INDIANAPOLIS -- Mark Dantonio and his Michigan State Spartans didn’t succumb to the pressures of overtime last autumn.

His heart did.

Overtime. Fourth down. Notre Dame ahead by three. Dantonio ordered a fake field goal -- a 29-yard toss from a punter to a tight end. Untouched to the end zone, the tension shattered and Spartan Stadium erupted. Jubilant players stampeded across the field. Adrenaline surged through Dantonio’s body -- his arms tingled and chest squeezed. But they weren’t symptoms of a white-knuckle victory.

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Dantonio had a heart attack 30 minutes later. 

Fourteen months have passed since a stent was inserted into a blood vessel near his heart. Having already triumphed in a staredown with his own mortality, Dantonio will face a less formidable opponent -- the Wisconsin Badgers -- on Saturday in the inaugural Big Ten championship game at Lucas Oil Stadium.

Such alarming heart issues are an occupational hazard in football, yet afflicted coaches maintain rigorous workloads, often at their own peril.

“[Coaches] expend a lot of the hormone -- adrenaline -- that is going to make them ready for the action,” said Dr. George Abela, chief of the division of cardiology at Michigan State. “If the heart hasn’t been prepared for that activity, it can falter, it can fail.”

Dantonio, 55, appears svelte for a man his age, showing none of the outward signs commonly associated with heart disease, which kills more than 800,000 Americans every year -- about a third of all deaths -- according to the American Heart Association.

Yet on Friday, Dantonio shrugged off the prospect of a relapse.

“I’m not worried at all about [my heart]. I exercise every day,” Dantonio, face graven, said. “Pressure is good; stress is not, so I won’t be stressed.”

But he works amid the pressures of coaching in an era where a 60-hour workweek is analogous to a vacation, and the specter of being fired looms over every decision. Spending myriad hours obsessing over strategy, film and recruiting, coaches find little time for sleep, which can exacerbate heart health issues, said executive stress consultant Dr. Gaby Cora.

[Coaches] expend a lot of the hormone -- adrenaline -- that is going to make them ready for the action. If the heart hasn’t been prepared for that activity, it can falter, it can fail.
-- Dr. George Abela, Chief of Cardiology Division, Michigan State University

“One of the problems is lack of sleep,” she said. “It’s not just the stress of the job; it’s the stress that they carry with them at night.”

Dantonio returned to the sidelines little less than a month after his heart muscle, crippled by a lack of oxygen, cramped and grew rigid inside his chest much like one of his player’s calves might during a game. “I’m going to ease back into this just like you would with any injury,” Dantonio said in his first press conference after the heart attack. “What doesn’t kill you makes you stronger.”

Cardiologists encourage heart attack victims to follow a similar course of action when they return to their daily responsibilities. For most, easing back in entails a month of rest,  followed by a gradual return to a full workload to avoid a quick relapse, Ablea said. If the job is particularly stressful, such as a coach, “we recommend they don’t go full speed right away.”

The newest -- and perhaps most renowned -- addition to the Big Ten coaching family, Ohio State’s Urban Meyer, resigned from Florida in 2010 after battling the chest pains that accompanied winning two national championships. In his introductory press conference at Ohio State on Monday,  Meyer ruminated on how those ailments have affected his life and career.

“I had a health scare a couple of years ago that made me sit back, reflect. I didn't feel right,” Meyer said. “A year ago I was -- in my mind -- I was convinced I was done coaching.”

It can happen at any level. Former Atlanta Falcons coach Dan Reeves had quadruple bypass surgery during an improbable run to the Super Bowl in 1998.  Scott Young, head coach of West Rowan High School in North Carolina, suffered a heart attack on Oct. 24.

Like his collegiate peers, Young, 40, has since returned to the sidelines in hopes of guiding West Rowan to its fourth consecutive state championship, working his typical 80-hour weeks along the way.

Doctors have cleared him to coach, but warn that the demands of his job do no favors for his weakened heart.

“[Doctors] say it is related to stress, but I love the stresses of the job,” he said. “They say don’t get too stressed. That’s bunk. I love what I do.”