Cardiac arrest in marathons and triathlons

Your Heart Health in a Heartbeat – Episode 6

LINKS:

Cardiac arrest during marathons: 10 facts to consider.

Study of triathlon deaths concludes more screening is needed.

Interesting research studies from the American College of Cardiology 2016 meeting.

TRANSCRIPT:

Hello everyone,

There has been bad news coming from the marathon and triathlon communities regarding cardiac deaths during these events.  At the London marathon, a middle aged man suffered a cardiac arrest, and in Canada, a few days ago, a middle-aged woman also had a cardiac arrest and died during the swim portion of a triathlon.

So I thought I would take a few minutes today to go over what we know about cardiac arrest at these endurance events, and then go over some new recommendations for screening that were proposed at a recent meeting of the American College of Cardiology.

So first, the marathons.  A few years ago, an important paper was published that looked at cardiac arrests occurring during marathons over a 10-year period.  Let me give you five highlights from that paper:

First, cardiac arrest is much more common in men than in women, by a factor of 9-to-1.

Second, the average age was 43, but the age range was wide, from 22 to 65 years of age

Third, the frequency has been increasing over the years.  That is likely because more people are participating in these kinds of events, and some of the participants are older than in the past.

Fourth, most cardiac arrests occur in the last third of a marathon.  That’s probably because of strain and exhaustion as contributing factors, or possibly electrolyte shifts.  The cardiac arrest that occurred in the London marathon occurred near the end of the race.

Fifth, in most cases, the victims were found to have had a pre-existing heart condition they were unaware of, most commonly a disease of the heart muscle, called cardiomyopathy, or a disease of the coronary arteries.

I wrote a more complete blog post on this topic and I will link to it in the show notes on the website.

Now, as far as triathlon events are concerned, a study was presented a few weeks ago at the American College of Cardiology’s scientific meeting.  The study was led by Dr. Larry Creswell, a heart surgeon who is also a triathlete and has written extensively on cardiac complications in athletes.

The study is not published yet, but I can summarize the main findings as they were reported:  First, the demographics were similar to those of the marathon study: average age in the mid 40’s and mostly men.  Secondly, most deaths occurred during the swim portion of the event.  Thirdly, like in the marathon study, many of the cardiac arrest cases had an identifiable pre-existing condition that could have been detected by screening.  On the basis of those findings, the investigator recommended that middle-aged should consider heart screening before these events.

That said, we should add that how you do the screening matters.  If you are going to screen with just an ECG or a routine physical, that may not be enough to pick up the conditions we’re interested in that might lead to cardiac arrest.  It is important that the screening be thorough.

535 kids screened!

Again, Athletic Heart SF is delighted to have participated in a screening event for school kids age 12-18 that took place on January 26, 2016, at Sacred Heart High School in Menlo Park.  The event was organized by Via Heart Project, and the kids also received instructions in basic CPR.

A total of 535 kids were screened, a 3 were found to have conditions that put them at risk of serious cardiac complications.  Others were also found to have some structural anomalies of the heart or aorta that would need further follow-up.

If you think your school district could benefit from a screening and would like to get involved, I encourage you to contact the non-profit Via Heart Project organization.  Also, don’t forget that the availability of AED is essential to increase survival rates in case of cardiac arrest.  If your local school is not properly equipped, Via Heart also helps with that.

Why are screening tests controversial?

Your heart health in a heartbeat – Episode 2

Mammograms, PSA tests, heart scans, lung scans are all subject of debate and controversy.  Why is that?  Join me as I clarify the reason why screening should not be viewed only from the perspective of public health,


Transcript

Today, I’d like to talk about screening tests in general and why there seems to be so much debate and confusion about them.  It seems that every other week there is a new report in the media raising doubt about the value of this screening test or that screening test, whether it’s mammography, the PSA test for prostate cancer, colonoscopy, heart scans, or what have you.  And you hear one group of people advising one way and another advising another way, and it’s very confusing.

So how do we make sense of that?Read more

Podcast interview with Sami Karam

 

I had the pleasure of being interviewed by Sami Karam, the editor of Populyst, an economics and demographics blog and podcast.  Sami heard about Athletic Heart of San Francisco and decided to devote a show to the topic of heart screens.  We covered a lot of ground, but the focus was mainly on detection of coronary disease and on contrasting the early detection strategy to the strategy of managing risk factors.  I hope you will find our conversation informative.  To listen to the podcast, simply click on the play button below or on this link.

 

The “mammogram of the heart”

 

The phrase “mammogram of the heart” refers to the heart scan that detects calcium build-up in the coronary arteries.  The phrase was coined by the pioneers in this technology to try to impress on the public and on the medical community the simplicity and value of this test.

Calcium in coronary artery detected by CT scan.Image attribution: Wikimedia Commons

Calcium in coronary artery detected by CT scan.
Image attribution: Wikimedia Commons

 

Just as a mammogram can identify cancer before it spreads, a heart scan can identify the presence of coronary artery disease before it causes symptoms.  And like the mammogram, the heart scan is easy to perform, uses a low amount of radiation, and is inexpensive.Read more

621 kids screened for heart disease!

 

Desta and I had the pleasure of participating in a heart screening day at Sequoia High School in Redwood City last Sunday.

Volunteer briefing at the start of the day

Volunteers obtaining 12-lead ECG’s

The event was organized by Via Heart Project, a non-profit organization that equips California public schools with AED’s.   Via Heart recently decided to organize heart screenings, and they put a lot of effort and talent into this first event.

They were assisted by the folks at the EP Save-a-Life Foundation, who have been organizing heart screens in the San Diego area for several years and who provided some of the equipment we used, such as the cardiac ultrasound machines.  In total, 203 volunteers helped out, not including the Redwood City Fire Department.Read more

The Widowmaker

 

UPDATE (07/06/2015):  THIS MOVIE IS NOW AVAILABLE ON NETFLIX

Anyone out there concerned about heart disease in yourself or a loved one?

Do me a favor and watch The Widowmaker.  This is the best piece of medical investigative journalism I have ever watched.  It will make you understand what is wrong with heart disease prevention in our broken health care system.

widowmaker-movie

The movie also has great drama, both in the personal testimonies of ordinary folks who have lost a loved one to heart disease, and in the depiction of the political power plays at the highest levels of the cardiology community.

The trailer is below, but it doesn’t begin to give justice to the richness of the movie.  To see the film, click on this link.  You can download it as a rental for $4.99 or buy it for $9.99.  You won’t regret it and I agree with their tag line:  IT COULD SAVE YOUR LIFE.Read more

Demystifying the cardiac stress test

 

For most people, the cardiac stress test is the epitome of modern cardiology.  For some, the thought of undergoing one may also cause cold sweats…Perhaps a little introduction can help clarify what it is and what it does, and will minimize any misplaced fear about this helpful diagnostic tool.Read more

Can you ever exercise too much?

Can you exercise too much

Image attribution: Julian Mason/Flickr.

Professional athletic trainer and sports journalist Ian MacMahan asked us that question as part of an article he published in The Atlantic Monthly magazine.

McMahan reported on recent research that raises concerns about ultra-endurance sports carried to an extreme level for many years.  Such an exercise regimen increases one’s chance of having arrhythmia, such as atrial fibrillation, and may also cause scarring in the ventricle of the heart.

Some cardiologists have sounded alarm bells, comparing such exercise regimens to a “toxin.”  In my opinion, it is not yet clear if long-term, high-intensity exercise alone is the cause of the problem, or if those affected have other factors that come into play.  Nevertheless, the research should not be dismissed.   Here are some highlights:Read more

Facts and nuances about cardiac screening

 

We are delighted to have been featured in a San Francisco Chronicle article which highlights the rising interest in cardiac screening among athletes.  I was correctly identified as being among the growing number of cardiologists who believe that current screening tools are excellent and underutilized.

The article covered the subject of screening in general, so I would like to offer some additional information for clarification. Read more