Preventing Cardiac Arrest in Marathon Runners


060614_running1Post by Deepak Pasi, M.D., F.A.C.C., NC Heart & Vascular.

Cardiac arrest in marathon runners is a very uncommon event. However, occurrences at recent race events have heightened the awareness of this dramatic and unexpected tragedy.

060614_running2The chance of suffering cardiac arrest during marathons is about 1 in 184,000, and the likelihood of dying from the arrest is about 1 in 259,000. Men are more likely to be a victim than women. The good news is that the chance of surviving the arrest is higher than in the usual out-of-the-hospital cardiac arrest. The reason for the arrest is dependent on age. If one suffers cardiac arrest before the age of 35, usually it is related to a congenital defect (from birth) and hereditary diseases. After the age of 35, it is usually related to early coronary artery disease.

There are numerous congenital heart diseases that can cause cardiac arrest. Here are a few:

  • Hypertrophic Cardiomyopathy in which the muscular wall or septum between the two ventricles abnormally thickens.
  • Anomalous Coronary Anatomy in which one of the heart arteries originates from a different location.
  • Arrhythmogenic Right Ventricular Dysplasia (ARVD) in which the wall of the ventricle is replaced by fatty tissue.
  • Long QT syndrome: Prolongation of the QT interval on the EKG.

The only way to prevent the cardiac arrest from happening is to detect the abnormality before the event happens. The athlete should heed the symptoms and body warnings and seek medical attention promptly. It is wrong to be under the impression that because one is an athlete then he or she is invincible or saying that ‘I have a good diet and exercise a lot, so I cannot have a heart problem.’

060614_running3Look for the following:

  • chest pain, burning, ache or discomfort
  • palpitations
  • shortness of breath
  • dizziness
  • family history of heart problem or sudden death

One should see a physician should you have any of the above symptoms or if you have any unexplained symptoms or concerns. It is also important to participate in this activity only after adequate training. You should make sure you are well hydrated before and after the marathon. You should never push for completion of the marathon if you are having any of the above symptoms.

There is much controversy on how to prevent the incidence of cardiac arrest for marathon runners. One school of thought is that the marathon runner or athlete should undergo a complete evaluation by a physician which may include an electrocardiogram (EKG), echocardiogram (echo) and/or stress testing. Opponents of that thought suggest that it would be very expensive and we do not have the money or the resources. Most would agree to seek medical attention for above symptoms, as well as encourage athlete and physician education.

In the end, there are many preventable causes of cardiac arrest in athletes. The marathon runner should listen to his or her body and report any unusual symptoms instead of ignoring the body’s warnings. If you have any of the above mentioned symptoms or have risk factors, you should seek medical attention before starting or continuing the sport.

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