A Strenuous Swim Triggers Exertional Angina

It was a beautiful late August summer day. The ocean was warm and the crystal clear Gulf Stream current was close in to shore. You could see your toes standing in shoulder deep water. It wasn't very windy and the wave action was light. Often times with conditions like these you can see tropical fish from far away waters carried North to Long Island by the currents.

I decided to swim out to the sand bar with my scuba mask and snorkel on. The swim out was slow and easy. There were jellyfish in the water but I could see them and avoid being stung. I got the sand bar and stood there briefly before heading back toward the beach. On the way back a couple of larger waves broke over me and flooded my snorkel. I cleared the snorkel and continued swimming but I began to get a little panicky, fearing that I would be unable to make it back to shore. My heart started racing. I felt the sting of a jellyfish brushing my arm. I began swimming harder, harder than I was used to.

Finally, I made it back to shore, but I was tired, out of breath, and I had chest tightness which extended into my left shoulder. I had angina. Rather than sit down and rest I thought I would feel better "walking it off." So I put Bradley on his leash and took a slow walk down the beach. After about 45 minutes the angina went away. But for the first time I realized that I now had significant physical limitations as a result of my aortic valve condition. The level of exertion that reached during my swim back to the beach had triggered angina. People with moderate to severe AS should not exercise at that level.