Sudden cardiac death during exercise

New study in the BMJ

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04/07/2008 at 17:27

I know we've discussed this before - but there is a new study reported in today's British Medical Journal here which might change our minds a bit.

Basically, in Italy there has been a mandatory screening programme for competative sportspeople looking for cardiac anomalies to try to cut down on the sudden deaths in athletes/sportspeople which grab the headlines from time to time.

We in the UK have always played down teh value of them, but a trawl back through the data of all the tests they have done in Italy over 5 years (30 000+!) has shown that a small but significant number of them (126) have no anomalies on resting ECG, but something important showing up on an ECG done on a treadmill. In 56 of them these were described as potentially fatal. That's about 1 in 500, which is more than I ever thought.

So - what do we think we should do about it? Is that enough of a pick-up to merit a screening program? It's certainly a higher rate than many conditions we screen for already, and a cheap and safe test. The study doesn't look at death rates - but I'm not sure about the ethics of letting it run that far somehow!

Any thoughts?

04/07/2008 at 20:05
It'd be nice if there was a free or cheap test that was optional - I'd be against anything compulsory as I imagine it would put people off competitive sport.    While 1 in 500 having a potentially fatal condition sounds shocking how many actually die of sudden cardiac failure due to the condition - a lot less than 1 in 500 sportspeople I'd  have thought. 
04/07/2008 at 20:13

If I had it I would rather not know to be honest unless there was something that could be done to prevent it from happening - I would be distraught if I had to give up exercise..... at least I would go quickly.

Just MHO

04/07/2008 at 20:22

Is there any point to this thread?

Some people have heart conditions....whether they run or not.

I dislike this kind of scare-mongering........just get out there and run!

If anybody is concerned about their health before they begin a running programme they should know the sensible thing to do is to have a medical check-up.

Your question of "what shall we do about it? Does it merit a screening programme?"..........Get Real!

04/07/2008 at 21:05

Feel the Pain - Yes -there is a point. I am, as far as I can know, real. People ask me about this as part of my job.

Why do you think that this is scaremongering? It's a factual report, based on the experiences of a country which funds it's healthcare differently to ours. They seem to be finding dangerous conditions better than we do, and report a way that we could improve.

If you do decide to go for a medical check up then you won't get the test outlined above - but you would in Italy or (I think) France. This should concern us,since the test seems to be of some value. You may not wish to think about it - fine - but it crops up often enough on these boards that others might wish to do so.

04/07/2008 at 21:06

Good thread BTB.

I attended a sports medicine conference recently where this subject was discussed.

A small % have gene defect that predicts them to sudden cardiac death. However the cardiac events some people have are brought on by exercise, so anything that raises awareness of such issues is in my view beneficial.

An example: in last year's London marathon - ok, exceptionally hot etc - BUT 75% of people treated by the medical services had ECG patterns showing mild myocardial infarctions (heart attacks). Why?....

The conditions? Fluid / nutrition? Insufficient training? Genetic predisposition?

Who knows, but that's too high a statistic to ignore it, I reckon.

It's not a recent problem either and this article gives some further information for those interested.

04/07/2008 at 21:21

Thanks for the link Siance. I think the difference between the tests that they review and today's study is that previously tests were done on subjects who weren't doing anything at the time - the Italian test is a stress test, so might begin to pick up those problems you identified where exercise is the precipitating factor.

Definitely need further study, as you say.

04/07/2008 at 22:35

Whats the purpose of this thread? Do you want people to be aware that they might have a heart attack when they are out running?

75% of people treated at the FLM basically had a mild heart attack! What a load of b*llocks!

Why don't you throw in that the guy who 'invented' the running boom in the USA had a heart attack.

Running gives 1000s of people a fantastic release and great exercise. No ifs or buts. 

Think about it....a normal healthy man/woman who is considering taking up running, and theres people like BTB and Siance scaring the shit out of them! ......Hold on a minute mate you might die of a heart attack!!

Don't worry BTB I'm sure the people who like to worry about everything in life will find this thread 'fascinating'.

04/07/2008 at 23:08
If people get put off running by this thread then they probably weren't going to keep running anyway.    I don't see any harm in discussing it - especially as it is compulsory that you have a test in some countries - no doubt it's the kind of thing that will appeal to campaigners for compulsory cycle helmet use or people who choose their car with reference to the latest crash test results.  
04/07/2008 at 23:27
Doesn't the Paris Marathon require you to have a valid medical certificate?
04/07/2008 at 23:40

What does the certificate say?..This person is capable of running 26.2 miles?.....Don't make me laugh.

Health and Safety Hitlers....Organisers are just covering themselves incase somebody enters thats never ran more than 10mins. and then obviously gets in trouble.

Jade Goody etc..

04/07/2008 at 23:54

A good healthy discussion doesn't do anyone any harm.  I don't think BTB or Siance are encouraging people not to run - just stimulating a bit of thought.

For my two-penneth-worth I find the research quite fascinating.  Doesn't put me off running, cycling or swimming, nor do I like to worry about everything in life. 

05/07/2008 at 00:21

If you believe this report, less than 0.2% of people 'could' be in danger when there H/B is raised. (BTBs figures 1 in 500).

They tested people of all ages ranging up to 80yrs old, many  living sedentary lifes. I'd have thought most people who have abused their body all their life and are 60+ will show certain 'problems'.

One minute they say meats bad for you, then dairy products, then drinking too much water! blah blah blah etc etc.

Excersise is good for you!.....All reports like this do is keep scientists in a job.

Screening programme for runners...lol...llol...I'm off to bed I can't take it anymore!

05/07/2008 at 13:04

FtP - if you've finished this morning's Daily Mail - what's wrong with sharing knowledge? As I said, I think offering to screen folks for exercise induced heart disease should be optional, but should we offer it at all? On the NHS or just privately? Once we have established that there is a way to predict a future problem with reasonable accuracy are we not morally obliged to consider offering it?

Obviously at least one country thought so, even before these figures were produced - don't be surprised if others do the same in time. Who might then insist on you having the test before letting you race in their country. (The French certificate needs to say that there is no contraindication to sports participation. This may change).

Of course there might be an EU wide regulation once we have signed up to the constitution...

05/07/2008 at 13:10
BtB - thanks - I regard that as useful information.
05/07/2008 at 13:26

I certainly think that providing links to such research are extremely useful and it does open up even more the debate about what healthcare should/could provide.

I have long argued that a preventative medical approach would in time result in savings to the health budget because potentially major, and expensive, health problems could be detected early enough to have more chance of successful treatment and for less intensive use of resources but that takes a long term approach and is unsuited to political soundbites of reducing waiting lists, providing more resources etc.

Evidence like this report all adds to the debate about what health care should be about. In the UK if one engages in sporting activity as a means of keeping fit, reducing obesity and the like what kind of imediate support is there on average if one suffers some bio mechanical problem through that sport. Unless very lucky - not a lot!!

05/07/2008 at 13:55

Assuming that I've correctly understood the initial post and BtB's responses to FtP ...

You seem to be advocating a screening programme that would identify those who could conceivably suddenly drop dead while exercising.

If there were to be such screening, I would suggest that it be carried out early in life in the hope of preventing sudden death in youngsters. But at my time of life I'd rather not submit myself to such a test. Having seen relatives die from long drawn-out and very nasty diseases, if I'm going to pop my clogs I'd rather do it quickly and just drop dead with no pain or warning. In fact, a sudden and massive cardiac arrest would be my departure of choice.

05/07/2008 at 14:00

<a title="eurheartj.oxfordjournals.org/cgi/content/abstract/23/6/477 " target="_blank">eurheartj.oxfordjournals.org/cgi/content/abstract/23/6/477 </a>might be of interest as it makes a link between "sport" and atrial fibrillation. Excuse me if I say it is not too technical.

I don't think we want to go down the road that exercise is bad for you. Living is bad for you!

It is no bad thing to be checked out, know the risks and perhaps improve at your sport by taking appropriate measures.

Dont' knock health & safety too much think of those who would be upset if something untoward happened to you.

05/07/2008 at 14:04
05/07/2008 at 14:15

"Dont' knock health & safety too much think of those who would be upset if something untoward happened to you."

..................or to one's children or grandchildren knowing that a test, costing £24, could reduce the chances of sudden death by  cardiomyopathy during sport by 90%

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