Dr. Larry Creswell recently wrote a blog post summarizing the excellent research work that he and his colleagues have conducted to better understand the causes and conditions of death during triathlon events.

They have identified all triathlon fatalities that occurred during a 31-year period (1985-2016) and analyzed as many of the relevant factors as possible.  Their work was published in the journal Annals of Internal Medicine.

They observed the following:

• Average age was 47 with a wide range, but the risk of death increases dramatically with age.
• Most victims were male (85%).  This is also the case among marathon fatalities, as we saw previously.
• About 40% of victims were fist time participants, and none of them were elite triathletes.
• Almost 75% of fatalities occurred during the swim event, frequently within the first few minutes.  No specific swimming condition (e.g., water temperature) could be identified.
• Many of the biking segment deaths were traumatic in nature.

In many cases of non-traumatic death, preexisting heart or vascular disease was discovered at autopsy.  The article notes that:

“A surprising and important observation of this investigation, on the basis of autopsy reports, was the high frequency of clinically silent cardiac abnormalities (present in about 50% of the cases with an autopsy report available) that may have caused or contributed to sudden cardiac death.”

Dr. Creswell recommends that athletes should consider their heart health before participating.  Middle-aged men in particular should consider undergoing cardiovascular screening ahead of the event.  Read his excellent blog here.

-Dr. Accad

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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.Read more

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

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

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.

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

In his excellent article on the debate regarding cardiac screening for athletes, Peter Vigneron remarks:

“Advanced cardiac screening can reduce the likelihood of sudden cardiac arrest, the most common cause of death among athletes. So why is it so controversial?”

We wonder as much!

The key to the controversy has to do with what perspective one adopts.

If one looks at the issue from a public health or population perspective, recommending mass screening for every athlete is logistically daunting, and potential problems (such as false positives and false negative test results) are likely to occur.  There is also an important socioeconomic dimension to the recommendation: who would pay for this?

On the other hand, if an individual athlete wishes to reduce his or her own risk of sudden cardiac arrest, there is no question that comprehensive, individualized testing is feasible and can avoid or greatly reduce the pitfalls of false positives and false negatives, because multiple tests are applied at once.  When performed by competent staff and interpreted by an experienced physician, these tests are extremely helpful to detect or exclude any underlying cardiovascular problem.

Furthermore, the cost of comprehensive screening does not have to be as onerous as Vigneron states.  He warns that an echocardiogram (ultrasound study of the heart) can cost up to $2000.  We provide the entire battery of tests for a fraction of that amount!Read more

Cardiomyopathies are very common causes of exercise-related cardiac arrest in youth and young adults, but can occur to anyone at any age.  An unfortunate example is the case of a 45-year-old seasoned runner who collapsed during a marathon last November in Tennessee.  The autopsy revealed an unsuspected cardiomyopathy.Read more

Last Sunday, an experienced marathon runner in his mid-50’s collapsed a few yards from the finish line during the Road2Hope half-marathon in Hamilton, Ontario.  Regrettably, the paramedics were unable to resuscitate him.  This unfortunate story illustrates the rare but tragic phenomenon of exercise-induced sudden cardiac arrest.Read more