When it comes to dealing with heart-related issues, endurance athletes probably are not the first population that comes to mind.

Try telling that to Sarah Max, a Bend cross-country skier who has been dealing with an arrhythmia — a condition in which the heart beats irregularly — for almost four years. But she has persevered and has continued her athletic career, most recently finishing fourth among women and 11th overall in Sunday’s Cascade Crest 25-kilometer nordic ski race at Mt. Bachelor ski area. This Saturday at Mt. Bachelor ski area, along with her twin 9-year-old daughters, Max will participate in the Tour for the Heart, a ski and snowshoe tour designed to promote awareness of heart disease in women.

“I think the benefit isn’t just that whatever comes out of the day itself, but it can get more women doing winter sports,” notes Max, who will celebrate her 37th birthday on Wednesday, of the first-year, 5-kilometer event.

The first time Max became aware of her arrhythmia, she says, was in spring 2008, during training. After completing an interval on skis, she felt some tightness in her chest, so she took a look at her heart-rate monitor.

“It (her heart rate) should have been maybe 140 at that time, and it was well over 200,” says Max, a freelance writer.

After a time, though, the rate dropped. Max discussed the episode with her doctor, who told her not to worry and that they would continue to monitor the situation. (According to the American Heart Association website, “Arrhythmias are extremely common. … Each year millions of people have them. Most cases are harmless, but some arrhythmias are extremely dangerous and require treatment and management.” The association advises that individuals who experience symptoms of an arrhythmia should consult a physician.)

But after an incident that same spring, one Max says frightened her most, she decided to get the arrhythmia checked out. During a trail run, Max’s heart rate again climbed to 200. This time, it remained elevated — for almost 30 minutes, she recalls.

“I think that I was so scared that the adrenaline was just perpetuating this problem,” says Max, who won the elite women’s division of Central Oregon’s multisport Pole Pedal Paddle race in 2008 and 2009.

So Max visited a local cardiologist and underwent some testing, which checked out fine and determined that her arrhythmia was not harmful. The cardiologist told her that if the arrhythmia became an issue, she could undergo a procedure called an ablation.

In the fall, the arrhythmia did become a problem. During a training camp with the Bend-based nordic ski team XC Oregon in Corvallis, her heart “went crazy again.”

“It’s hard, because as an athlete, or anybody, even if you just are not a competitive athlete … sports is supposed to be your outlet,” Max says of dealing with the arrhythmia.

That fall was a rough period for Max.

“Before I got my ablation, it was actually not good,” Max says. “I would get an arrhythmia almost any time I exercised. And in between, I felt terrible. I felt just kind of low energy.”

That same fall, Max went to a specialist in Portland to undergo an ablation, a procedure in which a catheter inserted through an artery to the heart is used to destroy or scar the tissue thought to be causing the arrhythmia.

Max says that after the procedure, her condition improved but did not disappear entirely. It even flared up again in spring 2010, and she underwent additional testing, but to this day the arrhythmia remains a bit of a mystery.

As time has passed, Max has gained an understanding of her body and how to manage her condition. For example, drinking coffee and then heading out for a run, she says, can trigger the arrhythmia.

“At this point, I just run right through it,” Max says. “I don’t even pay attention.” (Max is not defying medical advice by continuing in her lifestyle. In fact, at one point early on in dealing with her arrhythmia, Max recalls, her cardiologist told her, “Don’t change anything about what you do.”)

And she tries to rest more when fatigued and adjusts her training if she thinks it is needed.

She has not had to make more drastic adjustments to her life, though she would have, if necessary. And she will head up to Mount Bachelor on Saturday with her girls, Fiona and Isabel, for the Tour for the Heart, joining other female skiers and snowshoers in support of women’s heart health.

“When it was at its worst, honestly, there were times when I was so tired that I would’ve just been happy to have energy, and if it meant that I could never race again but be healthy, that was OK,” Max says, referring to her arrhythmia. “It put things in perspective. When you truly are concerned about your health, then it’s less about racing and more about just feeling good and being healthy.”

If you go:

Tour for the Heart

When: Saturday, 11 a.m.

What: 5-kilometer cross-country ski and snowshoe tour presented by Heart Center Cardiology and St. Charles Health System

Where: Mt. Bachelor Nordic Center

Why: To raise awareness of heart disease in women

Who: Women and girls; all ages and abilities welcome

Cost: $25

Registration: Available at signmeup.com, or by cash or check at packet pickup Friday (3 p.m. to 6 p.m. at Sunnyside Sports) and 10 a.m. Saturday at the event site

More information: tourfortheheart.org