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Sunday, October 18, 2009

Three Runners Die in Detroit Half Marathon

Sadly, three runners died at the Detroit Half Marathon today, as reported in The Detroit News.

Two runners collapsed and died around mile twelve, and the third shortly after finishing.  All three were men, ages 26, 36, and 65.  All received prompt medical attention and had defibrillators applied to them, all unsuccessfully.

In addition, a 23 year-old man died at the Baltimore Marathon last week, and two runners died at the San Jose Rock N Roll Half Marathon just a few weeks ago.

Why are apparently healthy athletes dying, and why is this a more common phenomenon recently?

A person can feel well, train for a race, but unknowingly may have heart disease.  In younger athletes, those under age 40, the most common cause of sudden death during a race is a structural abnormality of the heart, such as hypertrophic cardiomyopathy, dilated cardiomyopathy, or arrhythmogenic right ventricular dysplasia.  The presence of those structural abnormalities of the heart, combined with the stress of a competitive athletic event, can trigger a deadly arrhythmia.  Amongst older participants, unknown coronary artery disease may be present, and could lead to a heart attack or arrhythmia that could then lead to death.

Statistically, the odds of dying while competing in a marathon range from 1 in 50,000 to 1 in 150,000.

What should an athlete do?  How can we find these things before someone dies?

This is a controversial question amongst the cardiology community.  I believe that everyone who wishes to compete in any type of endurance sports needs a full physical before participation.  This includes a physical examination, blood pressure check, full panel of blood work including fasting cholesterol levels, and an EKG.  A physician should also inquire as to whether there is family history of heart disease in any first-degree relatives.

In Italy, guidelines are even stricter.  All young competitive athletes have a complete echocardiogram, or ultrasound of the heart.  As you can imagine, the vast majority of these echocardiograms are normal, and thus this recommendation is quite controversial.

Despite the risk in participating in competitive athletics, I hope that these recent events will not scare people away from being active, because an active lifestyle, in spite of these risks, is far better than a sedentary lifestyle.


Al Laurente said...

These guys probably pushed themselves so hard to the point that it was difficult to breath. In a race, we normally run 1 to 2 more minute miles due to adrenalin. I've done one full and two half's so far the past 2 years and have never pushed myself beyond exhaustion ... beyond what I did during training.

Sharon Mcnary said...

Do these odds (1 in 50,000) mean that I die of a heart attack in one of my 50,000 marathons? Or that 1 of 50,000 runners is likely to die in a marathon?

Sharon McN

Minority Report said...

Any idea what all this strenuous exercise is doing to your joints? Statins and sloth are working out well over here. No pain, no pain.

VeganHeartDoc said...

Minority Report --

My joints are fine, thank you! Those who do not exercise who carry excess weight are more likely to have joint problems than those of us who are active.

"Statins and sloth" is a phrase I've never heard. However, people who exercise live longer, feel better, weigh less, and have better control of their cholesterol and blood pressure than those who do not.

Minority Report said...

Ah, but you are still young, Doc. The sports yer pursuing are high impact and I believe that joint problems and other injuries are a matter of when, not if. At least that's what I hear from athletic trainers I know and from athletes I've seen. And this is not taking into account the cumulative probability of getting hit by a truck or going beak-over-tailfeathers on a bike.

Statins and sloth: One of my own. After 15 years of failed diet/exercise regimes that sapped my energy, were generally annoying, and which did squat for my blood panels, I elected to live better through chemistry. All the borderline/problem numbers are now in the green zone. $5 for a 90 day supply of simvastatin and no gym can beat that.

"However, people who exercise live longer, feel better, ..."

Maybe life just seems longer.

Still a vegetarian (not vegan) by upbringing and choice, so keep those restaurant and service recommendations coming.

Anonymous said...

Has there been any unusual solar activity during this time period? There have been studies that link cyclical solar activity and solar flares to a rise in heart attacks and strokes.

Gustaf Rosell said...

I am curious what the recommendations are for persons that have had open heart surgery like valve replacement or repairs, aortic grafts with or without pacemakers.

I have all the above after an aortic disruption and I run. So far not more than 10 km, but I am looking at a half marathon later. Used to run them and one full marathon before the surgeries.

I know it would probably be better to take it soft and run for fun, but I need or at least like the thrill of a race as motivation.

VeganHeartDoc said...

Gustaf -- kudos to you for being active after heart surgery! Talk to your doctor regarding whether you can or should run farther. I have a patient who had bypass surgery a year and a half ago after two heart attacks, and he just finished a 10K race in 55 minutes!