RE: Sad News. Alberto Salazar heart attack

The heart is both under endocrine and nervous stimulation.

PCI&stenting of the coronary arteries is indicated both in heart infaction and in ustable angina. In the case of unstable angina, it is not the occurance of an infarction (which is a permanent damage of the heart muscle) but chest pain due to acute ischemia of the hear. Usually because of a atherosclerotic thrombus that has ruptured and therefore clots one of the main arteries. If this is the case in this instance (since they say it is not a heart attack) he should be ok with proper medication and the stenting.

Marius

Mike Lundgren wrote:

To have a stent means that there was a significant narrowing in that coronary artery, that narrowing called PLAQUE. The plaque can rupture as it grows, and the body often responds by a blood clot forming to "heal over" the rupture, but often leads to a heart attack. As you have all seen on TV, that is called an ACS now, for Acute Coronary Syndrome, when the heart attack, or Myocardial Infarction, or MI, happens suddenly. So, yes, Al could have been running one day and have the plaque rupture the next.

He didn't have to have an MI, in fact the article states clearly that he didn't. He could've had unstable angina that required a stent. Theoretically he could've had Prinzmetal's angina too, though that wouldn't *usually* be treated with a stent.

If you read the end of my note, I talked about him having angina as the other possibility, and about POSSIBLY having an MI. Since we don't have access to his medical info, labs, etc., we don't know. I don't think you are saying anything I had already said.

Skuj wrote:

Look at the thread title....did AS have a serious heart attack? Is that not sad news? Sheesh! Thanks for the info, malmo.

What kind of training / running has AS been doing over the last 5-10 years?

Crazy! Get well, AS.

I was getting ready to run this morning,but when read this info.I went back and sit down after hearing sad news about American hero.I think I will take a day off today.Good athletes'doctors should take care of this kind of heart problems.

Malmo I just call you and left you a message to call me back thanks for this info.

Henry

Prinmetal's angina does not come from Coronary Artery Disease, so a stent doesn't help, plus it's extemely rare. To Marius, it's NOT atherosclerotic thombus that ruptures, it's the atherosclerotic PLAQUE that ruptures, leading to a thrombus which is also known as a clot.

Yes, the article said he didn't have a heart attack, but that is only assuming that that writer was given correct info, understood it, and wrote it correctly.

A high ranking Nike official saw him this morning and (according to his email)said that he was in good spirits, joking some. He did have a heart attack and stent placed, details not elaborated on. But it appears the cardiac arrest was from the heart attack (>20% of heart attacks do not make it to the hospital). He was given CPR on the bike path and EMS was just over a mile away at the fire station, unkown how long he was down for, but very fortunate to have survived. I do not have details of any sequela of his arrest, such as if there is any neurologic injury, but everything so far has been promising.

I know we have had a lot of speculations and seriously sad posts, will need to see what is revealed this week. Hope a complete and speedy recovery for Al and support for his family and friends. But let's wait for more information and keep speculations under control. All it takes is a plaque to rupture and bad things can happen quickly. Sad to see it happent to such a young and wonderful person.

I think it could be hereditary. A friend of mine recently had a stent put in after a stress test revealed that he had blockage. He's in his 50s, but has always been healthy and active. After my grandfather had some heart problems, including a heart attack, he persuaded my grandmother to get a stress test done. It was a good thing she did because she had severe artery blockage and now has 3 stents. She's has always watched her weight, walks 2 miles a day, and generally eats healthy. My sister is 22 and is a serious runner and cyclist, but has had to take medication for high BP that she had even when she was a young child. Unfortunately, no one is invincible, which is why it's a good idea to get checked out by a doctor every once in a while.

According to the American Heart Association's info, 75% of Coronary Artery Disease is lifestyle attributable, especially for people under age 60. Just because people exercise a bit, or don't smoke, doesn't mean that they are controlling their risks. Hypertension, cholesterol levels, poor diet, overweight, all contribute to that, not to mention early menopause/hysterectomies for women, and more. It's too easy to call it bad genes, and then write off any personal responsibities that are involved. This is largely a lifestyle disease, and not just whether someone can run 50 or 100 miles weekly.

Arterial blockage or plaque is caused by poor eating. Exercising doesn't change that. You can be superbly fit and have arteries that are nearly clogged. Next time you're choking down a Big Mac, think about it.

condolences to salazar and family, i pray for a speedy recovery.

about his condition- there seems to be a lot of speculation on this board on how a runner and such a good one could have suffered a heart attack or heart event, whichever it was. i would like to address a couple of things and strongly encourage people to listen to the evidence on matters of health and not hearsay on any message board or paper.

about a 1/3 of myocardial infarctions, or heart attacks, present as death. that means there are NO heart related symptoms before the fatal MI. a scary thought!

also, please do not listen to any posts that running causes or increases chances of heart related death or sudden death. this has been debated in the literature before and the fact remains that there is NO good data to suggest that the running has any long term detrimental cardiac implications. in fact, the data suggests quite the opposite. if someone tells you running is bad for your heart for this or that reason, ask for the data.

if he was stented, then he likely had an MI or at least some ischemia (unstable angina). (unfortunately, stenting has failed to improve mortality in any randomized, controlled trial.) it is also possible he came in with a tachyarrythmia, like ventricular tacchycardia or SVT, from an electrical disturbance in heart conduction, something that, though rare, a completely healthy (no heart disease) person can just get. if he was cathed, meaning a guided wire was placed in a vein(usually femoral) and run back up through to his heart to look for narrowing of a coronary artery (which supply blood to the muscles of the heart), and a narrowing was present, many cardiologist would stent this without good evidence that the narrowing is the culprit. (narrowing, even up to 90%, can be incidentally found on patients undergoing a cath for some other reason. these people are completely asymptomatic with a huge stenoses, which is quite interesting.)

some people on the board have mentioned Prinzmetal's, or variant, angina. this is caused by a spasm of the muscle in the coronary arteries and results in less flow of blood to the cardiac muscle. this is a rare condition and is most often seen in young women, though anyone can get it. unfortunately, if someone presents with acs due to variant angina, then they might be cathed and might be stented if a significant stenoses is seen. usually this does not happen, but since variant angina is a diagnosis of exclusion, it is not known til much after presentation. so this could certainly have happened.

basically one should not assume that any newspaper knows what the heck it is talking about when it comes to medicine and health. pop culture understandings of medicine are often quite inadequate and confusing (confusion is sometimes intractable from medicine no matter who explains it)

lastly, saying someone is in "serious" condition is quite arbitrary and subjective. in the hospital, words like stable, critical and serious are never used (in my experience) and have absolutely no standardized meaning. at the hospital where i work (as a physician), a large academic center, when someone calls the icu the nurse uses her own judgement, and may or may not be accurate, on whether someone is in x condition. so there is very little one can glean from this factoid, though newspapers love to use it.

Very interesting info. Just curious, what's your specialty? Hospitalist? Emergency medicine? Cardiology?

int. medicine

What I would like to know is how serious competitive running affects the heart. I am 47 in a week and wonder how the tough intervals I do affect my heart and health?

I think the hard training even today makes us stronger than the average joe. I can't train as hard or as many miles nowadays but still have resting heartrate in low 40's, upper 30's when I awake in morning.

But our family history still dictates how we live.

53 and counting.

the data is pretty limited in this. very little interest in studying health problems in the super fit. we have a lot of obese unhealthy adults to figure out first. in the few sudden deaths of seemingly healthy individuals there is almost always some unknown, preexisting pathology not related to running.

For whatever it's worth: I'm 52 years old. At 38, I had triple bypass. At 48, I had a very mild heart attack and had two stents put in--this two days after running for an hour in Big Sky, Montana, which is close to 8,000 feet, and feeling great. Three days after that the procedure failed, and I had to have new stents put in. I've been a runner since I was 15. I remain a runner (40 minutes a day). My problems are almost undoubtedly hereditary: my father and his five brothers all died of heart disease before reaching 53 years of age. However, in many cases--I'm not a physician, but I've spent more than my share of time in hospitals--we just don't know what the cause is. More importantly, the procedure AS had is relatively benign, and the prognosis generally excellent. If I have to have another stent put in, I doubt I would even be nervous in expectation of the procedure. By now AS is probably out of the hospital, and within a week or so he will be able to begin light jogging. As far as medicines, he'll probably be put on Toprol and/or Altace, the former is a Beta-Blocker and the latter an ACE inhibitor, both of which reduce the incidence of fatal heart attacks. My guess is that his life will be little affected by this, although he may need to modify his diet somewhat. For the rest of us, this should serve as a reminder that a lifetime of exercise is no guarantee that one is immune from cardiac episodes--and indeed as a general rule, I think just as when one is 50, one should have a colonoscopy, so when one is 40, one should start seeing a cardiologist or at least an internist once a year.

The tough intervals and overdistance miles are fine, unless you overtrain.

Running is associated with longevity and reduced CHD risk, even when that runner smokes, is overweight, or has other major risk factors for heart disease. Fitness is also linked to surviving through a heart attack, as in Alberto's case. Overall it is actually more lethal to be physically inactive than to smoke a pack of cigarettes/day.

High and low intensity exercise each produce oxidative stress in the body, with discernably differing aspects. However, the body typically adapts to these training demands by outstripping that added stress with an even greater production of an array of natural antioxidants, protecting the cellsc quite thoroughly.

The only real concerns here are that you are

1. not animal and trans fat loaded, which can clog arteries.

2. not deficient in minerals and key antoxidants, which can lead to an inflammatory state, insulin resistance, and elevated blood pressure, thus damaging arterial walls.

Thus the trend to pay as close attention to c-reactive protein levels in the blood as total cholesterol.

As stated previously, among other things, magnesium also helps maintain heart contractility and rhythm in addition to helping move sugar out of the blood stream, into the muscle.

Runners also tend to gorge, which is associated with higher cholesterol levels, triglycerides, and body weight. Overly strict dieting (also common among runners) can lead to deficiency in essential fatty acids (making cells more vulnerable), elevate blood pressure, and trigger heart rhythm disruptions, most of which by the way are completely safe.

The scientific literature is replete with studies highlighting the importance of diet and exercise in maintaining health. By training regularly, and providing your body w/ the optimal fuel for that training, you are also doing most everything you can do to take care of your health.

Admitedly, I have not always been a big Alberto fan, but I want to take this opportunity to wish him well, and very a speedy recovery. Hey Alberto, I'm glad you weren't outkicked!

dsrunner

I wish Alberto well!

I find that this thread has been good at drawing together information about heart problems in long term distance runners. Your recommendations are so correct Montesquieu. I am 71 and have raced/run/jogged since 1952. My father and my brother died of heart attacks at ages 52 and 53. My whole family has high blood pressure. I have taken toprol for many years. In January, I had my annual physical (several months late) and found that I had the usual and expected enlarged heart but that I also had a leaking valve and a fluttering heart. Since such a problem results in one having seven times the chance for a stroke, I agreed to take coumadin and recently had a cardio version. Both a week before my proceedure and a week after I jogged 80+ minutes with my two cardiologists. As of last Thursday my heart was working normally nad I now longer take coumadin.

I have found that a fair percent of long time, hard training distance runners have had leaking valves, (often resulting in cardio versions) and other problems due to their enlarged hearts. I know in my mind that running has extended my life. I now wonder how much of a negative affect that same running has had on we long term distance runners. By the way, of the group of about 48 distance runners that I have raced/trained/jogged and walked with each Sunday since 1971, three have died in their mid 80s. Another 7 still in the group are in their 80th year or older. Although many must now only walk the 80+ minutes each Sunday, NONE HAVE DIED OF HEART ATTACKS!

It appears that the positives of running far outweigh the negatives. What do the rest of you think?

Since I run upwards of 70 miles a week, I obviously consume more calories than the average Joe. That means I likely eat significantly more saturated fat and cholesterol. Does this increase my overall risk?