A Marathon Runner Who is Not Immune to the Need for a Coronary Bypass.
This story is about Phaisan, a 77-year-old man who exercises regularly. Despite being able to run 10–20 kilometers effortlessly, an electrocardiogram and coronary angiography unexpectedly revealed a dangerous cardiac arrhythmia and coronary artery disease.
Heart Diseases Lurk Despite Regular Exercise.
Heart Disease may be due to abnormalities in the structure or function of the heart, including issues with the coronary arteries, heart muscle, pericardium (the enveloping membrane of the heart), and heart rhythm abnormalities, all of which affect the blood pumping capacity to perfuse the entire body. The heart relies on an automatic pulse generator in the right atrium and electrical conduction system to coordinate its rhythmic contractions. When disrupted, it can lead to arrhythmias and potentially serious complications.
“I’ve been regularly exercising since I was a young man,” says Mr. Phaisarn, now 77, who recounts his lifelong athletic journey, from playing badminton until age 38 to becoming an inveterate runner. Even in his senior years, he continues to run regularly. With his indomitable athletic spirit, he competed in 10-kilometer races in the over-70 category. He is a senior who takes immaculate care of his physical health. Despite this, a checkup uncovers underlying risks. Despite his lifelong dedication to fitness and a complete absence of any noticeable symptoms, his health screening results revealed severe heart abnormalities.
Cardiac Arrhythmia: A Condition That Can Affect the Brain
Dr. Sanisara Chandrachamnong, a cardiac electrophysiologist at MedPark Hospital, recounts her first encounter with Mr. Phaisarn and discovers his two types of arrhythmias involving atria and ventricles.
He had atrial fibrillation with a very low ventricular rate because the electrical impulses from the atria failed to reach the lower chambers of the heart, causing ventricular rates to plummet to as low as 25 beats per minute, compared to the normal resting rate of 60–100 beats per minute. The atrioventricular rhythm dissociation placed him at significant risk of sudden cardiac arrest.
Cardiac arrhythmias are of three types based on heart rate, as follows:
- Tachycardia: A heart rate greater than 100 beats per minute, which may cause symptoms such as shortness of breath.
- Bradycardia: A heart rate below 60 beats per minute, which can lead to inadequate cerebral perfusion, resulting in lightheadedness or syncope.
- Atrial fibrillation: An irregular pulse that is associated with a significantly increased risk of ischemic stroke, as blood clots may form in the atrial appendages and subsequently embolize to the cerebral circulation.
Mr. Phaisarn’s condition was relatively complex, as he presented with both ventricular bradycardia and atrial fibrillation. Moreover, the possibility of underlying coronary artery disease needed careful evaluation.
Dr. Sanisara Chandrachamnong consulted with Assoc. Prof. Dr. Suwatchai Pornratanarangsi, an interventional cardiologist. He agreed that Mr. Phaisarn needs a coronary angiography.
However, coronary angiography can, in some cases, induce a slowing of the heart rate or even transient cardiac arrest, posing a heightened risk for Mr. Phaisarn, given his bradycardia. The medical team, therefore, elected to first implant a permanent pacemaker to ensure a stable heart rhythm during the procedure. The doctor also initiated anticoagulant therapy to lower the risk of stroke-inducing blood clots. After a one-month recovery, he returned for coronary angiography.
The coronary angiogram revealed multivessel disease with significant calcifications. In light of these findings, the team recommended Coronary Artery Bypass Grafting (CABG) rather than percutaneous coronary intervention (PCI).
Coronary Artery Bypass Grafting (CABG)
Dr. Supitchar Vongmanee, an attending cardiothoracic surgeon, explains:
“Coronary artery bypass surgery involves creating a new pathway for blood flow—similar to constructing a road that bypasses a blockage, which allows blood to reach the distal part of the coronary artery without having to flow through the narrowed segment. The bypass allows the heart muscle to obtain an adequate blood supply for recovery and repairing areas previously deprived of oxygen.” With appropriate postoperative care and healthy lifestyle habits, patients undergoing CABG can achieve long-term survival, often exceeding 20 years. Thanks to the expertise and experience of the surgical team, the procedure lasted just under three hours.
CABG is an open-heart surgery, which might understandably evoke anxiety for many patients. However, Mr. Phaisarn shared his experience of undergoing the surgery: “I heard that bypass surgery involves 'tinkering with all sorts of things in the heart, and some people said it sounded quite scary. When I actually went through it, there was nothing to be fearful about. The doctors took excellent care of me. I didn’t feel any distress at all, and afterward, I was able to return to my normal life, including exercising as usual.”
A Message from a Veteran Runner
Mr. Phaisarn would like to share a message with fellow runners. Many enjoy racing and believe they are healthy due to their physical activity. However, underlying conditions can go unnoticed and, if left untreated, may become life-threatening. He encourages everyone to undergo regular medical checkups to identify silent risks before they become a problem.