Sudden Death During the Triathlon

Harris, Kevin M.; Henry, Jason; Rohman, Eric; Haas, Tammy S.; Maron, Barry J.

doi:10.1001/jama.2010.368

Cited by 87 publications

(72 citation statements)

References 5 publications

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“…12,13 The fatality rate for triathlons is approximately twice that of marathons, largely because of increased CV events and drownings during the swim portion of the races. 14 The incidence of SCD among collegiate athletes during competition is about 1 per 40,000 participants per year for all athletes. 15 It is extremely important to keep in mind that the occurrence of SCD during marathons, triathlons, and collegiate athletic events is rare and should not deter individuals from participating in vigorous ET; the benefits of regular PA to the individual and to society as a whole far outweigh potential risks.…”

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

342

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: 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

342

305

View full text Add to dashboard Cite

show abstract

“…3a), cardiac arrhythmias often occur in association with alternating short periods of tachycardia and bradycardia correlated with exercise. Based on this, it is not surprising that the swimming segment of cold water triathlons accounts for over 90% of race day deaths in human athletes 31 with cardiac malfunction cited as an underlying contributing factor 24 .…”

Section: Discussionmentioning

confidence: 99%

Exercise at depth alters bradycardia and incidence of cardiac anomalies in deep-diving marine mammals

et al. 2015

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Unlike their terrestrial ancestors, marine mammals routinely confront extreme physiological and physical challenges while breath-holding and pursuing prey at depth. To determine how cetaceans and pinnipeds accomplish deep-sea chases, we deployed animal-borne instruments that recorded high-resolution electrocardiograms, behaviour and flipper accelerations of bottlenose dolphins (Tursiops truncatus) and Weddell seals (Leptonychotes weddellii) diving from the surface to 4200 m. Here we report that both exercise and depth alter the bradycardia associated with the dive response, with the greatest impacts at depths inducing lung collapse. Unexpectedly, cardiac arrhythmias occurred in 473% of deep, aerobic dives, which we attribute to the interplay between sympathetic and parasympathetic drivers for exercise and diving, respectively. Such marked cardiac variability alters the common view of a stereotypic 'dive reflex' in diving mammals. It also suggests the persistence of ancestral terrestrial traits in cardiac function that may help explain the unique sensitivity of some deep-diving marine mammals to anthropogenic disturbances.

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“…By emphasizing the low SD incidence, we do not wish to suppress interest in secondary prevention treatment strategies that could further reduce the occurrence of these tragic events, ie, enhanced early resuscitation/defibrillation programs and wider dissemination of automated external defibrillators proven to be effective in the management of sudden cardiac arrest on the athletic field. 24,64,[142][143][144][145] The unexpected and counterintuitive deaths of young and apparently healthy people, potentially with decades of productive life ahead of them, deserve our full attention. The infrequency of these events in no way mitigates their importance or impact on families and the community.…”

Section: Limitationsmentioning

confidence: 99%

“…[144][145][146][147] Unlike those in sanctioned high school and college sports, these athletes are usually older adults who participate of their own volition and are most likely to have unsuspected coronary artery disease as the cause of SD, although occasionally HCM or congenital coronary anomalies are responsible. [144][145][146][147] Mandatory or mass screening in this athlete population is impractical given the thousands of participants annually, with disqualification for detected cardiovascular disease an unenforceable policy. By convention, participation in such sports has been the prerogative and responsibility of the adult athlete, who accepts the inherent risks of serious injury or death during athletic competition.…”

Section: Public Access Competitive Sportsmentioning

confidence: 99%