Heart Attack

With a record 40,000 competitors set for Sunday's Blue Cross Broad Street Run, many may be looking for an energy boost. They may want to consider some advice from the International Marathon Medical Directors Association: Don't load up on caffeine. The group's recommendation — to consume no more than 200 mg of caffeine the morning of a race of 10K or more — is not widely known, even among endurance athletes. The guidance is aimed at an uncommon but disturbing phenomenon: young, experienced, seemingly healthy runners dropping dead near the finish line for reasons that are never explained.

VERSAILLES, Ky. - Dynaformer, the sire of Kentucky Derby winner Barbaro, died Sunday at Three Chimneys Farm two weeks after suffering a heart attack in his stall. The 27-year-old stallion was one of the most successful sires in the thoroughbred industry with 21 crops that have earned more than $105 million, including 130 stakes winners and 18 millionaires. Three Chimneys president Case Clay said in a news release Sunday that "Dynaformer impacted the industry in a way that few ever have or will" and called him an awe-inspiring horse to be around.

Ann Brunner was at home with her best friend when a sudden, wrenching pain took her breath away. Her chest felt like it was being crushed by a sumo wrestler, the squeeze migrating to her shoulders and back. She fell into a chair and her friend told her that her face was ashen. "I felt like the plug on my life had been pulled," Brunner recalls. Later, in the emergency room at Einstein Medical Center Philadelphia, an abnormal electrocardiogram and elevated blood enzymes confirmed what Brunner, a nurse for 34 years, already suspected.

MILTON, Wash. - A Washington school-bus driver has died two days after suffering a heart attack at the wheel, prompting students to take over. Fife School District Deputy Superintendent Jeff Short said that Ryan Callis, 43, died Wednesday night. Bus footage shows 13-year-old Jeremy Wuitschick rushing down the aisle to the unconscious driver and grabbing the wheel as other students yell: "Call 9-1-1!" Wuitschick turned off the ignition and guided the bus safely onto the curb.

O THER firefighters who have died in the line of duty since 1991: * Tracey Champion, 49, collapsed from a heart attack at a West Philadelphia fire in January 2006. * Capt. John Taylor, 53, died of asphyxiation trying to rescue the fallen Rey Rubio, 42, from a Port Richmond basement-turned-marijuana-greenhouse in August 2004. * Lt. Derrick Harvey, 45, died at Temple University Hospital of burns he suffered after falling through the floor of a rowhouse in Olney, in January 2004.

While I'm away, readers give the advice. On telling difficult truths in therapy: A big benefit of both therapy and groups like Al-Anon, I've found, is that when you hear what you've been thinking and feeling coming out of your mouth, in front of another human being, it changes your perspective right there. Saying it out loud is enormously powerful. For some reason, (kvetching) to your best friend or sister does not have this power.   On profanity and what it says about people who use it: When my children were young, I told them that what would pass at home or among their friends would get them in trouble with teachers or could offend other families, so they needed to be fluent in two "languages," just as if it were English and Spanish.

A noninvasive scan that looks inside cardiac arteries can rapidly and reliably rule out the possibility of a heart attack among many emergency-room patients complaining of chest pain, according to a study led by University of Pennsylvania researchers. The findings provide the strongest evidence to date that "CT angiography" could relieve a diagnostic dilemma - how to efficiently distinguish patients who can safely be sent home from those who should stay in the hospital. About eight million annual ER visits are for chest pain.

HALL OF FAME trainer Bob Baffert had a heart attack early Monday in Dubai, where he was preparing to run Game On Dude in the $10 million Dubai World Cup. Baffert's assistant, Jim Barnes, said from Santa Anita racetrack in Arcadia, Calif., that Baffert was "doing very good" after having three stents inserted in two arteries. Barnes said he had spoken to the trainer's wife, Jill Baffert, who had accompanied her husband to the Middle East, along with their young son, Bode Baffert . Barnes said Jill Baffert told him the procedure went well and "everything should be fine.

Scientists find a clue to predicting heart attack Scientists have found a clue that one day may help doctors determine if a heart attack is imminent, in hopes of preventing it. Most heart attacks happen when fatty deposits in an artery burst open, and a blood clot then forms to seal the break. If the clot is too big, it blocks off blood flow. "We don't have a way to get at whether an artery's going to crack, the precursor to a heart attack," said Eric Topol, director of California's Scripps Translational Science Institute.

Chronic constipation, heart disease and death Q: I had always believed that Elvis Presley died at 42 from a heart attack. However, I've recently read that his longtime physician George Nichopoulos believes Elvis died from chronic constipation. How does someone die from that? A: According to the autopsy report, hypertensive cardiovascular disease and a "colon problem" were the likely contributing factors to his premature death from a heart attack. It has been reported by his now-retired personal physician that Elvis suffered for years from chronic constipation and that his colon was markedly distended at autopsy.