Sudden Death & Exercise Information
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  • 1. Ged Byrne BodyTech Main St. Tullyallen, Drogheda, Co. Louth Tele: 0868662814 Email: SUDDEN DEATH AND EXERCISE
  • 2. Ged Byrne BodyTech Main St. Tullyallen, Drogheda, Co. Louth Tele: 0868662814 Email: CONTENTS 1. Introduction 2. History 3. Causes of Sudden Death Syndrome 4. Who is at risk? / Treatment 5. References
  • 3. Ged Byrne BodyTech Main St. Tullyallen, Drogheda, Co. Louth Tele: 0868662814 Email: INTRODUCTION Sudden death or sudden cardiac death (SCD) is when the heart stops without warning. Most cases are related to an undetected heart disease, which can be inherited or acquired in both young people and old. Athletes and non athletes are at risk, it can occur in an apparently healthy person. One in 500 people have a gene that can lead to a condition called Hypertrophic Cardiomyopathy which if undiagnosed can cause SCD. 100 or more people under the age of 35 die each year from Sudden Cardiac Death in Ireland. Lack of physical activity is now considered to be the fourth major risk factor for coronary heart disease. Yet, on occasion, trained and apparently healthy athletes die suddenly during exercise. A graphic example of this tragedy is that of a 57 year-old American who collapsed and died within one minute after setting a regional master's record for the 3000-m run indoors. The athlete had not previously reported cardiac symptoms and a maximal exercise test performed 22 months before his death did not reveal any cardiac abnormalities. The first component of this issue that needs attention is whether these deaths during exercise actually prove that exercise is the real culprit and therefore a dangerous activity; or, stated differently, whether exercise and sudden death are causally related. The overriding conclusion from a large number of studies of sudden death, including sudden deaths that occur during exercise, has shown that virtually all persons who die suddenly during exercise have a serious disease, usually of the heart, that adequately explains the cause of death.
  • 4. HISTORY OF SUDDEN DEATH AND EXERCISE The first modern sport to attract a concern was rowing. In 1845, the seventh Oxford and Cambridge Boat Race was the first to be rowed on the current course on the Thames between Putney and Mortlake. No sooner had it moved to its longer course through the British capital than an irate letter written by one Frederick C. Skey, past president and fellow of the Royal College of Surgeons, appeared in the Times, charging that "the University Boat Race as at present established is a national folly." Skey claimed that rowing was bringing young men to an early grave. Almost a century later a letter that appeared in the Journal of the American Medical Association stating that all members of the 1948 Harvard rowing crew had since died "of various cardiac disease". The assertion was enthusiastically denied by these oarsmen, who reported that they were all alive and well. Cycling was the next sport to attract attention. In the 1890s North Americans suddenly discovered the bicycle, and medicine had another sport about which to express its alarm. Cyclists were warned that a long time spent cycling could cause "kyphosis bicyclistarum" or in lay terms "cyclist's stoop". Then, as expected, there was "cyclist's heart". The heart was limited to only a certain number of heart beats, these physicians asserted, and the faster heart rate during cycling would only waste these beats and lead to premature heart failure. In 1909 five eminent British physicians who started a correspondence in the Times by stating that "school and cross-country races exceeding one mile in distance were wholly unsuitable for boys under the age of nineteen, as the continued strain involved is apt to cause permanent injury to the heart and other organs." From an analysis of 16,000 schoolboys covering a period of twenty years, Lempriere could find only two cases of sudden death during exercise that was not due to accidents. He concluded that "heart strain through exercise is practically unknown", a conclusion echoed by Sir Adolphe Abraham, who denounced the concept of the strained athletic heart.
  • 5. Running became a medical cause célébre in the 1970's as the popularity of the sport bloomed. One of the first articles to question the safety of such activity reported that half of 59 sudden deaths occurred during or immediately after severe or moderate physical activity, especially jogging. The authors questioned "whether it is worth risking an instantaneous coronary death by indulging in an activity, the possible benefit of which.....has yet to be proved." They also considered "the possible lethal peril of violent exercise to [heart-disease] patients." More fuel was added to this controversy in the early 1980's by the sudden death while running of James Fixx, the celebrated American runner and author. Fixx had achieved international celebrity status as author of the book that became an international best-seller because it best captured the mood of the running explosion that occurred in the late 1970s. Paradoxically, in a later book Fixx had written an appropriate epitaph both to himself and to the concept that runners could earn immunity from both heart disease and death: "...runners are much like ordinary mortals. They can, sad to say, get sick. They can even die."
  • 6. CAUSES OF SUDDEN DEATH SYNDROME Also called Sudden Cardiac Death (SCD), can be caused by a number of different heart problems, many of which are inherited. Some of these conditions include: Hypertrophic Cardiomyopathy (HCM) HCM which in simple terms is called a chunky heart muscle heart disorder. This is the most common cause of Sudden Death in young people. It is a relatively uncommon heart disease, but it is estimated that ten thousand people in the UK have the condition. The heart muscle may thicken in people who have high blood pressure or who have prolonged athletic training, but in HCM patients the muscle thickens without an obvious cause. HCM is caused by abnormalities in genes which make the protein responsible for contraction of the heart. It is a hereditary disease, in the majority of cases the condition is inherited from a defective gene of one of the parents. HCM can affect both men and women, but is most slightly more common in the black population (African / Afro-Caribbean origin). HCM is present from conception and excessive growth of the muscle can begin before birth when the foetal heart is developing. The over growth interferes with the hearts normal contracting and relaxing, which results in reduced blood being ejected out from the heart.
  • 7. Coronary heart disease (CHD) CHD is caused by narrowing of the blood vessels in the heart which restricts blood flow. CHD affects both young and old people. Heart rhythm abnormalities (arrhythmia) Arrhythmia (abnormal heart beat) such as Long QT Syndrome and Brugada Syndrome may cause SCD. Long QT syndrome: An inherited disorder from a family gene which causes the heart to beat too quickly, too slowly or in an irregular way that predispose to fainting, dizziness and palpitations. Brugada Syndrome: also an inherited disorder related to the membranes of the heart muscle cells. It can result in life threatening heart rhythms.
  • 8. Disease of the hearts electrical system The heart has electrical pathways into its chambers. Wolff Parkinson White Syndrome: the heart has one or more extra electrical pathways which cause’s a cross over of pathways to the hearts chambers that can cause abnormal heart rhythms. It is a result of extra pathways between the atrium (upper chambers of the heart) and the ventricles (lower chambers of the heart) it is present in approximately 1.5 people per 1000 people. This picture shows the normal electrical pathways of the heart.
  • 9. Miscellaneous Cocaine abuse, Anabolic steroid use, Myocarditis: An inflammation of the heart muscle, most often caused by a viral infection. However it may also be caused by a bacterial infection, rheumatic fever or an adverse reaction to some types of drugs. But the more important point is that none of these conditions is caused by exercise, however vigorous. Rather, the evidence is clear that regular exercise acts against the development especially of coronary atherosclerosis. There is also no evidence that exercise accelerates the progression of these other potentially-lethal cardiac conditions. (Timothy D Noakes MBChB MD )
  • 10. Who is at risk? & Treatment  A person who has a family history of unexplained death (including cot death) in people under 35 years old.  Someone who finds themselves breathless on effort.  If a person has chest pain on effort.  A person with unknown causes of dizziness, fainting and blackouts.  People with a fast heart rate that comes and goes even when resting.  Palpitations due to an irregular heart rhythm (arrhythmia). If you have any of these symptoms you should speak to your doctor (GP). Investigations for possible heart problems include:  Medical examination including questions from your doctor about your family’s medical history for Sudden Cardiac Death.  An Echocardiogram also called an Echo which is an ultrasound scan (same as a scan for pregnant women to see there baby’s) to view moving images of the heart muscle and valves.  An electrocardiogram also called an ECG, this test measures the rhythm and the electrical activity of your heart. Small sticky pads are placed on the body connected to wires that are linked up to the ECG machine. The machine reads and records, on paper, the electrical signals from the heart.
  • 11.  MRI scan.  Other test may be needed. When a person’s heart stops, can anything help? Yes. The chain of survival has 4 links that need to be made quickly to give the best chance of survival.  Get help, dial 112 (the new emergency phone number that replaces 999)  Perform (cardio pulmonary resuscitation) CPR, which helps pump blood to the brain and other body organs  Defibrillation with an automated external defibrillator (AED) delivers an electric shock to the heart. This is the only action that can restore a normal heart beat rhythm  Advance care by a medical team
  • 12. REFERENCES Timothy D Noakes MBChB MD Physiology, University of Cape Town Medical School, Observatory 7925, South Africa. IRISH HEART FOUNDATION Ged Byrne BodyTech Main St. Tullyallen, Drogheda, Co. Louth Tele: 0868662814 Email: