While the Chargers were warming up in Denver last Sunday, Jim Harbaugh felt his heart racing. He knew that feeling, having experienced it as a player in 1999 and as an NFL head coach 13 years later.

The two previous episodes led to medical procedures on his heart. His third bout, which began to surface the Saturday night before the Broncos game, had the Chargers coach dipping into the blue medical tent and eventually heading to the visitors’ locker room for an EKG to check his heart and an IV to replenish his fluids.

At 60, the sinewy Harbaugh is as fit as any head coach in the game, and his heart issues — diagnosed as atrial flutter — are not indisputably attributable to the stress of the game.

Three days after the game, the coach got good news from his doctors.

“The heart of an athlete was the direct quote from my cardiologist,” Harbaugh told reporters, smiling and flexing at the lectern.

“So that made me feel good. Said the stress test was really good, too. I think he used the word incredible. … Said my stamina was incredible and got stronger as it got more stressed. Back in rhythm.”

Nonetheless, to a lot of people who have done that job, the visual of him walking to the locker room looking pale and distressed, surrounded by medical personnel, was eerily relatable.

“This job can kill you,” said Brian Billick, who coached the Baltimore Ravens from 1999 to 2007. “I’m serious about that. I have (atrial fibrillation), and did, and it’s something you’ve got to be very. conscious of.

“The stress is something that, whether you have a heart issue or not, you have to learn to deal with. Everybody has stress in their job, I get that, but the stress in that job is truly 24/7.”

Not many people are going to shed a tear for NFL coaches. There’s an endless line of people who want one of those 32 positions, and the job pays millions of dollars per year. Stress, and the ability to handle it, comes with the territory. But coping with that pressure is a significant challenge.

“Yes, it’s a sport, and you’re not an emergency room doctor or air-traffic controller, but it’s a different kind of pressure,” said Steve Mariucci, formerly head coach of the San Francisco 49ers and Detroit Lions. “But it’s real and it’s public and it’s out there, and your family lives it too.”

Mariucci was fired as coach of the Lions with five games remaining in the 2005 season. He was shown the door just after Thanksgiving, and didn’t set foot outside his home for three weeks. Finally, with Christmas approaching, he was so restless he had to get out of the house.

He drove alone to a Costco, aimlessly walking the aisles and tasting the food samples. It was a baby step toward re-engaging with the real world.

“I could just feel eyeballs on me, like, ‘There he is. There’s the loser,'” Mariucci recalled. “I was just eating those little sausages on the toothpicks, walking and walking. It was too cold to walk outside. I thought, ‘I’ve got to buy something here.’ So I bought some white sweat socks.

“I had to buy something, otherwise I’d look like I was trying to steal something. You’ve got to figure out how to get back on your feet some way.”

But Mariucci noticed something else, something positive in those trying times. Somehow, he was getting healthier.

“I think it’s a good idea for anyone in any profession to get a physical every year,” he said. “So I went and got a physical after things calmed down, and my ‘everything’ tasted so much better. Blood pressure, cholesterol, you name it. All the tests that you can think of were better. Being away from coaching was almost like a healing process.”

Keep in mind, these are people who love the game and have devoted their professional lives to it. Working their way up the coaching ladder has afforded them fame and fortune. But there is a considerable trade-off, and that frequently comes in the form of deteriorating health.

Bruce Arians was widely recognized as one of the game’s outstanding offensive minds as an assistant coach and coordinator, then was NFL coach of the year in both Indianapolis and Arizona before winning a Super Bowl with Tampa Bay.

Throughout, he battled health issues, ones frequently related to stress. Once, after a loss with the Cardinals, he was so upset about the officiating that he sat upright in bed at 3 am convinced he was having a heart attack.

“All of a sudden I got those pains in my left arm you always hear about,” he said. “I woke up my wife and said, ‘Let’s go to the hospital. I think I’m having a heart attack.’ And they did the catheter thing and said, ‘Nope, you’re good.’ It was just stress. Stress does crazy things to your body.”

Sometimes, that surfaces in a very public way. Gary Kubiak, then coach of the Houston Texans, collapsed on the field just after halftime began in a 2013 game against the Indianapolis Colts.

While walking across the field, he dropped to his knees and looked as if he was having trouble breathing. Quickly, he was surrounded by medical staff and taken to the hospital by ambulance.

Doctors determined Kubiak suffered a transient ischemic attack or mini-stroke, possibly related to dehydration. The coach took a few weeks off before returning.

Three years later, when coaching in Denver, Kubiak was taken to the hospital after a loss to Atlanta. He was diagnosed with a complex migraine that led to extreme fatigue and body weakness.

“My two situations were kind of exactly the same,” Kubiak said. “I had the one in Houston, which was a little bit more scary, and the one with Denver I made it through the game. … In both cases, I was starting a young quarterback. I’m probably doubling up, doing everything I. can get him ready to play and give our team the chance to win the next week.”

An NFL head coach isn’t just responsible for himself. If he were, the job would be much easier. But he feels responsible for the jobs of two dozen assistant coaches, who have families. He’s also concerned about his own family, and, of course, the players on his roster.

Being a head coach is less about actual coaching and more about keeping a cupboard full of plates spinning.

“For me it wasn’t about the pressure of coaching,” said Tony Dungy, Hall of Fame coach of Tampa Bay and Indianapolis. “But it was a sense of you had so many things and people to take care of that you don’t always take care of yourself.

“That was the thing for me. You’ve got time constraints, you’ve got a staff and you’ve got players and game plans. Then you’ve got family, your kids and wife and all of that, and you’ And then when it comes to, ‘Well, I need to take care of myself,’ or, ‘I’m not feeling great,’ or, ‘I need to see a doctor,’ you can’t. Pretty soon you stop worrying about yourself and you just let yourself go.”

For Mike Martz, former coach of the St. Louis Rams, lack of sleep became a huge issue. He would get to the office at 5 am and often wouldn’t leave until 10 pm Sleep deprivation led to endocarditis, a rare and life-threatening infection of the heart’s inner lining. It landed him in the hospital, where only his wife was allowed to visit him.

“When you’re sick like that, you’re just screwed up,” Martz said. “I just wouldn’t let go of the team. I wouldn’t let it go. I felt like I was responsible, that I had let the team down, the organization. I had to stay home for two months and I was going crazy. …At the end of the year, they wanted to go in another direction.”

Kubiak, who backed up quarterback John Elway for nine seasons in Denver, said becoming a coach gave him a much fuller appreciation for the coaches who guided him.

“When you make that switch, man, when you go from playing to coaching, it doesn’t take long,” he said.

“It probably takes you a year, maybe six months, when you step into that fire and you start to understand just what those guys were up there doing to make you successful when you were going home to have dinner with your family and do all those things that normal people do … you get a true appreciation very, very quickly.”

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