Cardiac Arrest during Long-Distance Running Races

Kim, Jonathan H.; Malhotra, Rajeev; Chiampas, George; Troyanos, Chris; Cianca, John; Smith, Rex Neal; Wang, Thomas J.; Roberts, William O.; Thompson, Paul D.; Baggish, Aaron L.

doi:10.1056/nejmoa1106468

Cited by 521 publications

(414 citation statements)

References 35 publications

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“…The incidence is highest on Mondays. 45,46 In the young (<35 years), the most common cause of SCD is arrhythmia, mostly in the context of an apparently normal heart. 11,47 The most common causes of SCD are congenital abnormalities in those aged 0-13 years, primary arrhythmia in the 14-24-year age group, and CAD in those >25 years.…”

Section: Department Of Defense Cardiovascular Death Registry In the Umentioning

confidence: 99%

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A Clinical Perspective on Sudden Cardiac Death

2016

Arrhythmia &Amp; Electrophysiology Review

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This article presents the epidemiology, aetiology and pathophysiology of sudden cardiac death. The modern management of survivors as well as of family members of victims is discussed, as are the relevant recommendations of guidelines prepared by learned societies. KeywordsOut-of-hospital cardiac arrest, sports-related sudden death, sudden cardiac death, sudden unexplained death syndrome Disclosure: The authors have no conflicts of interest to declare.

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Section: Department Of Defense Cardiovascular Death Registry In the Umentioning

confidence: 99%

“…45 Some of these cardiac arrests might, however, have been provoked by heat stroke. 51 CAD is the predominant cause of SCD in older athletes.…”

Section: Vigorous Activity In Sedentary Individualsmentioning

confidence: 99%

A Clinical Perspective on Sudden Cardiac Death

2016

Arrhythmia &Amp; Electrophysiology Review

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“…Consequently, improving bystander response and survival following exercise‐related cardiac arrest are critical public health issues. Out‐of‐hospital cardiac arrest (OHCA) during exercise is likely to be a witnessed event; therefore, early initiation of cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use by bystanders could be critical in maximizing patient survival following cardiac arrest 5, 6, 7, 8…”

Section: Introductionmentioning

confidence: 99%

Exercise‐Related Out‐of‐Hospital Cardiac Arrest Among the General Population in the Era of Public‐Access Defibrillation: A Population‐Based Observation in Japan

Kiyohara

Nishiyama

Nishiuchi

et al. 2017

JAHA

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BackgroundExercise can trigger sudden cardiac arrest. Early initiation of cardiopulmonary resuscitation and automated external defibrillator use by laypersons could maximize the survival rate following exercise‐related out‐of‐hospital cardiac arrest (OHCA).Methods and Results OHCA data between 2005 and 2012 were obtained from a prospective population‐based OHCA registry in Osaka Prefecture. Patients with OHCA of presumed cardiac origin and occurring before emergency medical service personnel arrival were included. The incidence trends of exercise‐related OHCA over the 8‐year study period were assessed. Among patients with bystander‐witnessed, exercise‐related OHCA, the trends in the initiation of bystander cardiopulmonary resuscitation, public‐access defibrillation, and outcome were evaluated. The primary outcome was 1‐month survival with favorable neurological outcome, defined as cerebral performance category 1 or 2. During the study period, 0.7% of OHCAs of cardiac origin (222/31 030) were exercise related. The incidence of exercise‐related OHCA increased from 1.8 (per million population per year) in 2005 to 4.3 in 2012. Of these, 83.8% (186/222) were witnessed by bystanders. Among the patients with bystander‐witnessed, exercise‐related OHCA, the proportion that received bystander cardiopulmonary resuscitation (50.0% in 2005 and 86.2% in 2012) and public‐access defibrillation (7.1% in 2005 and 62.1% in 2012) significantly increased during the study period. Furthermore, the rate of 1‐month survival with favorable neurological outcome among these patients significantly improved (from 28.6% in 2005 to 58.6% in 2012).ConclusionsThe incidence rate of exercise‐related OHCA was low in the study population. The increase in bystander cardiopulmonary resuscitation and public‐access defibrillation rates were associated with improved outcome among patients with bystander‐witnessed, exercise‐related OHCA.

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“…The burden of ischemia during exercise in the cold will likely be even greater with more skin exposure to cold, and/or a longer duration of cold exposure. Observations from long‐distance running races suggest that ischemia burden alone may be sufficient to cause ventricular dysrhythmias and cardiac death 38. Moreover, cold stress may directly provoke arrhythmic cardiac death, through data demonstrating increased frequency of ventricular dysrhythmias during cold temperatures in patients with implanted cardioverter‐defibrillators 39.…”

Section: Discussionmentioning

confidence: 99%

Deleterious Effects of Cold Air Inhalation on Coronary Physiological Indices in Patients With Obstructive Coronary Artery Disease

Williams

Asrress

Lumley

et al. 2018

JAHA

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BackgroundCold air inhalation during exercise increases cardiac mortality, but the pathophysiology is unclear. During cold and exercise, dual‐sensor intracoronary wires measured coronary microvascular resistance (MVR) and blood flow velocity (CBF), and cardiac magnetic resonance measured subendocardial perfusion.Methods and ResultsForty‐two patients (62±9 years) undergoing cardiac catheterization, 32 with obstructive coronary stenoses and 10 without, performed either (1) 5 minutes of cold air inhalation (5°F) or (2) two 5‐minute supine‐cycling periods: 1 at room temperature and 1 during cold air inhalation (5°F) (randomized order). We compared rest and peak stress MVR, CBF, and subendocardial perfusion measurements. In patients with unobstructed coronary arteries (n=10), cold air inhalation at rest decreased MVR by 6% (P=0.41), increasing CBF by 20% (P<0.01). However, in patients with obstructive stenoses (n=10), cold air inhalation at rest increased MVR by 17% (P<0.01), reducing CBF by 3% (P=0.85). Consequently, in patients with obstructive stenoses undergoing the cardiac magnetic resonance protocol (n=10), cold air inhalation reduced subendocardial perfusion (P<0.05). Only patients with obstructive stenoses performed this protocol (n=12). Cycling at room temperature decreased MVR by 29% (P<0.001) and increased CBF by 61% (P<0.001). However, cold air inhalation during cycling blunted these adaptations in MVR (P=0.12) and CBF (P<0.05), an effect attributable to defective early diastolic CBF acceleration (P<0.05) and associated with greater ST‐segment depression (P<0.05).ConclusionsIn patients with obstructive coronary stenoses, cold air inhalation causes deleterious changes in MVR and CBF. These diminish or abolish the normal adaptations during exertion that ordinarily match myocardial blood supply to demand.

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Cardiac Arrest during Long-Distance Running Races

Cited by 521 publications

References 35 publications

A Clinical Perspective on Sudden Cardiac Death

A Clinical Perspective on Sudden Cardiac Death

Exercise‐Related Out‐of‐Hospital Cardiac Arrest Among the General Population in the Era of Public‐Access Defibrillation: A Population‐Based Observation in Japan

Deleterious Effects of Cold Air Inhalation on Coronary Physiological Indices in Patients With Obstructive Coronary Artery Disease

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