Are Triathletes At Higher Risk Of Cardiac Events?

Being a multiple-stage competition involving the completion of 3 continuous and sequential endurance disciplines, triathlon usually involves swimming, cycling, and running over various distances. It began in 1970s and has become an increasingly popular endurance activity worldwide. A standard Olympic triathlon involves a 1.5 km (0.9 mile) swim, followed by a 40 km (24.8 mile) bike ride and a 10 km (6.2 mile) run.

Obviously, triathlon puts unusually high demands on the body, especially the heart. Does it mean that triathlon is a dangerous sport?

Recent study by German researchers reported that men who compete in triathlons could put their heart at risk. After examining 55 male triathletes averaged 44 years old, and 30 female triathletes averaged 43 years old, the researchers found that 18 percent of the men had a condition known as myocardial fibrosis, but not the female triathletes. Myocardial fibrosis is scarring of the heart, and it usually affects the pumping chambers and can progress to heart failure. The findings were presented at the Radiological Society of North America annual meeting between Nov 26 and Dec 1, 2017 in Chicago.

The clinical relevance of these scars is currently unclear but they might lead to future heart failure and arrhythmia (irregular heartbeat). The researchers explained that higher exercise-induced systolic blood pressure may result in greater myocardial mass and more exercise might expose the athlete to a higher risk of myocarditis, or inflammation of the heart muscle. These factors, together with repeatedly increased stress of the left ventricular wall due to exercise, could injure the heart muscle. Meanwhile, the presence of testosterone may be one of other factors that explain the difference in myocardial fibrosis risk between male and female triathletes.

Findings presented at meetings should be considered preliminary because it has not been subjected to the scrutiny given to research published in medical journals. Previous studies have, however, found myocardial fibrosis in elite athletes.

Latest American data also indicated that triathletes may be more likely to die suddenly and suffer a fatal trauma or cardiac arrest than previously thought. A study of more than 9 million participants over 3 decades found that deaths and cardiac arrests struck 1.74 out of every 100,000 competitors. The findings were published October 17, 2017 in the ‘Annals of Internal Medicine’.

During the study period from 1985 to 2016, 135 people died suddenly or had a cardiac arrest. This included 107 sudden deaths and 13 race-related cardiac arrests that people survived because of prompt emergency medical attention. The victims were 47 years old on average, and 85 percent were male.

Autopsy data showed that clinically silent cardiovascular disease was present in an unexpected proportion of decedents. The incidence of cardiovascular events was much lower in female triathletes, 3.5-fold less than in men. Death risks also raised with age. Among men 60 and older, 19 participants died or suffered cardiac arrest out of every 100,000 competitors.

Hence, it is advisable for participants of triathlon or other sports to get medical checkup to see if they have any risk before participating. This is particularly important for middle-aged and older men.

Anger and Stress Can Be Deadly for People With Heart Disease!

According to the American College of Cardiology, there are more than 400,000 sudden cardiac deaths in the United States every year. Previous studies also showed that earthquakes, war or even the loss of a World Cup soccer match could raise rates of death from sudden cardiac arrest. Sudden cardiac arrest is a condition in which the heart stops circulating blood.

Recently, a study by Yale University in New Haven, Connecticut indicated that anger and other strong emotions could trigger potentially deadly heart rhythms in certain people with heart disease. The paper was published on February 23, 2009 in the Journal of the American College of Cardiology.

62 patients with heart disease were studied by the researchers. They were equipped with implantable heart defibrillators or ICDs (implantable cardioverter-defibrillator), which are devices that deliver an electrical shock to restore a normal heartbeat when dangerous heart rhythms or arrhythmias are detected.

The patients were asked to recount a recent angry episode so that the research team could perform a so-called T-Wave Alternans test to measure electrical instability in the heart. By specifically asking questions to get people to relive the angry episode, the researchers found in the lab setting that anger did increase the electrical instability in these patients.

These patients were then followed for 3 years. The study found that people who had the highest anger-induced electrical instability were 10 times more likely to have an arrhythmia in follow-up.

The researchers suggested that anger could be deadly for people who are already vulnerable to this type of disturbance in the heart. However, how anger and stress might affect people with normal hearts is likely very different from how it might affect the heart with structural abnormalities. Therefore, they cautioned that people should not simply extrapolate their results to normal people.

Meanwhile, a study has been conducted by the same researchers to see if anger management classes can actually help reduce the risk of arrhythmia for patients who are at risk.

What Is The Risk Factor For Sudden Death in Patients With Myotonic Dystrophy?

When we talk about muscular dystrophy (MD), we refer it to a group of more than 30 genetic diseases characterized by progressive weakness and degeneration of the skeletal muscles that control movement.

Myotonic muscular dystrophy or in short myotonic dystrophy, being the most common form of MD, will cause a person prolonged muscle spasms, cataracts, cardiac abnormalities, and endocrine disturbances. Patients with myotonic dystrophy have long, thin faces, drooping eyelids, and a swan-like neck.

Statistics showed that approximately 1 of every 8,000 people in the United States was affected by myotonic dystrophy. The heart muscle of the people with such disease is adversely affected.

Over the period of 10 years, neurologists and cardiologists at 23 clinics studied 406 adults with myotonic dystrophy. During that period, 20 percent of the patients enrolled in the study died, one-third of them in sudden death were likely due to cardiac arrhythmia.

Cardiac arrhythmia (also known as dysrhythmia) is a condition in which abnormal electrical activity occurred in the heart. The heartbeat, either regular or irregular, may become too fast or too slow. Some arrhythmias are life threatening, which can cause cardiac arrest and sudden death. Sudden death means death occurs in a stable patient within 1 hour of the onset of symptoms.

The study carried out by the Indiana University School of Medicine found that adults having myotonic dystrophy and abnormal electrocardiograms are more than 3 times more likely to die suddenly than patients who have normal ECG, while those with atrial (upper) chamber arrthymias had a 5 times higher risk.

The researchers had identified the risk factors that predict a high risk of sudden death in people with myotonic dystrophy and their findings were published in the June 19, 2008 edition of the New England Journal of Medicine.

The report also revealed that pacemakers, commonly used to treat some forms of arrhythmia, did not help these patients prevent sudden death. However, using electrophysiological studies or by surgically implanting a cardioverter-defibrillator, doctors can guard against sudden death in patients showing this risk factor.

Are Heart Tests Necessary for All Athletes?

The collapse of athletes during or after the match is not uncommon. For instance, in 2007, Sevilla footballer Antonio Puerta died 3 days after collapsing during a Primera Liga match, and in 2003, Cameroon's Marc-Vivien Foe died during a Confederations Cup match.

Figures revealed by the Italian researchers from the Institute of Sports Medicine at the University of Florence, show that one young athlete dies every 3 days from an unrecognized heart disease in the United States alone. Therefore, the researchers recommend mandatory heart screenings for all athletes as this could detect potentially fatal problems and save lives.

Their paper published on July 4, 2008 in the British Medical Journal indicated that exercise electrocardiograms could identify cardiac abnormalities among people who seek to take part in competitive sports. In their opinion, a family history and physical examination may miss many undiagnosed heart problems

The study analyzed data from more than 30,000 heart screenings over a period of 5 years (between 2002 and 2006). It was found that 1,459 people showed some form of heart problem during an exercise electrocardiogram and 348 people had abnormal results during their resting electrocardiogram. Only 159 of these people had serious conditions that prevent them from competing. Yet, only 6 of these athletes would have been identified through a family history and physical examination.

Incidentally, Italy is the only country where these tests are mandatory. The tests will cost 40 euro and is recommended by the researchers as mandatory in other countries.

The issue of pre-screening programs using electrocardiograms has been controversial. In fact, the American Heart Association had reaffirmed in 2007 their recommendation against universal use of electrocardiography, citing cost, low prevalence of disease and a high false positive rate. On the other hand, the European Society of Cardiology, International Olympic Committee and other sports league do endorse the screenings on grounds on grounds basis as some studies have found them effective.

A detailed personal and family history and physical examination will detect some athletes with underlying heart disease, but the addition of screening process using electrocardiograms will detect more athletes with silent cardiovascular disorders at risk of sudden death, as indicated by some health experts.

Is Distance Running A Dangerous Sport?

Taking part in a marathon is not easy and definitely not suitable for everyone because one needs to run for a distance of about 42 km. In October 2007, a 35-year-old police officer running in the Chicago Marathon collapsed and died. In Singapore, a 25-year-old army captain also died after finishing a half marathon in August 2007.

Does this mean that marathon is a dangerous sport? Before drawing any conclusion, let us hear what the experts have said about marathon.

In fact, statistics showed that sudden death during running a marathon is very rare. In Singapore, there is only one death in every 15,000 to 18,000 healthy runners each year. The more common one are ailments such as musculoskeletal and heat injuries, according to experts.

People with uncontrolled hypertension and ischemic heart disease should not take part in marathons. This is because unforeseen stresses from heat, dehydration and physical or psychological pressures could well strain the cardiovascular system. People suspected of other medical conditions should get a pre-race screen.

Once results of screening confirm one’s fitness for running marathon, he or she should then undergo adequate training. The runner should at least have completed a distance run of 30 to 32 km at some point during the training for a marathon. The purpose is to allow acclimatization to weather, testing the type of clothing need, knowing energy and fluid needs, and gauging body's limits.

Running for 42 km straight is very likely to wear out the body. The human body begins to experience fatigue as soon as the carbohydrate stores are depleted. Therefore, a high-carbohydrate meal should be taken before the big race to provided sufficient fluid and energy for a run. Meanwhile, do not try new food just before a race as this could cause gastrointestinal discomfort. Instead, opt for safe food choices such as bananas or power bars.

During the run, the runner should monitor his or her physical state because the day's temperature and humidity could also affect the body adversely. Under the hot weather, blood is diverted to the skin for heat dissipation. This, coupled with fluid loss from sweating, will affect the body's ability to deliver oxygen and energy to the muscles. Such disturbance of the body’s heat regulation would trigger the occurrence of heat stroke. The result could be fatal if multiple organ complications emerge.

Hence, the runner should be aware of such as high internal temperatures and significant changes in one's mental state. In addition, unusual chest pains or palpitations, disorientation or confusion could also indicate cardiac-related conditions and other injuries.

If runners could observe points mentioned above, they might minimize their risk of having fatal consequence during the marathon event.

Sudden Death Might Be Reduced By Primary Care Physicians

The best way to reduce the rate of sudden death is to place automated defibrillators (AEDs) into the hands of bystanders, whether they are trained or not. This is the common belief that prevails among people.

Nevertheless, a trial conducted by researchers had proved otherwise. The study showed that public access to and intervention with AEDs on average could save merely one life in a community over a three-year period with a cost of providing 800 volunteers with ready access to AEDs.

The rate of sudden death was reduced by only 5 percent, even after AEDs were given to all heart attack survivors.

On the other hand, there is evidence showing that primary care physicians can reduce sudden death by nearly 30 percent. This is done through advising their patients to quit smoking, adopt a regular exercise program, eat fish high in omega-3 oil, and prescribing for them appropriate medicines for hypertension and heart failure.

Sudden Adult Death Syndrome

The number of adults who collapsed and die suddenly without any explanation could be greater than that recorded officially, according to a study conducted by British Heart Foundation (BHF).

This study involved 692 white people aged 16 to 64 years who had no prior cardiac disease, but on whom postmortem examination found either a heart-related or no identifiable cause of death. The researchers found that most died from heart-related causes with 4.1 percent of the cases could not find any cause.

It was estimated that each year, 3,500 apparently healthy adults die suddenly from cardiac or unexplained causes, and for about 150 of these deaths, no cause could be identified. Many of these cases might be due to electrical abnormalities of the heart of which some may be inherited.

Heart Rate Can Be Lower By Eating Fish!

Increased heart rate is a risk factor for sudden death. Sudden death also known as cardiac arrest, and it occurs when the heart stops abruptly.

According to a study on 9,758 men, aged 50 to 59 from Lille, France and Belfast, Ireland, healthy men who ate fish regularly had lower average heart rates as compared to those who did not.

The men in the study were divided into 4 groups according to their fish intake: less than once per week (27.3 percent), once per week (46.9 percent), twice per week (20.1 percent), and more than twice per week (5.7 percent).

The adjusted heart rate ranged from 67.5 beats per minute (bpm) in men who ate fish less than once a week to 65.6 bpm for those consuming fish more than twice per week.

Omega-3 fatty acid may prevent sudden death and fatal cardiovascular events by regulating heartbeat and preventing irregular cardiac rhythms associated with sudden death. Cold-water fish such as salmon, tuna, and mackerel are good sources of omega-3 fatty acids.

Sudden Cardiac Death?

For the past few weeks, there were 4 young male victims who had no known health problems or family history of sudden deaths died during sleep. Although actual reasons have not been known, most deaths of this kind were believed to be caused by cardiovascular conditions.

According to cardiologists, the chances of sudden cardiac death are small for healthy persons with no family history of sudden death, congenital heart disease and multiple risk factors such as diabetes and hypertension. It is estimated to be one in 1,000.

Men are more at risk as they are generally more prone to coronary artery disease. There is no well-documented data on sudden death during sleep. But, a French study conducted in 1994 found that one-third of all sudden deaths occur during sleep. Often, victims were not aware that they had congenital or underlying heart conditions such as a blockage in a blood vessel or the heart.

The abnormalities in the heart or brain, if detected early, can be treated with medication, surgery, or devices such as pacemaker. Nevertheless, the best approach is to minimize the chances of developing a heart condition through a balanced diet, regular exercise and strict control of existing conditions like hypertension, diabetes, and high cholesterol.