Fitness Isn't Heart Health

How pro triathlete Timothy O’Donnell returned to racing after a heart attack.


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The Heart Attack 

“Before I had my heart attack, I was coming off the greatest race in my life.”

Timothy O’Donnell is an elite triathlete. He placed second in the 2019 Ironman World Championships in Kona, Hawaii, completing a 2.4 mile swim, 112 mile bike leg, and a full marathon in under eight hours. 

By all external measures of health, Tim appeared to be at peak physical condition going into the 2021 Challenge Miami triathlon. He was 40 and coming off a phenomenal race season – and accomplished that with two young children at home. 

When he began to experience chest pains during the race and shooting pain in his left arm, he couldn’t believe that he could be having a heart attack. He thought perhaps he was just getting sick, as he struggled to breathe on the 11-mile run.  He pushed through the discomfort to take 11th place. 

It wasn’t until after the race, when he spoke to his doctor and went to an emergency room, that he learned that he had experienced a heart attack commonly known as the “widowmaker.”

“When you think about that brief second, you question your mortality and life – you realize quickly you don't want to lose it,” Tim said while reflecting on his heart attack survival.

The Truth About Heart Attack Risk

How is it that a professional athlete like Timothy O’Donnell can experience a heart attack at the age of 40? 

What many of us know about our heart health can be measured in numbers. Doctors typically check markers like blood pressure and cholesterol to identify our heart attack risk. If we don’t have shortness of breath or chest pain, if we are young and prioritize healthy habits, we may think our hearts are well.

Unfortunately, this approach to heart attack prevention allows cardiac disease to remain the number one cause of death in the United States. Over 50% of individuals who have a heart attack will not experience any symptoms before the event, and 70% of heart attack victims are considered “low risk” for coronary artery disease by traditional measures. The current standards for heart attack risk assessment are simply not good enough to consistently and accurately prevent cardiac events.

A widowmaker heart attack is caused by a blockage in the left anterior descending artery, which carries over 50% of blood to the heart. It has a survival rate of 12%. While Tim had none of the most common risk factors for heart attack – he was not overweight or sedentary, and he had relatively normal cholesterol and blood pressure – his family history revealed that he had a genetic susceptibility to this kind of blockage, as his father also had a heart attack at a young age.

Dr. David Tusek, Tim’s primary care doctor noted, “Most of us are not elite triathletes like Tim.  And if someone with his world class level of training and fitness and overall healthy lifestyle can suffer a life-threatening widowmaker heart attack at 40, what about the rest of us? How would we even know that something is wrong?”

The truth about heart disease is that risk is not just determined by lifestyle. Most of us can improve our heart health with healthy habits like physical activity and a nutritious diet, but true prevention requires tools that can see the root of heart disease: the buildup of plaque in the arteries that can lead to blockages and cardiac arrest.

The Recovery 

After his heart attack, Tim slowed down the pace of his life. He spent more time with his family and evaluated his priorities closely: “I started to really have to think, What is the rest of your life going to look like? I love training, I love triathlon, and I wanted to keep doing it. And on top of that, it's how, you know, we put food on the table for our kids.”

Eventually Tim and his wife Miranda Carfrae, or Rinny, came to the decision that if Tim could find a way to truly understand his heart health and risk of another heart attack, then he could perhaps return to the sport he loved.

“There was definitely a part of me that worried about him going back, racing, but I'm not going to stop him from living. What, I'm going to put him in a cage and make him sit on the couch all day?” Rinny said. “For both of us, the most important thing is for him to be alive and to be able to see our children grow up and for us to grow all together.”

Tim began to work closely with Dr. Tusek, who recommended Cleerly as part of his return-to-sport evaluation. Cleerly is a software that analyzes a 3D scan of the heart, called a coronary computed tomography angiogram (CCTA), for heart plaque and blockages. Cleerly can reveal what the human eye can’t see, and precisely quantify areas of disease within the coronary arteries.

“For me, the hardest part of the comeback wasn't the training,” Tim said. “It was the mental side of it and, and honestly, the emotional side of it, too. I had many, many training sessions where the thought, ‘is this going to kill you?’ came into my head …  I needed to get that doubt out of my head. And that's when I found Cleerly.”

Redefining Risk

Tim had his first Cleerly analysis in summer of 2022. The process involved getting a coronary computed tomography angiography (CCTA) scan at an imaging center and then sending those scan results through Cleerly’s software to be analyzed and thoroughly reviewed by artificial intelligence and trained scan readers. As part of the scan, he and his doctor received a report that detailed his results.

“My scan results showed everything stabilized nicely behind the stent in my LAD [left anterior descending artery] and then almost no plaque in other parts of my heart,” Tim said. 

Based on his Cleerly analysis, Tim’s doctor concluded that his risk of another heart attack was low. The stent placed in his heart after his first cardiac arrest was allowing blood to freely move through his arteries. These results gave Tim the peace of mind he needed to push himself in his training and set his racing goals.

Less than two years after his heart attack, Tim returned to professional triathlon racing. In April of 2023, he won Ironman 70.3 Peru – his first win since his comeback. This win helped cement his confidence in his choice to race again and illustrated that recovery after a heart attack is possible: “I've had a great career, and if I had to walk away … I think I would have been okay, “ Tim stated. “But that being said, if I could stay around a little bit longer, let's do it.”

A New Mission to Educate and Prevent Heart Attacks

“Through my journey I’ve been able to educate others, be a catalyst for early interventions and be a constant reminder that none of us are invincible, “ Tim wrote in a social media post in June 2023. Tim continues to make his health and wellness a priority. He plans to have Cleerly scans annually to closely monitor if new plaque or blockages have appeared in his heart.

“All the other tests I did were helpful, but they weren't definitive. And it was the Cleerly scan for me that really showed the whole picture and t put everything right in front of my eyes and that's what I needed,” he said.“And I knew after I did the Cleerly scan, there's nothing else I can do that's going to show anything better than this.”

“All the other tests I did were helpful, but they weren't definitive. And it was the Cleerly scan for me that really showed — It showed the whole picture and it put everything right in front of my eyes and that's what I needed … And I knew after I did the Cleerly scan, there's nothing else I can do that's going to show anything better than this.”

— Timothy O'Donnell