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When Juan Sanchez runs, it’s almost always without his shirt on, as if the fabric might slow him down or interfere with his desire to commune spiritually with nature and with God.

Running is the 45-year-old St. Helena man’s escape, both from life’s daily concerns and from a family legacy he doesn’t want to inherit. Running also is what filled the floor-to-ceiling cabinet in the Pope Street home that he built with dozens of medals he earned at marathons and ultra-marathons across the North Bay and the country.

“There’s elite runners that are just the best there is, and just beneath them is another layer. That’s where Juan is,” said Art Webb, a legendary Santa Rosa runner and co-founder of the city’s marathon who has twice competed with Sanchez at Badwater, a 135-mile lung-scorcher on the eastern side of the Sierra Nevada that bills itself as the world’s toughest footrace.

Perhaps the day will come when Sanchez, a construction worker, again will lace up his running shoes and slip on his tight compression shorts — what his wife, Katie, refers to as his Superman attire — and head out again to indulge the passion that had him running 140 miles in a single week, the equivalent of more than five marathons.

But that won’t happen today or any time soon.

Seemingly in the best shape of his life, Sanchez recently underwent surgery for a potentially life-threatening heart arrhythmia that may have been exacerbated or even caused by running, the very thing that brought him solace.

The surprise discovery came after a 62-mile race in Folsom this spring. Sanchez experienced unusual fatigue during the May 10 event and days later visited a Napa clinic out of concern. He wore his running attire, anticipating that he would lead a group run later that day to raise money for a St. Helena elementary school.

But tests, including an EKG, revealed his resting heart rate to be an alarming 170 beats per minute. A doctor told Sanchez that the only place he should run to was an emergency room.

“It’s shocking,” Sanchez said. “I always suspected to have, in the future, issues with my ankles, my knees, my feet, whatever. The last thing I expected to have issues with was my heart.”

Sanchez’s new journey with heart disease thrusts him into a national debate over whether endurance sports such as ultra-running, cycling and triathlons can increase a person’s risk for severe injury or premature death. The exploding popularity of these pursuits is reflected on the North Coast in such high-profile events as the Vineman triathlon and Levi’s GranFondo, the long-distance cycling ride, as well as in dozens of lesser-known events held practically every weekend year-round.

The debate has been fueled by the rising number of patients who some doctors say are showing up in their offices with cardiac ailments, including enlarged hearts, that are associated in some way with their pursuit of endurance sports.

A number of high-profile deaths have also elevated the issue. They include Brian Maxwell, an elite long-distance runner, coach and the founder of PowerBar, the energy product company, who collapsed and died of a heart attack in 2004 at the age of 51.

The endurance sports world was rocked again two years ago with the death of ultra-runner Micah True, the central figure in Christopher McDougall’s book “Born to Run,” which helped fuel the booming interest in high-mileage running. True, 58, died of a heart attack while out on a run in the wilds of southern New Mexico. An autopsy revealed he died from cardiomyopathy, the result of an enlarged heart.

For Sanchez, the idea that running in some way could have harmed his heart was the furthest thing from his mind until two months ago. Since he was a boy, the sport has been his passion, and in adulthood it became his way to escape the shadow of an alcoholic father.

Sanchez grew up in Mexico City in a family that included 11 children. He ran three miles to school and completed his first marathon by the time he turned 20. In 1990, he emigrated to the United States seeking to support his family and to put some distance between himself and his father.

Running helped Sanchez steer clear of paths he might otherwise have chosen, he said. He rarely drinks and has never touched tobacco.

“That’s why I kept increasing the distance, increasing the distance, to try and find that happiness and fulfillment, and the man I wanted to be,” he said.

Sanchez spoke at his St. Helena home while Katie played with Isabella, the couple’s 8-month-old daughter. Family portraits hang on the wall, along with the couple’s vows from their wedding last year.

“Thank you for pursuing me with persistence and passion,” Katie’s vow began. On another wall was an oak carving and an excerpt from the Book of Joshua: “As for me and my household, we will serve the Lord.”

Katie, 31, a fitness instructor, shared her own theory on the unsettling turn in her husband’s health. For years, she said, he did not properly fuel himself during and after his long runs, and that possibly threw his electrolytes off-kilter, contributing to his heart ailment. She also said running 100 miles is not normal for anyone. But she knew what she was getting into with Juan.

“I married a shirtless runner,” she said.

When he was training for a big race, Sanchez thought nothing about running from his home in St. Helena to his church in Napa and back home again, a round-trip of 30 miles. That was after he put in a full day of work on a construction site. Passing motorists would gawk at this lean figure barreling along Highway 29, his arms swinging madly and his fists unclenched, like he was karate-chopping air. Sanchez even ran on the railroad tracks used by the Napa Valley Wine Train until a cop threatened to arrest him.

But lifting up his shirt last week to reveal bruises on his chest, Sanchez shared that he now wonders whether he took things too far, whether his desire to run farther and faster ended up shutting him down.

He’d never spent a single night in a hospital prior to being admitted to Angwin’s St. Helena Hospital in May, the same day he was seen at the clinic in Napa. Over the next five days, doctors shocked his heart and gave him powerful medications in an effort to get his heart into a normal rhythm.

Sanchez subsequently underwent a cutting-edge procedure at St. Helena Hospital to permanently address his irregular heart rate, or atrial fibrillation. A surgeon made four small incisions each the width of a ballpoint pen on the sides of Sanchez’s chest and then with the aid of cameras used radio frequency waves to create scar lines on the surface of his heart to redirect the erratic electrical impulses.

Another doctor, a cardiologist, performed a more traditional procedure with a catheter, going in through Sanchez’s groin to create more scar lines in the upper chambers of his heart. Combined, the procedures took about three hours.

“We burned a pattern on his heart to obliterate the abnormal rhythm,” said Dr. Gan Dunnington, who performed the chest surgery.

He said in the past, Sanchez’s condition would have required bypass heart surgery or the lifelong use of medications that can cause debilitating side effects. Neither is the optimal choice for a relatively young endurance athlete.

Dunnington has cleared Sanchez to exercise. But he said time will tell whether Sanchez will ever return to running long distances or require additional medical attention.

“We think it’s a cure, but there’s not enough specific data in this specific population to know how he’ll respond to this stress,” he said.

Sanchez said his father suffered a heart attack and has a pacemaker implanted, but otherwise, heart disease isn’t prevalent in his family. One of his brothers, Federico, 43, is signed up for next week’s Badwater race, which now traces a brutal path from the town of Lone Pine through Owens Valley to a finish more than halfway up Mount Whitney. Sanchez had been planning to be a part of his brother’s crew before his heart problems surfaced.

Dunnington said Sanchez likely has a genetic predisposition to atrial fibrillation, and that running with such intensity probably unmasked it.

“I don’t think it would have happened as early in his life, but I think it would have happened,” Dunnington said.

The effects of endurance sports on an athlete’s body are only now becoming better understood, with some studies suggesting that a person reaches the point of diminishing returns at certain thresholds. The question is where that line is found.

Todd Weitzenberg, chief of sports medicine with Kaiser Permanente in Santa Rosa, said the fact athletes can develop large hearts, which in turn can foster electrical problems, has been well-documented for some time. He said doctors are treating more patients with heart problems related to intense exercise as the popularity of endurance events has soared.

“I don’t want to discourage people from doing those kinds of things, but I think there’s an inherent risk in doing them,” he said. “Juan’s lucky that he was able to detect this and get treated. A fair number of runners aren’t so lucky and present by dying during one of these runs.”

Dunnington has treated about 140 patients at St. Helena Hospital for atrial fibrillation using the “hybrid maze” technique used on Sanchez. Most are in their 60s and 70s. His youngest patients — about 10 of the total — have all been endurance athletes, including a female triathlete in her early 40s who underwent the procedure just before Sanchez.

The cases may mean that athletes are seeking out the procedure, making it an unreliable indicator of any actual increase in athletes running into heart problems. Or the numbers may signal a troubling trend of more people breaking down from their exercise routines.

“It’s hard to imagine that anything extreme is going to be good for you over a long period of time, including exercise,” Dunnington said.

Even Webb, the Santa Rosa Marathon official, who is 72 and has competed in 15 consecutive Badwater races, said he’s backed off on the miles he runs. “Logically it makes sense. If you tax the system that much, something is going to fall apart,” he said.

Sanchez’s unexpected health problems have created financial difficulties for him and his family. A self-employed construction worker, he doesn’t have health insurance, and because he’s not a U.S. citizen, he can’t buy coverage through the state-run marketplace. He’s in the process of applying for permanent residency status while friends are rallying to try and help him with his medical expenses. That included a group run and silent auction Wednesday night in St. Helena.

Sanchez said he and his family have been blessed by an outpouring of love and concern from the St. Helena community and his church in Napa. He said he believes God led him to this place in his life and will lead him out of it.

He hopes that’s back out on the road, with his running shoes on and the wind blowing across his bare chest.

“If it’s your passion, how can you walk away and live in fear every day of your life?” he said. “If you don’t go over the limit, how can you find the peace and joy you’ve been looking for?”

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