UNE coach died while running

My spouse had the same experience. Most good cardiologists will be able to spot these specific structural and EKG changes and link them to endurance sports with a good medical history interview.

off base wrote:

McVote wrote:

I'm no cardiologist, but the AED will not even activate for certain heart attacks...not sure what happened to this young man, but an AED may or may not have helped.

This was not a heart attack. It was sudden cardiac arrest. AEDs are often much more affective than CPR for SCA events. This is especially true for young, healthy victims. If the victim's rhythm is not one that responds to electric shock, the AED will provide that feedback and normal CPR should be continued until medical personal arrive.

While it's true that they can't save everyone, over 300,000 people die in the US every year from SCA that may have been prevented with quick use of an AED.

Yes, the article states that he died of sudden cardiac arrest, which is not a heart attack. If a young athlete (or anyone) goes down and is pulseless and apneic, CPR and an AED are first line treatments that can save lives (more so the AED).

The AED will determine if the rhythm is shockable or not, it is designed to treat pulseless VT/VF. The quicker it is applied, the more likely the patient will live. It is very important to know where the AED is located in your gym.

A heart attack often presents differently than a SCA, when a patient progresses from VT to VF, they will go unconscious very quickly (in seconds) due to the massive drop in blood pressure.

The reason why a long QT is potentially dangerous is because it increases the likelihood of an R on T phenomenon, where a R-wave falls during the vulnerable period on the T-wave which can lead to spontaneous VT/VF.

Are there any MDs/Cardiologists that can chime in? From what I know typically someone so young and active would have SCD due to an electrical issue in the heart. Could a lung infection like in this case have thrown electrolytes (mag or potassium etc.)off to put this person in an arrhythmia? And let's say an athlete has felt palpitations or dizziness during exercise prior, from my knowledge they'll do a resting EKG and check electrolytes but if all clear on resting EKG is that enough to clear the athlete? Should an exercise stress test be given to screen this type of athlete if the resting is benign is what I'm wondering? Is it insurance related why more stress tests aren't given or is this type of test not anymore accurate than the resting?

So no MDs on here? Just wondering as hearing, reading about this type of event scares ppl...and often ppl become very critical of the sport of running, however, I think in most SCD cases any sort of activity that raises the HR might trigger an event. The question is in healthcare are we doing enough to screen ppl particularly athletes?

Smoove, I'd be interested in talking with you privately. That was my highschool coach. I'd love to hear some stories.

Not an MD, but I work in the field that deals with these types of patients. A resting EKG and stress test/EKG can only go so far. They are tools in the tool box so to speak, along with holter monitors and implantable loop recorders.

If the athlete complains of syncope and palpitations during exercise, they will likely undergo a resting EKG, along with a stress test and holter.

A resting EKG can pick up abnormalities such as a WPW pattern, which puts someone at greater risk for a lethal arrhythmia. A stress test/holter could also show something like frequent PVC's or non. sust. runs of VT during exercise, or it could show a supraventricular tachycardia such as AVRT or AVNRT ( both not lethal unless associated with WPW - and usually only AVRT is associated with WPW).

Hypokalemia can lead to VT, and hypocalcemia can prolong the QT interval, which can lead to an R on T phenomenon, and spontaneous VT/VF.

ARVD and Hypertrophic Cardiomyopathy are also associated with SCD in young athletes, particularly ARVD. ARVD can be picked up through a series of tests to include a resting EKG and Echo. A right bundle branch block is rare in young people, particularly young athletes, so a young athlete with a RBBB presenting on a resting EKG would raise suspicion for ARVD.

Sure. Reach out to me at ymca_runner@hotmail.com

I know my heart is screwed up. When I lay on right side in bed my heart feels like it's pressing against my chest wall and I lose my breath.

Time to switch to your right hand stardust.

jamin wrote:

I know my heart is screwed up. When I lay on right side in bed my heart feels like it's pressing against my chest wall and I lose my breath.

jamin wrote:

I know my heart is screwed up. When I lay on right side in bed my heart feels like it's pressing against my chest wall and I lose my breath.

en.m.wikipedia.org/wiki/Somatic_symptom_disorder

Such a sad news.

I went to a test 4 years ago, where a heart specialist looked at my heart with some machine (like a md uses on pregnant women), think it was called an echo. And EKG was done. He told me I had a big heart (athletes heart) but not in a bad medical way. Does that mean I have done all the testing that needs to be done for life? I run every day and news like this are always scary.

Zee wrote:

Are there any MDs/Cardiologists that can chime in? From what I know typically someone so young and active would have SCD due to an electrical issue in the heart. Could a lung infection like in this case have thrown electrolytes (mag or potassium etc.)off to put this person in an arrhythmia? And let's say an athlete has felt palpitations or dizziness during exercise prior, from my knowledge they'll do a resting EKG and check electrolytes but if all clear on resting EKG is that enough to clear the athlete? Should an exercise stress test be given to screen this type of athlete if the resting is benign is what I'm wondering? Is it insurance related why more stress tests aren't given or is this type of test not anymore accurate than the resting?

Also not an MD, but if in addition to lung infection he had myocarditis, that would definitely increase the risk of SCD.

Thank you for the response. I am not sure also if we need to be more conservative about exercising with or right after an infection. I'm just a floor nurse but potassium supplements are given often by our docs the moment they see anyone's potassium even a little low. With an infection,diarrhea, vomiting, kidney issues the list goes on its not uncommon for someone's electrolytes to be off. I'm just not sure if we need to be more careful with taxing our hearts/lungs until fully recovered from illness. Of course healthcare providers should be checking all these things prior to clearing an athlete to exercise I would hope. I think we also need to be more educated all the way around maybe researching SCD causes more. I know that we hear a lot that there can be a genetic link but maybe we need to look more at exercising with or after infections. Overall just making sure if an athlete presents with symptoms or have a history of symptoms that all bases are covered.

Of course we need to be WAYY more conservative around infections. The best treatment is prevention. I train with a HR monitor, and if my HR is elevated too much at my normal pace, I pack it in. Not only for things like cardiac risk, but for all around recovery and prevention of infection in the first place.

I'm just not sure if many outpatient providers that are not cardiologists routinley f/u with a stress test/holster if the resting EKG is benign? For an athlete that experiences an episode of syncope/chest pain etc. should we advocate for the stress/holter if the resting is clear in your opinion?

The point someone made about the myocarditis was good too and goes along w/the question about exercising with an infection...I know most of us are guilty of exercising when sick I am just concerned if that should be taken more seriously by everyone overall.

Zee wrote:

I'm just not sure if many outpatient providers that are not cardiologists routinley f/u with a stress test/holster if the resting EKG is benign? For an athlete that experiences an episode of syncope/chest pain etc. should we advocate for the stress/holter if the resting is clear in your opinion?

The point someone made about the myocarditis was good too and goes along w/the question about exercising with an infection...I know most of us are guilty of exercising when sick I am just concerned if that should be taken more seriously by everyone overall.

IF the athlete experienced symptoms while exercising, and those symptoms could potentially be cardiac in nature, then they would definitely follow up with stress test/holter.

FWIW I was diagnosed with and had an ablation for AVNRT, it's how it I learned about and got involved with the field that I am in now.

My primary care physician ran a resting EKG (which was read by a cardiologist), and I had the stress test and got a holter within two weeks.

Both the EKG and stress test were normal. I explained my symptoms (frequent episodes of a very fast heart rate following intense exercise/syncope.) I didn't even have to ask for the holter. Once I got it, I went out to the track and ran intervals until I put myself in an episode. I recorded it (HR was 260bpm) and got the ablation done within two months.

Indications are more stringent for treatment than they are for testing. The total cost of running an EKG/Stress test/Holter is minimal compared to the implantation of an ICD for example. But while indications (i.e. class I, class II etc.) are often used as guidelines for insurance and cost purposes, they also weigh the risks and benefits for patients.

Invasive medical procedures are serious business and can have serious complications. As such, if they are not needed, then they should be avoided. Reading EKG's is not a perfect science and even abnormal findings can be benign in nature. More invasive testing can lead to unnecessary treatment. It is a careful balancing act, but in my experience, both in work and as a patient, problems potentially of cardiac origin are regarded very seriously by the medical community.

There is a lot of misinformation on these boards which is presented in a very confident, matter of fact manner. Please do not post medical advice if you are not an MD. Even then, it's not a very good idea.

I am an academic physician actively engaged in research concerning sports cardiology.

A couple of quick points and corrections (not advice):

1. Sudden cardiac arrest means only that the heart "stopped" and is the cause of death. It CAN be a heart attack, despite what some have stated on this board. It can be any of a host of arrhythmias: Ventricular tachycardia (including torsades de pointe), ventricular fibrillation, but very very rarely SVT (including wolf parkinson white usually with atrial fibrillation, AVNRT, and others). These arrhythmias can be due to a heart attack (either from traditional blockages of the arteries or birth defects with the arteries that feed the heart). They can be due to genetic cardiomyopathies (ARVC, HOCM, non-ischemic cardiomyopathy), acquired cardiomyopathies, myocarditis, and many others.

2. AED's and high-quality chest compressions are likely the ONLY things that will save someone's life. Period. Are there some arrhythmias that do not respond to AED's? Yes. However, it would be virtually criminal to avoid using an AED because you read that on Letsrun. Please keep in mind, 99.9999% of people on this message board have literally no idea what they're saying. It just sounds good to them and makes them feel better about themselves.

3. The difference between the "athlete heart" and problematic conditions such as hypertrophic cardiomyopathy is not something understood by the general practitioner or even the general cardiologist. You will need a sports cardiologist to tease out the difference. Even then, you may actually have to de-train to see the difference. The diagnosis of ARVC is even more difficult sometimes requiring special electrophysiology studies and even genetic studies to truly answer the question.

4. Listening to advice about electrolytes (and the replacement thereof), drug-induced changes to the QT interval, someone's odd need to describe the R on T phenomenon to non-physicians (who have no idea what an R or a T is) is NOT a good idea. If you have concerns over your health, consult a physician and have a low threshold to seek the expertise of a sports cardiologist.

Dude, you need to go for a run. Your medical points were sound, but your opinions of the other posters were way off base.

physician wrote:

There is a lot of misinformation on these boards which is presented in a very confident, matter of fact manner. Please do not post medical advice if you are not an MD. Even then, it's not a very good idea.

The only medical advice I read here was around getting checked out by a doctor; which is advice even a non-MD is qualified to give.

physician wrote: However, it would be virtually criminal to avoid using an AED because you read that on Letsrun.

Nobody said not to use it. One guy suggested it would not work every time, which must be a correct observation.

physician wrote: Please keep in mind, 99.9999% of people on this message board have literally no idea what they're saying. It just sounds good to them and makes them feel better about themselves.

Take a deep breath. People are way smarter than you give them credit for. Even the average man on the street (IQ=100), on an average day, is right more than 99% of the time in his decisions. Here on letsrun, we have a pretty good idea when someone is blowing smoke.

Fair enough. It was likely a bit heavy-handed. My apologies.

However, it's the certainty with which posters present their opinions that bothers me. It's never "I have heard..." or "I think X but I would verify". It's always a statement of "fact".

Some of the corrections I attempted to address were so that no one acts on these random assertions. Just because YOU can tease out the semantic differences in some of the points raised does not mean every reader on this board can as well. Despite your well-taken point on tone and over-reading "advice", I do believe very distinct clarification is required when information is posted here.

It isn't if we're debating the best shoe of the season, we're discussing sudden cardiac death. Pardon me if I think the stakes are rather high here.