For Timothy O’Donnell, hours of denial gave way in the emergency room of a South Florida hospital late on the night of March 13, 2021, when the trauma care specialist called the resuscitation team and told it to stay close.

“I was thinking, ‘Oh, man, are you going to die right here?’ ” O’Donnell, a triathlon champion and one of the world’s fittest men, recalled of that terrifying day a little more than 13 months ago. “That’s where the mindset of the athlete kicked in. Just put negativity out of the mind and focus on surviving.”

And yet, hours earlier, that mindset had nearly cost him his life. It set off a series of events that illustrate the limits of the tough-it-out mentality that pervades endurance sports, sometimes with deadly consequences.

For roughly 20 miles on his bike and through his 11-mile run at the Miami Challenge triathlon, a 62-mile championship competition, O’Donnell had battled through severe tightness in his chest and pain shooting down his left arm as he competed against some of the top triathletes in the world.

The attitude that made him so good at ignoring pain kept him going when he lost track of how far he had cycled and got off his bike one lap early. That mindset was there when he set out on the 11-mile run, the final segment, even though he struggled to breathe and felt as if he were having an asthma attack.

O’Donnell, 41, who is from Boulder, Colorado, was making a mistake that too many seemingly healthy middle-aged men make each year, often with catastrophic consequences. He simply could not accept that someone like him might be having a heart attack, let alone one called the widow maker because of its severity and its frequency among unsuspecting middle-aged men who are fit and have no idea they might be at risk.

“This is not all that uncommon a story,” said Aaron Baggish, O’Donnell’s cardiologist and the director of a clinic at Massachusetts General Hospital that provides comprehensive cardiovascular care to athletes. “You can exercise and stay healthy and reduce your risk, but no amount of exercise offers complete immunity from heart disease.”

After a year of rehabilitation and medical research, and plenty of soul-searching and long talks with his wife, the three-time Ironman world champion Mirinda Carfrae, O’Donnell is ready to compete seriously again.

He had planned to round into racing form, beginning two weeks ago with St. Anthony’s Triathlon in St. Petersburg, Florida, but a cold forced him to pull out. Now his comeback will begin in earnest this weekend in Chattanooga, Tennessee, at the Ironman 70.3 North American Championship, followed by the full Ironman continental championship in June in Des Moines, Iowa.

“The idea is to get back to Kona,” O’Donnell said, referring to the Ironman World Championship, which takes place in Kailua-Kona, Hawaii, in October.

Pursuing brutal tests of endurance a little more than a year after a nearly fatal cardiac event might sound reckless, and O’Donnell and Carfrae, who have two young children, had misgivings at first. They agreed that if there was any chance continuing racing would impair the health of his heart, he would quit.

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