Acute Coronary Thrombosis in Boston Marathon Runners

Albano, Alfred; Thompson, Paul D.; Kapur, Navin K.

doi:10.1056/nejmc1111015

Cited by 42 publications

(23 citation statements)

References 5 publications

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“…15,42 However, the significance of the elevated cardiac biomarkers after endurance efforts remains uncertain, and it has been argued that these may be entirely benign transient increases resulting from CV adaptations to long-term ET. 12,16,38,43 ADVERSE STRUCTURAL REMODELING Accumulating evidence suggests that the adverse effects of both short-term intense PA and cumulative endurance exercise are most apparent in the rightsided cardiac chambers. Cardiac output at rest is approximately 5 L/min but typically increases 5-fold to about 25 L/min during vigorous ET.…”

Section: Biomarker Evidence For Cardiac Damage With Extreme Endurance Etmentioning

confidence: 99%

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Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

O’Keefe

Patil

Lavie

et al. 2012

Mayo Clinic Proceedings

343

305

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A routine of regular exercise is highly effective for prevention and treatment of many common chronic diseases and improves cardiovascular (CV) health and longevity. However, long-term excessive endurance exercise may induce pathologic structural remodeling of the heart and large arteries. Emerging data suggest that chronic training for and competing in extreme endurance events such as marathons, ultramarathons, ironman distance triathlons, and very long distance bicycle races, can cause transient acute volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which return to normal within 1 week. Over months to years of repetitive injury, this process, in some individuals, may lead to patchy myocardial fibrosis, particularly in the atria, interventricular septum, and right ventricle, creating a substrate for atrial and ventricular arrhythmias. Additionally, long-term excessive sustained exercise may be associated with coronary artery calcification, diastolic dysfunction, and large-artery wall stiffening. However, this concept is still hypothetical and there is some inconsistency in the reported findings. Furthermore, lifelong vigorous exercisers generally have low mortality rates and excellent functional capacity. Notwithstanding, the hypothesis that long-term excessive endurance exercise may induce adverse CV remodeling warrants further investigation to identify at-risk individuals and formulate physical fitness regimens for conferring optimal CV health and longevity.

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Section: Biomarker Evidence For Cardiac Damage With Extreme Endurance Etmentioning

confidence: 99%

“…In athletes older than 30 years, CHD and acute myocardial infarction 16 and ischemia are the predominant causes of exercise-related SCD.…”

Section: Sudden Cardiac Death and Endurance Etmentioning

confidence: 99%

Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

O’Keefe

Patil

Lavie

et al. 2012

Mayo Clinic Proceedings

343

305

View full text Add to dashboard Cite

show abstract

“…A report of 3 runners with acute myocardial infarctions due to plaque rupture after the 2011 Boston marathon validates these findings in asymptomatic runners as relevant to the pathogenesis of cardiac arrest and sudden death in the epidemiological studies [13].…”

Section: Discussionmentioning

confidence: 68%

The rationale for pre-race aspirin to protect susceptible runners from sudden cardiac death during marathons: Deconstructing the Pheidippides conundrum

Siegel¹

2013

WJCD

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Objectives: While endurance exercise such as training for marathons is cardioprotective, cardiac arrests and sudden death occur in previously healthy runners during races predominantly in middle-aged males due to atherosclerotic heart disease. Recent evidence related to this problem is reviewed herein including epidemiologic studies and findings related to acute cardiac risk in asymptomatic middle-aged male runners during races. Method: Literature review related to the above. Findings: The risks of cardiac arrest and sudden death were 1 in 57,002 and 1 in 171,005 respectively in runners with a mean age of 49.7 years among 1,710,052 participants in marathons in the United States since 1980. Atherosclerotic heart disease was the cause of death in over 90% of cases in two retrospective studies and a greater than two-fold increase in cardiac arrests was observed in middle-aged men in the latter half of a 10-year prospective registry beginning in the year 2000. Asymptomatic middle-aged male runners showed elevated biomarkers of inflammation such as interleukin-6, C-reactive protein together with procoagulant effects including in vivo platelet activation, indicating susceptibility to atherothrombosis. Conclusions: Antithrombotic prophylaxis is evidencebased by validated clinical paradigms to prevent cardiac arrest and sudden death in susceptibile marathon runners at high risk for atherothrombosis during races.

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“…Acute coronary thrombosis has been described in several marathon runners immediately after completing the 2011 Boston Marathon [2]. Our case illustrates a fit, young seasonal marathon runner presented with acute occlusive coronary thrombosis which was successfully treated with thromboaspiration without balloon angioplasty and stenting.…”

Section: Discussionmentioning

confidence: 91%

“…Sudden cardiac death among marathon runners is 1 event per 100,000 participants [1]. There were reported cases of myocardial infarction after prolonged exercise with coronary artery thrombosis [2,3].…”

Section: Introductionmentioning

confidence: 99%

Twist of Fate of a Modern Day Pheidippides - Young Marathon Runner with Acute Right Coronary Artery Thrombosis

Tan¹

2017

J Cardiovasc Dis Diagn

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Acute Coronary Thrombosis in Boston Marathon Runners

Cited by 42 publications

References 5 publications

Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

The rationale for pre-race aspirin to protect susceptible runners from sudden cardiac death during marathons: Deconstructing the Pheidippides conundrum

Twist of Fate of a Modern Day Pheidippides - Young Marathon Runner with Acute Right Coronary Artery Thrombosis

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