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The Haywire Heart: How Too Much Exercise Can Kill You, and What You Can Do to Protect Your Heart
Too much exercise can kill you. The Haywire Heart is the first book to examine heart conditions in athletes. Intended for anyone who competes in endurance sports like cycling, triathlon, running races of all distances, and cross-country skiing, The Haywire Heart presents the evidence that going too hard or too long can damage your heart forever. You’ll find what to watch out for, what to do about it, and how to protect your heart so you can enjoy the sports you love for years to come.
The Haywire Heart shares the developing research into a group of conditions known as “athlete’s heart”, starting with a wide-ranging look at the warning signs, symptoms, and how to recognize your potential risk. Leading cardiac electrophysiologist and masters athlete Dr. John Mandrola explores the prevention and treatment of heart conditions in athletes like arrhythmia, atrial fibrillation and flutter, tachycardia, hypertrophy, and coronary artery disease. He reviews new research about exercise intensity and duration, recovery, inflammation and calcification, and the ways athletes inflict lasting harm.
These heart problems are appearing with alarming frequency among masters athletes who are pushing their bodies harder than ever in the hope that exercise will keep them healthy and strong into their senior years. The book is complete with gripping case studies of elite and age-group athletes from journalist Chris Case—like the scary condition that nearly killed cyclist and coauthor Lennard Zinn—and includes a frank discussion of exercise addiction and the mental habits that prevent athletes from seeking medical help when they need it.
Dr. Mandrola explains why many doctors misdiagnose heart conditions in athletes and offers an invaluable guide on how to talk with your doctor about your condition and its proven treatments. He covers known heart irritants, training and rest modifications, effective medicines, and safe supplements that can reduce the likelihood of heart damage from exercise.
Heart conditions affect hardcore athletes as well as those who take up sports seeking better health and weight loss. The Haywire Heart is a groundbreaking and critically important guide to heart care for athletes. By protecting your heart now and watching for the warning signs, you can avoid crippling heart conditions and continue to exercise and compete for years to come.
323 pages, Kindle Edition
Published April 4, 2018
221 people are currently reading
422 people want to read
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Displaying 1 - 30 of 48 reviews
April 29, 2017
The Haywire Heart describes the cardiac problems that aging endurance athletes can develop as a result of pushing to hard to excel. As an older amateur bicycle racer, I found this book to be a timely warning about my own tendency to push too hard during training. It also made me think about the cyclists who used to compete with me in my age group but who have almost all dropped out of the sport as we have aged. Some have heart conditions that no longer allow them to complete. One passed away from a sudden heart attack.
I think all middle-aged and older endurance athletes should read this book. It is well-written and explains the stresses on the heart in layman's terms. It is important that we athletes continue to train and compete as long as we are able, but armed with some knowledge, perhaps we can do so in a manner that will allow our bodies and especially our hearts to complete well into old age.
I think all middle-aged and older endurance athletes should read this book. It is well-written and explains the stresses on the heart in layman's terms. It is important that we athletes continue to train and compete as long as we are able, but armed with some knowledge, perhaps we can do so in a manner that will allow our bodies and especially our hearts to complete well into old age.
February 23, 2025
A friend recommended this book. To be more specific, a running friend who had a heart attack during one of our training runs recommended this book. And to be more descriptive; we are both over 60.
Great book. Much of the book was technical, but told in a way that was very compelling, even to the layman. The author included an athlete’s case study in every chapter to drive home the point being discussed, which was a very effective method of describing complex medical conditions.
The author made clear that there is much to be learned in the area of endurance sports-related heart issues because of the difficulty in conducting controlled studies. Although insufficient empirical evidence exists to definitively make the case that endurance sports is injurious to the heart, the correlation between endurance athletes (especially mature, elite endurance athletes) and heart issues is too strong to ignore.
Key take aways :
- the heart is an extremely complex organ
-endurance athletics is not an insurance policy for heart health (especially if you are male)
- pushing too hard places undue strain on your heart and can cause long term damage
- dehydration can cause long term damage
- an athlete’s lower resting heart rate can cause a neurological/chemically-induced arrhythmia
There was much more to this book than that, but I finished the book about 1-1/2 months ago, and those are my enduring takeaways.
Great book. Much of the book was technical, but told in a way that was very compelling, even to the layman. The author included an athlete’s case study in every chapter to drive home the point being discussed, which was a very effective method of describing complex medical conditions.
The author made clear that there is much to be learned in the area of endurance sports-related heart issues because of the difficulty in conducting controlled studies. Although insufficient empirical evidence exists to definitively make the case that endurance sports is injurious to the heart, the correlation between endurance athletes (especially mature, elite endurance athletes) and heart issues is too strong to ignore.
Key take aways :
- the heart is an extremely complex organ
-endurance athletics is not an insurance policy for heart health (especially if you are male)
- pushing too hard places undue strain on your heart and can cause long term damage
- dehydration can cause long term damage
- an athlete’s lower resting heart rate can cause a neurological/chemically-induced arrhythmia
There was much more to this book than that, but I finished the book about 1-1/2 months ago, and those are my enduring takeaways.
This entire review has been hidden because of spoilers.
January 13, 2017
This is a book about heart problems that occur in endurance athletes. It has to thread a difficult needle between discouraging folks from exercising and defining how much exercise is too much. Go to any mall in America and look around. Too much exercise doesn't seem to be a big problem, and indeed this book is not about the average American, but is intended for the life-long, hard-driving, endurance athlete. The authors do a good job in defining this focus and certainly wouldn't want the casual cover reader to conclude that moderate exercise is bad. But like anything, too much of a good thing can be bad, and the book is full of real-life stories of athletes who drove themselves so hard that their hearts suffered serious consequences.
The other audience of this book is physicians, particularly cardiologists and electrophysiologists who deal from time to time with endurance athletes. Their normals are not the same normals as the average patient, and they benefit from seeing doctors experiences in their problems.
I was surprised how much data there is associating multiple cardiac problems with endurance athleticism. It does give one pause (not that I'm at risk), and I would think this data and the patient stories in this book might indeed cause an "exercise addict" to moderate his or her ways.
My colleague and friend Dr. John Mandrola's chapters on the medical evidence of the effects of extreme exercise, as well as modern diagnostic and treatment modalities are very clear and would be of benefit to any patient with rhythm problems. Reading his advice for patients on how to prepare for a doctor's visit strikes so close to home: I wish all patient's would heed his advice!
My only minor quibble is with the final chapter, The Takeaway. This seems to be a bit of a hodgepodge, containing advice on supplements (I think the bane of the fitness industry), bystander CPR and ICDs, rather than a real summary of the book. The Epilogue of the book better serves that function. Advice to take garlic, or stating the Japanese have a high iodine intake and also a low incidence of heart disease seems less scientific than the rest of the book and maybe out of place.
But, overall this is an excellent book on a little-known subject, directed at athletes but containing lots of good information for doctors who take care of them.
The other audience of this book is physicians, particularly cardiologists and electrophysiologists who deal from time to time with endurance athletes. Their normals are not the same normals as the average patient, and they benefit from seeing doctors experiences in their problems.
I was surprised how much data there is associating multiple cardiac problems with endurance athleticism. It does give one pause (not that I'm at risk), and I would think this data and the patient stories in this book might indeed cause an "exercise addict" to moderate his or her ways.
My colleague and friend Dr. John Mandrola's chapters on the medical evidence of the effects of extreme exercise, as well as modern diagnostic and treatment modalities are very clear and would be of benefit to any patient with rhythm problems. Reading his advice for patients on how to prepare for a doctor's visit strikes so close to home: I wish all patient's would heed his advice!
My only minor quibble is with the final chapter, The Takeaway. This seems to be a bit of a hodgepodge, containing advice on supplements (I think the bane of the fitness industry), bystander CPR and ICDs, rather than a real summary of the book. The Epilogue of the book better serves that function. Advice to take garlic, or stating the Japanese have a high iodine intake and also a low incidence of heart disease seems less scientific than the rest of the book and maybe out of place.
But, overall this is an excellent book on a little-known subject, directed at athletes but containing lots of good information for doctors who take care of them.
November 11, 2016
Very interesting. Certainly not something most people will have to worry about but for ultra exercisers or those who study exercise science it's worth looking at this understudied phenomenon.
April 6, 2017
Clear, concise and well laid-out. This book gives someone like me a lot to consider about when it comes to my cycling routine and how it may actually be adversely impacting my heart.
July 13, 2023
I purchased this book after developing exercise-induced atrial fibrillation (a-fib). As a long-distance runner, I wish I had read it years ago! The book provides a well-researched and comprehensive coverage of the condition and related literature. Although it is aimed at a non-academic and non-clinical audience, it does assume some basic familiarity with clinical approaches and physiology. The authors present a combination of case studies, clinical work, animal research, and other scientific evidence to explain the prevalence of this condition, possible physiological mechanisms, prevention strategies, and coping strategies for living with it.
The case studies in the book are particularly well-chosen, each highlighting different aspects of exercise-induced heart problems (not just a-fib). The book remains inconclusive in its findings, reflecting the current state of inconclusiveness in the literature regarding why some endurance athletes develop exercise-induced a-fib while others do not.
I highly recommend this book to anyone interested in understanding the relationship between endurance activity and cardiac health. However, I believe it should be specifically read by middle-aged men (around 45-55) who tend to push themselves too hard in activities like running, cycling, or other endurance sports. There is a genuine risk of causing permanent damage, and this book effectively explains how and why this happens, as well as providing guidance on what to do about it. As I mentioned earlier, I regret not reading this book years ago.
The case studies in the book are particularly well-chosen, each highlighting different aspects of exercise-induced heart problems (not just a-fib). The book remains inconclusive in its findings, reflecting the current state of inconclusiveness in the literature regarding why some endurance athletes develop exercise-induced a-fib while others do not.
I highly recommend this book to anyone interested in understanding the relationship between endurance activity and cardiac health. However, I believe it should be specifically read by middle-aged men (around 45-55) who tend to push themselves too hard in activities like running, cycling, or other endurance sports. There is a genuine risk of causing permanent damage, and this book effectively explains how and why this happens, as well as providing guidance on what to do about it. As I mentioned earlier, I regret not reading this book years ago.
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September 26, 2019Compelling and informative
This comprehensive look at the effects of endurance athletics on the athletes heart, takes an insightful look into the mechanics and mentality that can cause catastrophic damage to our central engine. Presenting elite atletes as examples, shows that pushing the edge of the envelope can have severe life altering repercussions. But even the everyday newcomer or endurance amateur can make their hearts go haywire.
Generally easy to read, I highly recommend this book to any endurance athelete!
This comprehensive look at the effects of endurance athletics on the athletes heart, takes an insightful look into the mechanics and mentality that can cause catastrophic damage to our central engine. Presenting elite atletes as examples, shows that pushing the edge of the envelope can have severe life altering repercussions. But even the everyday newcomer or endurance amateur can make their hearts go haywire.
Generally easy to read, I highly recommend this book to any endurance athelete!
December 18, 2017
The first part of the book is a little daunting leaving me feeling like I’d picked up something way over my intellectual head. I persisted though and found the rest of the book approachable and interesting. I was left with a feeling of needing to evaluate my own training load and motivation to push myself hard at all times. This is a very good book for endurance athletes and probably a vital book for health professionals that work with them.
March 29, 2019
IF YOU'RE AN ENDURANCE ATHLETE READ THIS BOOK,
I've trained with a power meter since 2011 and have read practically all the books about training including all of Joe Friel's books especially the ones for athletes over 50 yet I don't recall anything about AF. This book opened my eyes to the potential adverse effects of overreaching. Kudos to the authors for demystifying a complex subject.
I've trained with a power meter since 2011 and have read practically all the books about training including all of Joe Friel's books especially the ones for athletes over 50 yet I don't recall anything about AF. This book opened my eyes to the potential adverse effects of overreaching. Kudos to the authors for demystifying a complex subject.
June 15, 2017
Sobering
As a "mature" runner who has always gotten good cardiac grades from his doctor, this book was very sobering. It was also very scientific; indeed, a good part of it was beyond me. But the conclusions were not.
As a "mature" runner who has always gotten good cardiac grades from his doctor, this book was very sobering. It was also very scientific; indeed, a good part of it was beyond me. But the conclusions were not.
November 7, 2017
Wow, scary stuff. But very informative.
Really wanted to learn about aging gracefully as an older athlete who is still obsessive about miles and squeezing workouts in. Thanks for this great information.
Really wanted to learn about aging gracefully as an older athlete who is still obsessive about miles and squeezing workouts in. Thanks for this great information.
June 25, 2021
This book offers a comprehensive review of the effects of endurance exercise on the heart. I was surprised how much data there is associating multiple cardiac problems with endurance athleticism. Great read if you are involved in endurance sports.
February 8, 2017
This is an informative and important book for any older endurance athlete. I recommend it.
April 11, 2025
This is an alarming—and frankly alarmist—book. The author goes to great lengths to warn about the heightened risk of heart arrhythmias from doing too much endurance training. He shares several real-life examples and gives the impression that severe and even life-threatening arrhythmias are quite common among endurance athletes.
The problem is, he doesn’t provide any clear data on what “too much” actually means, nor does he offer statistics on how prevalent these arrhythmias are. He also doesn’t really explain how you can protect yourself, despite the book’s subtitle.
He doesn’t explain what constitutes intensive training either. According to some sources, that starts with a heart rate of 70 beats per minute — something you can easily exceed with just a bit of exercice.
Some research suggests that doing more than 2,000 hours of endurance training over a lifetime might be too much. That’s shockingly low. If someone starts running or cycling at fifteen and keeps it up until eighty-five, they could only exercise a little more than 1half an hour per week on average (that’s 2000/(52x70).
That’s quite a downer, especially after reading books like Younger Next Year by Chris Crowley and Henry Lodge, which enthusiastically promote vigorous exercise well into old age.
Now I’m in doubt and feel stuck between Scylla and Charybdis: if I want to stay fit into very old age so I can keep doing the things I love, I need to train hard—but if I do, I might not even make it that far…
The problem is, he doesn’t provide any clear data on what “too much” actually means, nor does he offer statistics on how prevalent these arrhythmias are. He also doesn’t really explain how you can protect yourself, despite the book’s subtitle.
He doesn’t explain what constitutes intensive training either. According to some sources, that starts with a heart rate of 70 beats per minute — something you can easily exceed with just a bit of exercice.
Some research suggests that doing more than 2,000 hours of endurance training over a lifetime might be too much. That’s shockingly low. If someone starts running or cycling at fifteen and keeps it up until eighty-five, they could only exercise a little more than 1half an hour per week on average (that’s 2000/(52x70).
That’s quite a downer, especially after reading books like Younger Next Year by Chris Crowley and Henry Lodge, which enthusiastically promote vigorous exercise well into old age.
Now I’m in doubt and feel stuck between Scylla and Charybdis: if I want to stay fit into very old age so I can keep doing the things I love, I need to train hard—but if I do, I might not even make it that far…
September 20, 2024
Great read about athletes and their various heart issues. From ablations to x-rays, the authors establish themselves as knowledgeable and human. Covering all the common tools at the doctor's disposal and the differences between someone who exercises normally and someone who is in training. The sub-title is a bit over the top "..how too much exercise can kill you.." since a lot of what is covered is how many forms of heart disease, including A-fib, aren't deadly in and of themselves.
Written from the athlete's perspective, it provides an inside view of the doctor's world, one which doesn't normally contain many endurance athletes. For me, personally, it helped me realize that I wasn't the only athlete out there who needed to come to terms with balancing training, diet, drugs and possible surgeries. Uplifting and concrete ideas on moving forward from diagnosis to a more healthy life.
Written from the athlete's perspective, it provides an inside view of the doctor's world, one which doesn't normally contain many endurance athletes. For me, personally, it helped me realize that I wasn't the only athlete out there who needed to come to terms with balancing training, diet, drugs and possible surgeries. Uplifting and concrete ideas on moving forward from diagnosis to a more healthy life.
June 20, 2023
I do a lot of cycling and developed AF a couple of years ago. I've been looking for advice on heart arythmias since then and have already cut back ony training volume, which was a difficult step to take.
I found a lot of the information in this book very useful, sometimes it's quite technical but I don't mind that. A lot of the advice seems to grounded in fact, supported with citations but I felt some of the advice was a bit spurious so I've given it 4 stars.
I have a very specific arythmia and this book deals with some much more serious problems which made it scary to read. This made me feel more anxious about my condition. A better book for AF is the excellent Restart Your Heart: The Playbook for Thriving with AF by Aserm Desai.
Still it's a good read.
I found a lot of the information in this book very useful, sometimes it's quite technical but I don't mind that. A lot of the advice seems to grounded in fact, supported with citations but I felt some of the advice was a bit spurious so I've given it 4 stars.
I have a very specific arythmia and this book deals with some much more serious problems which made it scary to read. This made me feel more anxious about my condition. A better book for AF is the excellent Restart Your Heart: The Playbook for Thriving with AF by Aserm Desai.
Still it's a good read.
December 16, 2025
An interesting work on the effects of long term endurance excercise on the heart. The three authors deliver an in depth explanation full of individual case studies and multi-subject trials that is both very technical and highly readable.
Even if you're not an endurance athelete the explanations of normal heart function and pathologies such as arrhythmias is fascinating. For those of us managing heart issues this book can be particularly helpful, making more clear the information we're presented in doctor's offices and providing practical insights.
Even if you're not an endurance athelete the explanations of normal heart function and pathologies such as arrhythmias is fascinating. For those of us managing heart issues this book can be particularly helpful, making more clear the information we're presented in doctor's offices and providing practical insights.
June 22, 2025
i read it because i'm wrestling with being diagnosed with Paroxysmal Atrial Fibrillation (Paroxysmal AFib) in my early 50's. There are several relevant case studies, gives a good background on the inner workings of the heart and what can cause AFib in people who have gotten exercise throughout their life.
Not a book I would recommend for the general public but if you or someone you know has AFib there are some great tidbits which allow you to learn more about your diagnosis.
Not a book I would recommend for the general public but if you or someone you know has AFib there are some great tidbits which allow you to learn more about your diagnosis.
October 1, 2021
Great book if you have any kind of arrhythmia
Book is aimed at endurance athletes but applies to everyone. Excellent detail in cardiac functions and arrhythmias. Very detailed may have difficulty following but you should get though it. Also good description of treatment options and life style changes
Book is aimed at endurance athletes but applies to everyone. Excellent detail in cardiac functions and arrhythmias. Very detailed may have difficulty following but you should get though it. Also good description of treatment options and life style changes
May 17, 2022
A good read to anyone who’s into performance
Informative, Well documented, easy to understand. The book brought about a reevaluation of my aproach to sport and health in general.
Informative, Well documented, easy to understand. The book brought about a reevaluation of my aproach to sport and health in general.
September 12, 2022
Interesting read - getting ready to dive into cardiology/anatomy.
February 6, 2023
3.5 stars. Interesting read for someone with a history of heart arrhythmias and endurance sports. Skipped over quite a bit, too detailed
April 12, 2023
Great book for those who want to ensure they don't ruin their heart by excess exercise.
May 22, 2023
Good background information but little in terms of actual productive advice moving forward except keep your heart rate down.
July 23, 2023
Really interesting!
August 21, 2024
Pretty interesting to see what others going thru afib feel
April 15, 2025
The case reports/anecdotes were fun.
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June 14, 2020I don't feel equipped to give this book a star rating. I listened to the audiobook based on a recommendation from an atrial fibrillation Facebook support group that I recently joined. My first identified atrial fibrillation occurred in October of 2016, and I'd been doing marathons and trail 50k's. My afib was detected during a routine physical and confirmed by a cardiologist later that same day. However, when I was about to be given a cardioversion four days later, my heart was back to a normal sinus rhythm. I had no afib at my 2017 physical, but had it again in 2018, and since then it's been more prevalent. My cardiologist does not seem to make much of the endurance-athlete angle. Maybe because since I've started having the afib, I have gained a substantial amount of weight, and I don't think he sees an athlete when he looks at me. Just another fat heart patient who should really lose weight.
In any event, the book includes case studies about endurance athletes' experiences with afib, and their experience of afib tends to be considerably different from mine. They notice fluttering sensations and palpitations in their chests. I do not. I never really know I am in afib, though I've been noticing lately increased fatigue and sometimes shortness of breath during even mild exertion. However, it is difficult for me to know whether that is due to the afib or due to the meds I am on.
Still, this book is worth a read (or listen) for endurance athletes facing arrhythmias.
In any event, the book includes case studies about endurance athletes' experiences with afib, and their experience of afib tends to be considerably different from mine. They notice fluttering sensations and palpitations in their chests. I do not. I never really know I am in afib, though I've been noticing lately increased fatigue and sometimes shortness of breath during even mild exertion. However, it is difficult for me to know whether that is due to the afib or due to the meds I am on.
Still, this book is worth a read (or listen) for endurance athletes facing arrhythmias.
July 17, 2017
This book makes the link between excessive endurance exercise and electrical conduction problems within the heart, primarily atrial fibrillation. It is well written and extremely well researched with enough technical detail and references to keep me happy, but not so opaque that the lay person would be unable understand the concepts. There is a chapter on how the heart functions, how extreme amounts of endurance exercise can damage the heart leading to conduction issues and how to treat and prevent it (decrease the amount of training is number one, but who wants to hear that?). The book suffers from a little bit of repetition. Unfortunately, and understandably, it is not able to answer the question, "How much exercise is too much?" as that is down to individual susceptibilities and tolerances. However, it is a must read for Iron people and other athletes who think that if a little is good, a lot can only be better.
March 9, 2017
Excellent, thoughtful, well reasoned discussion of the heart problems that can be encountered by older folks in general but especially in aging endurance athletes. As a 71 year old endurance cyclist of 40+ years experience who has just been diagnosed with AF (Atrial Fibrillation), I felt that this book was written just for me and I gained much by reading it.
This is a book that should be required reading for all aging athletes of any level of experience and especially by those who are trying to become endurance athletes later in life. Certainly, not all will develop heart problems, but there are words of warning here for the ones who do as well as cautionary tales for healthy athletes who wish to stay healthy as the years pass.
This is a book that should be required reading for all aging athletes of any level of experience and especially by those who are trying to become endurance athletes later in life. Certainly, not all will develop heart problems, but there are words of warning here for the ones who do as well as cautionary tales for healthy athletes who wish to stay healthy as the years pass.
Displaying 1 - 30 of 48 reviews