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Saturday, July 21, 2007

Sudden death in runners - isn't exercise meant to protect the heart?


A Heart Attack
is caused by a circulation or plumbing problem in the heart,;while Sudden Cardiac Arrest is caused by an electrical problem in the heart.

In our last post, we used the term heart attack, and were informed that this was incorrect, and should have been cardiac arrest - we disagree with the 'incorrect' part, though we acknowledge that sudden death during exercise can have electrical explanations, and so perhaps 'incomplete' would have been more appropriate! Ou
r focus in the post is primarily on the circulatory causes which we believe are still more prevalent, according to literature on runners (see the Jim Fixx section). In this post, then, we speak of heart attacks. I'm sure the 'purists' will shudder, but this is not a peer-reviewed journal article, so we have to take certain liberties or we would end up writing a thesis that no one would read - one of the prolems with science, sometimes. Perhaps in the future, we'll do a separate post on electrical disturbances...




The history of our perceptions





How often does it happen?


So what MIGHT HAVE happened to Salazar?


Studies from the 1980's and 1990's have found that virtually all the runners who die suddenly during exercise are suffering from some sort of serious heart disease before their fatal heart attack. There are probably about 30 possibilities, but we’ll focus on one or two.

Coronary artery disease (CAD)



Cardiac abnormalities





Ignoring the warning signs


So where does that leave you as a runner?



“runners are much like ordinary mortals. They can, sad to say, get sick. They can even die”.


R & J


Anonymous said...

What a great co-incidence, I have just discovered your blog and I have a relevant question for this topic. A month ago I went for a check-up, and was told by my doctor that I have high blood pressure and cholesterol. I run every day, between 30 and 60 minutes, and compete in some trail running races. My doctor wants to put me on medication, because he suspects my problem is hereditary. I’m a little worried that it will impact my running performance? And also weather it is safe to run (hard) when taking medication for these conditions? Are my competitive days over?

Ross Tucker and Jonathan Dugas said...

Hi there,

First, you should know that we are PhD's and not MD's. Therefore we are not medical practioners, and you should always seek medical advice from a licensed doctor.

Having said that, we are not aware of any effect on performance of cholestroel lowering medication, although this would depend on what type of drug it is and its mechanism of action.

Next, exercise has a profound effect on controlling hypertension. Many factors affect hypertension such as age, diet, and genetics, but if you exercise every day for 30-60 min this should be helping you control your hypertension. Only your age would then be a good reason to go on hypertensive medication, for example if you are perhaps 60 or older.

Can you get a second opinion? We would suggest seeing a specialist such as a sports clinician at a cardiac rehab facility. These doctors are trained in how exercise can be used as a successful intervention in chronic diseases of life style such as heart disease and hypertension.

Running "hard" can be an issue if you have hypertension or heart disease, and again depending on your age. As you age your risk increases, and therefore it is a good idea to run with a heart rate monitor to keep your heart rate within prescribed limits.

The bottom line is that cardiac risk is the combination of many different clinical variables plus your age and your sex and activity level. With the limited amount of info you have provided here, it is difficult to make real conclusions about your scenario.

Good luck, hope this helps.

Kind Regards,
The Sports Scientists
Ross and Jonathan

Anonymous said...

Thanks for the feedback, I suppose I should have given more details, I'm a 34 year old male (a little young to be worried about these problems, I though?) and I've been running for about 6 years now, also been following the usual lifestyle advice (cut salt / sugar / fat / red meat, eat vegetables / fruit etc. etc.)

That's why I got worried when the doctor said there might be a problem, since I assumed I was already living a healthy lifestyle.

In fact, I don’t think I can live much healthier than I already am, so medication does seem inevitable. My main concern is thus the impact of the medication.

I do however think I'll take your advice and seek a second opinion from somebody who’s a little more involved in sport.

Once again, thanks for the feedback.

PS. Also been running with a heart rate monitor for years...

Ross Tucker and Jonathan Dugas said...


Just to add - there are a couple of classes of BP medication. Often, they will first give you what is called a diuretic, and they have a very minimal effect on exercise performance. If that doesn't work, they can then choose between using something called a B-blocker, or an ACE inhibitor - technical names, I know, but don't worry about that.

The important thing is that the B-Blockers do have quite a large negative effect on performance, the ACE inhibitor group doesn't. So it's worth telling the doctor specifically that you need to keep exercising, and therefore need a class that will not affect you too badly. If the doctor can't comply with that request, then you certainly would need to think of another opinion!

Then the final thing is that you might even want to consider having your BP measured over an entire day (they call this an ambulatory measurement), because BP is known to fluctuate, and is it possible that your previous measurement just came at a time when your BP was on the high side?

If that's the case, then perhaps you normal BP is actually lower and normal? If not, then I would do further investigation, because usually, when someone is active, healthy and still young, high blood pressure is rare, and may be an indication that further tests are required. Without meaning to scare you, a doctor would not normally just classify someone as having hypertension given the circumstances here. So look into a more complete BP measurement and take it from there, perhaps?

Good luck
Ross and Jonathan

1 FIT RN said...

Medication only treats the symptom! When will (most) doctors start treating the CAUSE! The cause of CAD is cholesterol! It's true...look it up.

To have the best health (not to mention performance) research WHERE cholesterol comes from and STOP eating it! It is such a no brainer but many don't link it up.

Cholesterol is found in ALL animal proteins. Think you can't perform without animal protein...ask Carl Lewis, Edwin Moses, Ruth Heidrich, Brendan Braizer, Tim VanOrden, etc.

A good book is Thrive by professional Ironman Brendan Braizer.

ps If you start eating a healthy diet (which is defined as a diet with NO animal proteins and LOTS of raw veggies/fruits) please contact your physician because your cholesterol and bp meds will drop you SO quick you will have orthostatic hypotension and malabsorbtion problems.

Ross Tucker and Jonathan Dugas said...


Can't help feeling you've missed the point of the post somewhat - it was never meant to convey the best treatments for CAD, that's a separate issue altogether. This post was really a news insight post looking at the specific case of Salazar as applied to other runners who may be wondering about the fact that a super-fit elite athlete could suffer from such an event.

So our intention was never to advocate any form of prevention - of course it comes up, it's material to the argument. And so we agree with you 100%, but I don't think that it was the crucial message we were communicating. You are of course, correct, but this was not the ideal occasion to advocate it.


Jay said...

I am 61 years of age and after running 18 marathons I had a triple by-pass surgery about four months ago. While training for a half marathon, I ignored chest pains for six weeks. During tha half marathon, i had chest/shoulder pains for the first 11 miles, I ignored it. Due to intense running my heart had developed collateral arteries and I think they protected me from a heart attack. My recommendation to all runner is that go see a Cardiologist and get certified by him before you run any marathon.

Anonymous said...

it would seem a discussion of diet should take place here. it has been shown through change of diet you can reverse and prevent heart disease.
from my understanding a lot of heart attacks are caused when small blockages break free and make their way to the heart.
it would be interesting to know what Jim Fixx"s diet was like.

Stephen Walker, PhD said...

Hi guys,

Thanks for the good science here. My area of expertise involves health and sport psychology. My work is focused on mental conditioning for peak performance, however, this research and a very scary personal experience (similar to Alberto Salazar's) has long had me exploring this topic in earnest for several reasons - not the least of which includes the desire for a long and happy life. I come from a nightmare of genetic contributors to CHD, however, I've been ever vigilant and maintained an active lifestyle & excellent physical condition.

As both a healthcare provider and patient - I've been amazed at the ways in which this field has evolved...or hasn't evolved.

Cardiology as a medical discipline has maintained very controversial positions on preventive measures that I believe are very well documented. Whereas a subcommittee in the American College of Cardiology (SHAPE (stroke/heart attack prevention) has strongly advocated for EBCT heart scans and certain blood tests that identify inflammatory markers that cause platelets to become sticky - think clotting factor) - cardiology - as a collective - has focused on the best practices in managing cardiac events not preventing them.

In my case, a dental infection precipitated an inflammatory response that landed me in the coronary care unit. In 1996, who would have known? However, the science is much better now and the research has been extensive. However, the financial players in the USA have directed what is covered and whats not - never mind the research.

An EBCT heart scan and a slightly more elaborate blood test (either VAP test or PLAQ) test would have undeniably identified my risk. On a research effort I participated in with the Denver Bronco Alumni - it was determined that a risk stratification protocol is not only the way to go - but can offer an immense cost savings (prevention vs. treatment.) I write about this research in a posting on my own blog: "What Every CEO-COO Should Know About the Cost of a Heart Attack" - www.PodiumSportsJournal.com

I'm confident that your analysis on Ryan Shay's and Alberto Salazar's conditions is noteworthy, however, I also know that sudden cardiac arrest is not always from an electrical derivation. Unstable plaque burdens, stress hormones, inflammatory markers in the blood, etc. can play a much larger role than previously considered (think water quality of the blood vs a plumbing problem caused by deteriorating pipes.) Internal medicine specialists that understand this dynamic are much better suited to engage in preventive cardiology.

Even after many years, the standard protocols for evaluating a person's risk of HA in the USA begins with a treadmill and ends with angiography - the relative costs of risk stratification vs. traditionally conducted medical screening (covered by insurance vs EBCT/PLAQ testing(which is not)...I am finding the best medicine (aka preventive) is often not recommended since many physicians won't prescribe any test that is not included in an insurance carrier's formulary.

Not only could President Clinton's heart condition been diagnosed years earlier - the judicious employment of prescriptive medications and lifestyle adjustments would likely have enabled him to avoid a dangerous and horribly intrusive CABG surgery. Ever the optimist, I'm hoping new revisions in the health care plan recently adopted will properly emphasize prevention.

Thanks for addressing these issues and for providing a forum for discussion.