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The threat of heart failure in endurance sport

AP/Travis Long for the News & Observer
Sad story in the regional news: Two runners fell over dead at the recent Raleigh Marathon.

It's unfortunate, but these stories are not uncommon. Check out this great input from my friend and Master Competitor reader David Campbell:

Very sad to hear that. There was a runner in Dallas who collapsed at mile 12.5. I think people pick up the pace near the end and their heart rate can't take it so well. I was about 100 yards away. Before I could get there some one jumped on the fallen runner, did a few chest compressions and up jumped the runner looking ready to fight the next person who did that to him!

As a cardiovascular surgeon I always adhered to the fact that exercise does not cure cardiac disease but rather unmasks it. There is a large portion of the population with significant cardiovascular disease that are asymptomatic until  they exercise and hit a critical heart rate. In a normal heart increased heart rate increases blood flow to the heart muscle, but in a heart with blockages in the coronary arteries, an increase in heart rate leads to a dramatic drop in blood flow to the heart muscle down stream from the blockage. The result can be a fatal arrhythmia or infarction (ie 'the big one"). 

The first snow of every year I would have a rush of heart surgery cases when sedimentary people suddenly decided to get out and shovel snow from their driveway.  Most of these people thought they were completely healthy even though most never exercised, were over weight, and nearly 100% smoked.

A cardiac stress test should answer questions about occult heart disease for any one who is at risk and wants to start an exercise program. At risk includes people who have a history of tobacco use, diabetes, high cholesterol or a family history of vascular or heart disease. Lesser risk factors include hypertension, advanced age and obesity. My montra is "when in doubt, check it out" before exercising.

Thanks, David. We all need to stay aware of, and responsive to, personal health issues. I have my annual physical for a complete report and I hope you do, too.


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