.

So I resigned to walking for almost all of the next 5 hours. I knew I wanted at least a 75k, at about 12laps an hour, I would get close to that target, provided nothing else developed. I started counting off each hour with about 14 laps - yes, very pedestrian, but consistent.

With about 2 hours to go, a slight cramp starting developing also in my left ankle. I had to remind myself not to get ahead of myself. Target shifted to 200laps, and it looked possible.

I hit that in 11h:15m or so and now wanted a double marathon. Bring on another 10 laps. Its only when I passed that 210laps, did I muster some courage to start running again.

1:xx lap min phase - the finish

It's Paris Olympics time and in the 100m final yesterday, Noah Lyles was in the last place at the 40m mark, but finished as the Olympic Champion. In whatever goal you are trying to achieve, what's best for you to win at the end might require a slow start.

It is not how to start, but how you finish that matters! I picked up pace on the 211th lap, then as the confidence grew I went faster and faster. 211 lap in 3:05, 212 in 2:32, 213 in 2:15, 214 in 1:59, 215 in 1:50

To sum it up, I ended up with 214laps / 85.6km on the board in 12hrs, 16th overall in a field of about 100 runners, with shades of happiness & disappointment, but reminding myself again - it is the journey and not so much the destination that life is mostly about!

Tanzania's John Stephen Akhwari who was injured but still limped to the finish line of the Olympic marathon in 1968. He was asked why he had carried on, and his reply went down in history. "My country did not send me 5,000 miles to start the race," he said. "They sent me to finish the race."

Thanks for reading!