A Heartbeat Away

Had Randy Nash been on the fire road just a few minutes earlier, he might have seen Carl Triola or heard the sirens of the ambulance that whisked the cross country coach away.

But the 54-year-old lumber salesman and avid mountain biker had no idea anything had been amiss when he and four friends reached a bridge inside Annadel State Park in Santa Rosa and began their grueling ascent.

Two hours later, the father of four lay on a trail high up in the park, dying from sudden cardiac arrest as his friends frantically attempted CPR.

Triola, in the meantime, was fighting for his own life.

Having turned around at the same bridge where Nash pressed on, the 38-year-old Casa Grande High School coach collapsed in a parking lot on Annadel's western edge.

His heart suddenly stopped beating.

Only the quick work of a retired cardiac nurse who happened to witness Triola's collapse and the timely arrival of paramedics who shocked his heart saved the man's life.

What many are struggling to understand is how two seemingly fit men could suffer such calamity while doing something that is supposed to be good for the body and soul.

The answer is a revealing tale of roads not taken, warning signs not heeded, luck and the workings of the human heart.

Fateful decision

Triola and Nash arrived at Annadel about an hour apart Jan. 13, a bitingly cold but sunny Sunday morning that was a welcome relief from several days of lashing rain and wind.

Triola jogged to the park at about 9 a.m. from the Hoen Avenue home he shares with his wife, Vicky, and Luke, their 7-year-old son.

He went in through the park's Stonehedge entrance and connected with Canyon Trail, a fire road that starts out flat before ascending sharply into the hills.

It was to be, by Triola's standards, a short, four-mile jaunt. He runs regularly and has completed two marathons, including a respectable 4-hour, 23-minute finish last spring at the Napa Valley Marathon.

But he decided to cut it short that morning because he hadn't been training as much and he donated blood the day before.

At the bridge where Canyon Trail splits with Spring Creek Trail, Triola turned around.

That decision probably saved his life.

"You don't think one choice will make a difference," he said. "I decided to stay on the main trail and come back."

When he collapsed in the parking lot, the retired nurse and an unidentified man began CPR immediately.

Paramedics were on scene within four minutes.

"He got medical attention early. That's why he survived," said Dr. Peter Chang-Sing, chairman of Santa Rosa Memorial Hospital's cardiovascular surgery and medicine department.

Most people don't survive. Sudden cardiac death is the nation's leading killer, claiming 325,000 lives annually. Only one in six victims survive the initial attack without lasting brain damage, Chang-Sing said.

Nash had no such luck.

His ride took him farther and farther into Annadel's remote reaches.

With its close proximity to Santa Rosa, Annadel can seem like a relatively benign playground. The reality is that with 27 miles of trails spread across 5,000 acres, it can be as rugged as any rural outpost.

Two park rangers typically patrol that vast area, although the park currently has a vacancy. Volunteers on horseback and bikes also help out.

"It would be virtually impossible to be on every trail and be ready for every incident. We do our best with what we've got," said Supervising Park Ranger Angy Nowicki.

Nash was particularly out of range. He collapsed on Marsh Trail, which at 1,320 feet represents Annadel's highest point.

As usual, he'd gotten up around 6:30 a.m. at the Rincon Valley home he shares with Ellen, his wife of 26 years, and 21-year-old Jordan, the couple's son.

The couple, who met while both were at Santa Rosa High School in the 1970s, discussed Nash's retirement plans and about upping his life insurance policy. Then he drove off with his $1,500 Specialized mountain bike in the back of his work truck.

"We were starting to think about retirement because a lot of our friends were retiring at 50," said Ellen Nash, an administrative assistant for the California Highway Patrol. "But Randy loved to work."

Funny and outgoing, Nash had worked for Mead Clark Lumber Co. since the early 1990s. He'd been active all his life, but after learning three years ago that he had high cholesterol, he was trying to trim some weight off his 190-pound frame.

Looking back, Ellen Nash said she'd recently noticed her husband would get winded simply bringing wood in for the stove.

A grueling climb

At Annadel, Nash joined up with four members of his regular riding group: Blake Ridgway, his wife, Jean, Rich Drady and Leighton Schnur.

Ridgway, who'd known Nash for almost 30 years, worked with him at Mead Clark, as did Schnur. Drady is a Santa Rosa contractor.

Ridgway said the group started out at about 10 a.m. with a warm-up lap around Howarth Park and Spring Lake before entering Annadel on Canyon Trail and heading for the summit, a route that would take them about eight miles and include an elevation gain of about 1,000 feet.

"It's about as tough as it gets up there," Ridgway said.

Emerging from the redwoods on Ridge Trail, the group stopped to admire the view. Sunlight streamed through clouds high above the city.

"My God," Nash said. "This is so unbelievable."

Near Ledson Marsh, the group paused again around noon to rest and refuel with energy bars. Nash told an off-color joke that got everyone laughing. Then it was back on the trail.

The group had ridden about 100 feet on Marsh Trail when Jean Ridgway and Schnur saw Nash slump over on his bike and crash.

Up ahead, Blake Ridgway and Drady heard Jean Ridgway whistling loudly and rode back to discover Nash on the ground. He wasn't breathing.

Blake Ridgway, who has undergone CPR training, tried to breathe air into his friend's lungs while Drady pushed on his chest.

It already was too late.

Sudden death

"Five minutes into it -- I don't remember saying this -- but I turned to everyone and said, 'This is not good. We're losing him,' " Blake Ridgway recalled. "He wasn't breathing on his own and he had no pulse."

About 20 minutes later, in response to a cell-phone call to 911, the Sonoma County sheriff's helicopter landed at Ledson Marsh. But the only thing deputies could do was pronounce Nash dead.

"You start out the morning with five people, and you have to ride back with four. That was tough," said Drady, who had the tough task of driving Nash's truck home.

Ellen Nash came outside when the group pulled up. So, too, did the neighbors when they heard her scream.

"It was absolutely gut-wrenching," Blake Ridgway said. "It was almost a second death watching Ellen and Jordan go through that."

Both Nash and Triola were at risk for sudden cardiac death, but for different reasons.

Sudden cardiac death is the result of an abrupt and rapid loss of heart function in a person who may or may not have diagnosed heart disease.

The term "heart attack," on the other hand, refers to the death of heart muscle tissue due to a loss of blood supply. It, too, can cause sudden death.

Nash's death certificate states that he died from sudden cardiac death resulting from coronary artery disease, which is the fatty buildup in the arteries that supply blood to the heart muscle.

A contributing factor, according to the document, was "physical exertion of bicycling."

Warning signs

There may have been little anyone could do to help Nash after he collapsed. Most victims of sudden cardiac death require help in four to six minutes. But there were warning signs that could have alerted him to trouble.

Besides taking Lipitor to control his cholesterol, he'd complained to his wife about chest pains. On bike rides a week before his death, Nash remarked to his buddies that the effort seemed to be getting harder.

He also had a family history of heart disease -- his father had had two open-heart surgeries.

In hindsight, Ellen Nash said, her husband should not have been riding such a challenging route the day he died.

"It was too strenuous," she said. "But did he know that? He was having the time of his life."

Triola had no warning anything was wrong with him, however.

Tests afterward revealed one of the arteries leading to his heart is out of place. Unknown to the track coach, it had been that way since birth and was restricting blood flow to his heart.

That produced an arrhythmia -- an abnormal heart rhythm -- that ultimately led to his heart stopping.

Chang-Sing said the men might have benefited from a nuclear stress test, in which a small amount of radioactive material is injected into a person and traced to reveal any problems with the heart.

He recommends such tests for men over 50 and for post-menopausal women, as well as for anyone who has risk factors for heart disease, including those with hypertension or diabetes.

"Exercise can be a trigger and put a strain on the heart in the wrong patient who does not have a clear understanding of what their underlying heart condition might be," he said.

A new life

Drady said he's already scheduled an appointment for his first-ever stress test. The lesson he learned from Nash's death: "Don't just blow off those little things. When you feel something that's not right, get it checked out."

Triola is convinced that running actually improved his odds. Amazingly, his heart muscle suffered no lasting damage from the momentary pause.

Doctors implanted a defibrillator in Triola's chest that automatically will deliver a shock should his heart's rhythm ever go haywire again. He's also considering open-heart surgery to fix the errant artery.

It's likely he'll never be able to run like he once did. On the other hand, he should be around for the birth of his second child six months from now.

"I'm looking forward to that and spending more time with my son and wife," he said.

You can reach Staff Writer Derek J. Moore at 521-5336 or derek.moore@pressdemocrat.com.