Is this an alarm that we should swim more to strengthen our hearts? Though similar tragedies happened to swimmers in the past, too, I believe. Seems all are in their late 50's?
News from
www.newsday.com/.../ny-nyrun0312133574nov03,0,6679842.story
Marathon runner dies after collapsing at finish line
BY DANIEL EDWARD ROSEN9:32 PM EST, November 2, 2008
A 58-year-old runner who had just finished the New York Marathon Sunday collapsed at the finish line after going into cardiac arrest and later died at a local hospital, police said.
Carlos Jose Gomes, of Sao Paolo, Brazil, was pronounced dead at Lenox Hill Hospital at about 5:20 p.m., police said. He had fallen ill after he crossed the finish line of the 26.2 mile race near the intersection of 81st Street and Central Park West.
Two other people suffered cardiac arrest Sunday while running in the race, police said.
A 59-year-old man collapsed in the middle of the Queensboro Bridge, police said. A fellow runner stopped and administered CPR until two emergency medical technicians arrived.
The runner was taken to New York-Presbyterian/Weill Cornell Medical Center, where he was listed as critical but stable, according to one of the EMTs.
Jean-Louis Maubaret, 59, a French national, was running alongside his wife across the Queensboro Bridge between the 15th and 16th mile of the race when he collapsed, unconscious and not breathing, according to EMT Salvatore Sangeniti.
Sangeniti, 47, of the New York Fire Department EMS Division 4, was crossing the bridge from the Manhattan side when he and his partner, Amanda Wong, received a radio call about the runner. They reached the middle of the bridge to find another runner performing CPR.
Sangeniti, of Centereach, said he placed a defibrillator on Maubaret's chest. After one shock, he said, the runner regained consciousness and resumed breathing.
The runner who performed CPR returned to the race once he saw that Maubaret had regained consciousness, Sangeniti said.
Another marathoner suffered cardiac arrest on East 107th Street yesterday afternoon. The man, whose name was not immediately known, had collapsed and was not breathing, according to an FDNY spokesman. EMTs performed CPR as he was rushed by ambulance to Mount Sinai Medical Center.
Former Member
This hits home for me today. My dad is having heart surgery as I write this. He is in excellent shape but has a genetic defect which causes blockages in tiny vessels. Heart rate monitors have saved his life since he monitors his heart rate as he runs, bikes and swims.
I hope today goes smoothly for your dad and he has a quick recovery. Sending healthy vibes his way...
I recently got a heart-rate training book which states that half the heart sends blood to the upper body and the other half to the lower body. If so, doing a form of exercise that only works half the body might not be enough. Bring on the cross-training!
Running exercises mostly the lower half, but swimming is better as it exercises all parts of the body.
Bad news, according to NY Times: by now two runners of the Sunday marathon have died.
Sorry to hear about your dad Alison...wish him the best of luck with all his recoveries...my dad too has prostate cancer...he's had it since I was 10 (12 years)...luckily treatment options are pretty good for placing it in remission these days. I'll keep him in my prayers!
Thanks Morgan. HE's home today and feeling great. He'll be back to his weekly walk along the river tomorrow.
My layman's understanding of cardiac death associated with exercise is that a "heart attack" is different from "sudden cardiac arrest"--though the two can be related.
A heart attack, or myocardial infarction, occurs when a blood clot (usually from a dislodged atherosclerotic plaque fragment) ends up blocking one of the coronary arteries, starving heart muscle of the oxygen and nutrients it needs to keep operating. When you have a heart attack, you can usually live long enough to get to the hospital; clot busting drugs (including tPa and even chewing an aspirin tablet) can make a difference. In a sense, a heart attack is a PLUMBING problem.
Sudden cardiac arrest, on the other hand, occurs when the electrical impulses that mediate coordinated beating of the heart chambers get badly out of whack, especially in the lower ventricles which supply blood to the body, brain, and lungs. Normally, the heart's pacemaker causes a regular thud-thud, thud-thud that correlates with the shunting of blood from the atria (upper two chambers) to the ventricles (lower two chambers) and then into circulation. In really bad cases, the electrical coordination here gets so out of whack that the heart beats like an uncoordinated "bag of worms"--Latin, I once heard, for fibrillation. Once this starts, your body, brain, lungs, etc. stop getting any blood supply. Victims of sudden cardiac arrest usually die within minutes if their hearts are not shocked back into a normal rhythm by a defibrillator. Sudden cardiac arrest thus is an ELECTRICAL problem.
Most athletes who die in marathons are victims of the cardiac arrest. In pool competitions, paramedics are supposed to have automatic defibrillators at the ready. I doubt there's been much research, but I would suspect that pool swimming would have a lower death rate than marathons because of proximity of defibrillators to the participating athletes. In open water swimming, I would think that sudden cardiac arrest would have even higher mortality because the victim would slip under the water and more likely drown without assistance.
One final note: atherosclerosis can contribute to sudden cardiac arrest by causing small classic heart attacks that scar the heart muscle, making it less able to propagate electrical signals properly. High blood pressure can also lead to pathological enlargement of heat muscle, which also affects electrical conduction in sometimes harmful ways. But the bottom line is that heart attacks and sudden cardiac arrest are two different problems.
"The majority of sudden deaths occurring in middle aged athletes are due to atherosclerosis with plaque rupture resulting in myocardial infarction (heart attack) and ventricular fibrillation."
So you are saying that the plaque rupture blocks one of the coronary arteries, the resulting blood insufficiency to heart muscle triggers the ventricular fibrillation, the ventricle then ceases to pump effectively, and the victim dies from systemic oxygen/nutrients depletion rather than merely just heart muscle insufficiency?
In other words, the m.i. triggers the v-fib?
If the m.i. does not trigger v-fib, and does not block so much blood flow to the heart that parts of it can continue to function a little, then the so-called coronary thrombosis patient (again, the "classic" heart attack) has pain and other symptoms, but can last for hours or longer, correct? It's only when v-fib (or other catastophic arrythmias) is triggered that he or she has only minutes to live, right?
Isn't it also possible that electrolyte imbalances, heat stress, pre-existing vulnerabilities in the heart's electrical system, etc. are also causes for v-fib in highly exertional exercise? When they do autopsies of victims of sudden cardiac death in exercisers, do most of the victims have evidence of blocked arteries that acted as the first domino and triggered the v-fib?
Let me paste in an excerpt from a story I wrote on this recently:
Another external culprit: extreme disturbances in the salts the body uses to propagate electrical signals. Ironically, this can happen in guys who otherwise epitomize robust health. So-called hyponatremia of exercise, for instance, strikes when endurance athletes drink too much water to remain well-hydrated in the heat while failing to replace the sodium and other key electrolytes they're sweating away. Despite revised fluid replacement guidelines from organizations like USA Track and Field,some runners continue to over-hydrate themselves literally to death.
"The electrical system of the heart relies on sodium and potassium and calcium to work," says William H. Maisel, MD, MPH, director of the Pacemaker and Device Service at Beth Israel Deaconess Medical Center. "If these get too far out of whack, it can lead to cardiac arrest--something that unfortunately still happens at almost every major marathon."
By far the most common cause of arrhythmias, however, are changes to the heart caused by the aging process itself, especially when this includes all-too-common co-travelers like high blood pressure, valve damage, and other forms of heart disease. It turns out, for instance, that cells in the sinus "pacemaker" are not the only ones capable of firing off an inaugurating electrical signal. Every cardiac muscle cell has this ability--and with age, the tendency increases for "loose cannons" to fire spontaneously, usurping the sinus's role
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Billy, as far as ibuprofen goes, as common as it is to pop a bunch of these and then go exercise, it's not a good idea. Besides kibboshing the prostaglandins that foster inflammaton, NSAIDs also hamper the prostaglandins that protect the stomach lining (causing ulcers or low grade bleeding in some people) and, even more importantly, hinder the prostaglandins that promote fluid flow through the kidneys. If you become dehydrated, and take a lot of NSAIDs, you are at risk for kidney failure. Though not common, one fellow after the Boston Marathon did precisely this and went into kidney failure on his flight home.
The evidence that NSAIDs promote healing is sketchy at best; most so-called tendinitis conditions are, in fact, tendonopathies--you want to foster blood flow to poorly vascularized tissues (like the Achilles tendon, knee, tennis elbow, shoulder, plantar fascia) rather than inhibit inflamation here. Hence newer techniques like nitroglycerine patches for some of the slow healing areas.
Just my layman's point of view based on hearing a talk about this at the ACSM conference and readings hither and yon from medline.
I don't think there is any additional health benefit to running and training for marathons, as opposed to routine physical activity such as an hourlong running or swimming workout several times a week. It does not surprise me at all to see people dying during marathons, you are putting your body under significant stress.
Researchers have known for a few years now that a marker for heart stress usually seen in heart attacks rises in the blood of marathon runners. Whether or not this is dangerous remains somewhat debated, but it does suggest that marathons are stressful to even well-trained hearts.
Representative study conclusion:
CONCLUSION: Troponin increases were relatively common among marathon finishers and can reach levels typically diagnostic for acute myocardial infarction. Less marathon experience and younger age appeared to be associated with troponin increases, whereas race duration and the presence of traditional cardiovascular risk factors were not. Further work is needed to determine the clinical significance of these findings.
Gull, just for the record, are you saying that the majority of cardiac arrest deaths in endurance exercise events are triggered by clots? Or is this just one of multiple possibilities, including other problems (perhaps unknown to the runner) such as valve damage, left ventricle hypertrophy from high blood pressure, hyponatremia, and/or foci for arrhythmia due to occult scar tissue from earlier small m.i.'s., etc. ?
"It does not surprise me at all to see people dying during marathons, you are putting your body under significant stress."
Believe me, if you're running at a slow pace, enjoying the views (NYC and Marine Corps Marathon), talking some, taking a ton of ibuprofen, you ain't stressing all that much, which was my case back in 1997,98 and 99. The training, that was stressful, all those long runs, without modern Ipods, with just those old Sony Walkmans with tapes...Jim Thornton summarizes well most of what happens. It seems this Brazilian guy who died in NYC was well trained, had all his tests done before training and running the marathon. Marathons are more dangerous for the fast athletes or for those who didn't prepare well enough. But usually all that hurts is your feet bones and joints after spending hours jogging along. The one factor that running has that is more dangerous than swimming is the fact that while running your heart has to pump blood upstream to your head and while swimming it just flows easily along, thus avoiding a problem (which might have killed Jim Fixx, of running fame) which is lack of oxygen to the brain.Unless swimming butterfly with poor technique (my case) it is pretty difficult to get your HR way up high while swimming.
But the bottom line is that heart attacks and sudden cardiac arrest are two different problems.
That is not a correct statement. The majority of sudden deaths occurring in middle aged athletes are due to atherosclerosis with plaque rupture resulting in myocardial infarction (heart attack) and ventricular fibrillation. And the survival rate for out of hospital cardiac arrest is only 10%.
It is true that patients with a prior history of myocardial infarction, particularly if they have sustained significant damage to the heart muscle, are at risk for sudden death on the basis of an arrhythmia, which at that point is a purely electrical problem. These individuals should have a defibrillator implanted prophylactically.
In young athletes, the most common cause of sudden death is hypertrophic cardiomyopathy.
The one factor that running has that is more dangerous than swimming is the fact that while running your heart has to pump blood upstream to your head and while swimming it just flows easily along, thus avoiding a problem (which might have killed Jim Fixx, of running fame) which is lack of oxygen to the brain.
Also incorrect. Blood flow to the brain ceases when your heart fibrillates, regardless of your body position. Jim Fixx had extensive atherosclerosis at the time of his death.
A 59-year-old man collapsed in the middle of the Queensboro Bridge, police said. A fellow runner stopped and administered CPR until two emergency medical technicians arrived.
I thought this was good to read. I'm glad to see there are still folks who will step in and do what's right.
