Qualifying for the Boston Marathon was the crowning achievement of Esau Velasquez’s running career.

So when he suffered a heart attack six months before the race, he was determined not to let it stop him.

The Katy resident, now 51, learned he’d been chosen to run in the marathon shortly after he suffered a heart attack in October 2021. The news came as he was preparing to start cardiac rehabilitation, so he called a few programs in the Houston area to ask whether it would be possible to run.

“I kind of had it in my mind to make it a goal,” Velazquez said. “If it was doable and it didn’t put me in any type of danger, I wanted to try to shoot for it.”

He ended up at Memorial Hermann, where the cardiac rehab team put him on a 12-week program to strengthen his heart. The team monitored him to ensure he was safe as he worked out on a bicycle, an elliptical and a treadmill. His cardiologist signed off on him two weeks before the race.

Velazquez completed the marathon in 4 hours and 47 minutes, much slower than his typical effort. But it gave him the confidence to continue with his rehab so he could return to full strength.

He’s now recovered to the point where he’s been given the all-clear for the Chevron Houston Marathon on Jan. 15. He’s aiming to finish the race in 3 hours and 23 minutes — two minutes faster than the time he needs to qualify for the Boston Marathon in his age group.

“I haven’t gotten there yet,” he said, “but I’m on my way to getting back to the paces and the distances I was doing before my heart attack.”

Cardiac rehab started growing in popularity in the 1970s as a way to improve health outcomes after a heart attack, coronary artery bypass surgery or other heart problems. Studies have found cardiac rehab decreases the chances of death in the five years after a heart attack or bypass surgery by roughly 35 percent, according to the U.S. Centers for Disease Control and Prevention.

“We have the numbers to determine there have been positive changes in the trend of their cardiovascular disease,” said Dr. Francisco Fuentes, the medical director of Cardiac Rehabilitation for Memorial Hermann-Texas Medical Center “We hope that will reduce the burden of the disease, and overall make people feel better.”

Despite those outcomes, participation in cardiac rehab remains low. A 2017 analysis by the CDC found that approximately one-third of eligible patients participated in cardiac rehab.

Velazquez has completed 14 marathons since a friend invited him to run the Houston Marathon in 2010. That first race sparked something of a midlife crisis in Velazquez, but it manifested in a way that improved his health.

“Instead of buying a Corvette and going through that kind of midlife crisis, mine was more or less focused on getting in better health,” he said. “This sparked an interest.”

Three months later he participated for the first of eight times in the MS 150, a 180-mile cycling event that raises money for multiple sclerosis research. By 2013 he was competing in his first Half Ironman triathlon; he completed a Full Ironman one year later.

“You could say that running was my gateway drug to bigger and bigger endurance events,” he said.

Velazquez was in excellent health when he started feeling pain in his chest and back while watching the Astros in Game 2 of the 2021 World Series. He figured he’d hurt his back, so he did some stretches to relieve the pain. When it wouldn’t go away, he told his wife he needed to go to the emergency room.

Doctors checked his heart. Velazquez was shocked by the results.

“Sure enough, the machine was just going all over the place,” he said. “The doctor at the emergency room said, ‘You’re having a heart attack.’”

Specifically, he was having what’s known as a widowmaker heart attack, caused by a blood clot in his left anterior descending, or LAD, artery. That type of heart attack is life-threatening because the LAD is the largest coronary artery, providing 50 percent of the heart muscle’s blood supply.

Velazquez took some aspirin and medication to relieve the pain before he was admitted to the hospital, where he needed surgery to have a stent placed in his heart. He was in the hospital for 36 hours before being discharged with a referral for cardiac rehab.

Velazquez wasn’t a typical cardiac rehab patient, due to his excellent health before the heart attack. Most patients are in their 40s to 90s, though some are as young as 20, said Katherine Stone, a senior exercise specialist with Memorial Hermann’s Heart and Vascular Cardiac and Pulmonary Rehabilitation.

The program is tailored to each patient, though all begin with a six-minute walk to gauge endurance and heart rate, among other things. The patient is then put on a program designed to strengthen the heart and improve quality of life, Stone said.

“Our whole goal is to improve their quality of life — their ability to take care of themselves, travel, visit with family,” Stone said. “Everybody's got their different goals. Obviously, Esau’s was much higher.”

Velazquez’s rehab began with workouts on a seated stepper before he moved to a treadmill and an elliptical. All patients wear a portable heart monitor so the team can keep an eye on their cardiac activity as they exercise.

The team also includes a dietician, a respiratory therapist, an exercise physiologist, counselors and nurses. They work with patients to educate them about their risk factors for another cardiac event and address any depression or anxiety they may be experiencing after a traumatic experience. They also teach patients how to exercise at home in a safe way.

“You don’t want to do too much. There’s over-exercising as well,” Stone said. “Learning that appropriate level is important.”

Velazquez was determined to be a model patient because he knew time was of the essence. It also helped that he was in good shape before his heart attack.

“He was naturally, to begin with, extremely motivated,” Fuentes said. “We were trying to make sure that every step that we took was as safe as could be.”

The program doubled as Velazquez’s training for the marathon. He completed all the miles he planned to run in a week during his three rehab sessions and during a longer run over the weekend.

“It gave me the peace of mind that I would be able to not just go through the rehab, but also put in the training and the hours and the miles there,” Velazquez said.

The sign-off from his cardiologist that came two weeks before the Boston Marathon made him confident that he could finish the race. He couldn’t run his usual speed, so he decided to just soak in the experience.

“I was able to actually enjoy it more than any other marathon because there was really no stress,” he said.

After the marathon, he returned to Memorial Hermann for additional rehab, which helped him build more confidence. He ran the HSMA 25K on Nov. 20 in Houston and finished in just under 1 hour and 56 minutes — faster than his typical pace.

Now, thanks to cardiac rehab, he feels ready to qualify for the Boston Marathon again when he runs the Houston Marathon on Sunday.

“Hopefully, with good weather on race day,” he said, “I should be able to beat my goal.”

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