After finishing his first triathlon, Sanjay Shah celebrated fairly typically by hugging his wife and daughters. He then stepped aside to make a phone call. It was to his cardiologist.

Im alive and I finished the race, Shah told his doctor at the Perelman School of Medicine at the University of Pennsylvania.

Shah was back into racing condition thanks, in part, to guidance and care from sports cardiology professionals at Penn Medicine.

His training started years before with a decision to take charge of his health in a broader way. Earlier in life, he faced a diabetes diagnosis. That later led to Shah becoming more active. He even lost 40 pounds while training for marathons. He then entered the Rock and Roll Half Marathon in 2009.

That race, and Shahs spirit, came to a sudden stop during mile ten of the half marathon.

I had started feeling a tingling in my jaw. I had taken a caffeine gel during the race, and thought maybe that was affecting me somehow. It was more than just a tingling jaw. Shahs friends noticed a change in his color and urged him to stop running. They wanted to call 9-1-1, but Shah insisted he just needed to rest for a minute or two. Then, he started running again, finishing the final three miles of the race. Despite the accomplishment, instead of words of congratulations, his friends had a blunt and clear message for him, They made me promise that I would go to a cardiologist, recalls Shah.

Days later Shah was sitting in a Penn cardiologists office to undergo stress tests. Twelve minutes on the treadmill didnt raise any red flags. After all, Shah was an avid runner. However, more stress tests that day would, indeed, reveal he was having heart issues.

Shah had trouble wrapping his head around this new reality. "I felt pretty depressed just knowing I had a heart issue. I took pride in exercising regularly. I was even training other people for marathons, Shah recalls. His doctors had said with proper recovery time and a healthy diet, he could take up racing once again.

Racing was the least of his worries at the time, however. This sudden health complication left Shah worrying what the future held for family. "I had no will. I had two girls that I needed to put through college, says Shah. As men we dont like to cry, but I came close to it."

Doctors recommended an angioplasty and four stents to clear blockages in multiple arteries.

Before the procedure even took place, Shah decided hed give himself a challenge that hed never attempted: completing that triathlon.

I signed up to do Philadelphia Triathlon before my angioplasty. I told my doctor look, I have so much faith that I signed up to do a triathlon. I will cross that finish line."

Shahs surgery was a success, but he knew that simply completing the surgery and receiving stents wasnt a green light to completing a triathlon. This became alarmingly clear to him when he started having some mild chest pains during training. Shah knew he needed guidance so that he didnt inadvertently create more health problems for himself. Thats when he turned to Neel P. Chokshi, MD, MBA, medical director of the Sports Cardiology and Fitness Program and an associate professor of Cardiology in the Perelman School of Medicine at the University of Pennsylvania. He asked Chokshi about that minor chest pain, and more. He was also interested understanding effective training protocols for a triathlon to optimize his performance, minimize his risk of a heart related event and improve his diabetes via exercise, recalls Chokshi.

While Shah still struggled to wrap his mind around how someone as active as him could have such serious heart issues, Chokshi says although coronary disease in avid exercisers may seem unlikely, its not uncommon to find other risk factors that can raise risk for heart issues. Diet, cholesterol, blood pressure and lifetime exposure to these factors are important contributors to risk. What is often more surprising in these patients, is the presentation or signs of disease. These patients often present with subtler symptoms in light of their high degrees of fitness. Chokshi says even a small change in running pace or mild chest pains during a warm up can often represent a real issue.

Shah underwent several tailored stress tests with Chokshi and his team to ensure his safety at a high intensity of exercise, but a triathlon is difficult to simulate in a doctors office. Additional stressors, according to Chokshi, include heat stress and electrolyte changes from hours of endurance activity, as well as the possibility of heart attacks or irregular heart rhythms triggered by similar competitive situations.

We encouraged him to log more training hours and to participate in shorter events to build up to a triathlon race, says Chokshi. From there, Shah worked with one of Penns exercise physiologists to develop a training program.

Since his first successful triathlon, Shah has completed a total of six Half Ironman races up and down the East Coast. He credits is care team at Penn Medicine for giving him a second chance at life. When his heart issues were discovered back in 2009, Shah chose to view the complications as a way to change course for the better.

I had two options, Shah recalls. I can look at this and be sad and stop doing what Im doing, or I can pick up another challenge and catch the bull from the horns.

Chokshi says that kind of attitude in a heart patient is key to success, Completing a triathlon is a significant feat for any individual given the mental toughness, physical endurance and commitment required. Patients are often discouraged by their conditions and even their age, but Sanjays story demonstrates the possibilities after being diagnosed with a heart issue.

Running has now become a family affair for the Shahs. Sanjays granddaughters, ages 6 and 8, are now taking part in 5ks with their grandfather. Shahs own daughter is now a coach for a girls track team. Shah is eager to share his story with family, friends, and anyone who will listen to spread the message about heart health. He says exercise and a healthy diet are crucial.

"Having fun and enjoying life is in important. But you dont want to pay for it and you lose it all. It's not worth losing it all due to the bad effects it has on your heart. We all like to party, drink, eat what we wantbut we pay the price."

To learn more about Penns Sports Cardiology and Fitness program, or to find a doctor, click here.

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Heart Health is What Keeps This Penn Cardiology Patient Running - Penn Medicine