UNE coach died while running

In the spirit of furthering the knowledge of sudden cardiac death on this message board, I will continue with some important points.

Coronary heart disease (CHD), or blockages in the arteries, is the most common cause of sudden cardiac death (SCD) in the western world (roughly 70%). CHD and SCD are not exactly the same thing. However, SCD can be the first manifestation of coronary disease. We tend to think of people having a heart attack as having chest pain, going to the hospital, and then receiving treatment. Sadly, some people simply just die suddenly. For me, the distinction was a semantic one and not worth making when the point was to contribute to other readers' knowledge. Take home point: for most people, if you address risk factors for coronary disease...you are addressing risk for SCD.

"R-on-T" is a specific mechanism for a specific type of arrhythmia. It is a cardiac electrophysiology concept which is not even 100% understood by electrophysiologists. The concept is that the electrical environment in the heart muscle is not uniform throughout its entirety. In a condition called "long QT", this is even more true. Long QT can be inherited, caused by medications, or caused by electrolyte imbalances (the first two likely being inextricably linked). In the right setting, this electrical inhomogeneity can cause certain arrhythmias which can lead to SCD. It seems odd to me to expect that non-medical professionals are going to teach themselves ECG waves or read about phase singularities in order to have a working knowledge of R-on-T.

At least one poster, if not more, specifically requested an MD with expertise in the field to comment. I will do my best to contribute in a meaningful fashion. There are a host of conditions which surface in the running community and would be interesting to discuss.

Taking the high road I see. Semantics aside, as a physician, you should know that SCA/SCD and a heart attack are not regarded as the same thing in the medical community. 50% of people will die from their first heart attack. Does this mean that their death could be classified as a SCD? Yes, but in medicine, if you are referring to SCA/D, you are referring to death due to an arrhythmia.

This distinction in terminology helps prevent confusion like what initially took place in this thread (posters thinking the UNE coach died of a heart attack).

I'd be shocked if you were a Dr, but then again, I've seen worse.

I am granting that, in the medical arena, SCD and myocardial infarction (MI or heart attack) are not the same thing. Please review my post to see that, although that distinction can be made, doing so without appropriate explanation is potentially problematic.

Can sudden death from MI be said to represent SCD? Yes. Ischemia generates the very substrate (enhanced automaticity and delayed afterdepolarizations to name two) from which life-threatening arrhythmias are born. How do you think these people die? Ischemia kills by way of ventricular tachycardia/fibrillation in these cases. They are not dying from cardiogenic shock as death is not immediate in that scenario. Thus, death is due to a sudden arrhythmia as you pointed out...which is the case in SCD. Be it ischemia, myocardial disarray or fibrofatty infiltration interrupting conduction systems, electrolyte imbalance, or channelopathy....there is always a trigger for the arrhythmia. Arrhythmias do not occur out of absolutely nowhere. Picking and choosing which of those triggers is included under the umbrella of SCD is myopic.

I think it is useful to say: A tragedy such as the UNE coach dying from SCD could be due to many causes. A heart attack is one such cause. In an otherwise healthy younger runner, this is less likely than if he was 60 and a life-long smoker. It is more likely that another conditions was the culprit....and we have cataloged a great many of these conditions in this post.

If you want to "take the high road" then stick to the facts and engage in debate. Do not end each one of your posts with an emotional jab for which there is honestly no grounds.

Ischemia due to a heart attack does not cause these types of manifestations immediately. This is why a 1st class indication for an ICD (primary prevention) is a patient 40days post MI.

SCA means death due to an arrhythmia. How or why or what caused that arrhythmia is neither here nor there. The patient died from sudden onset VT/VF.

You don't say "SCD caused by excessive consumption of cheeseburgers" you say "SCD due to VF...or more likely, if talking with anyone in medicine, VF is already presumed.

"Ischemia due to a heart attack does not cause these types of manifestations immediately."

Yes it can...and by the mechanisms I just listed. See more proof below:

"Sudden cardiac death is the most common and often the first manifestation of coronary heart disease and is responsible for ≈50% of the mortality from cardiovascular disease in the United States and other developed countries."

Wellens, et al. "Sudden Cardiac Death". Circulation. 1998;98:2334-2351

"This is why a 1st class indication for an ICD (primary prevention) is a patient 40days post MI."

This is true but not for everyone with an MI. The answer is more nuanced than you suggest. It is only true for those who 1) presented with SCA, 2) have LV dysfunction 40 days post-MI and are NYHA I, 3) those who have LVEF

Oh well, it cut off the rest of my post.

Last points were..if you only said SCD and never teased out the "why", you would miss out on testing family members, addressing further risk factors, medications, etc.

All humans die eventually from VT/VF or PEA/Asystole. It is our final common pathway. The terminology and investigation of SCD has to be much more granular than just saying..."death from arrhythmia".

physician wrote:

"Ischemia due to a heart attack does not cause these types of manifestations immediately."

Yes it can...and by the mechanisms I just listed. See more proof below:

"Sudden cardiac death is the most common and often the first manifestation of coronary heart disease and is responsible for ≈50% of the mortality from cardiovascular disease in the United States and other developed countries."

Wellens, et al. "Sudden Cardiac Death". Circulation. 1998;98:2334-2351

"This is why a 1st class indication for an ICD (primary prevention) is a patient 40days post MI."

This is true but not for everyone with an MI. The answer is more nuanced than you suggest. It is only true for those who 1) presented with SCA, 2) have LV dysfunction 40 days post-MI and are NYHA I, 3) those who have LVEF

"1) Presented with SCA"....Well that wouldn't be primary prevention then would it?

The indication is 40days post MI, period. You're not a physician, stop pretending that you are.

Low wrote:

29 year old guy collapsed mid workout on a treadmill. It's a sad story. Assistant D3 coach and also was a HS track/xc coach as well. It's a scary scenario given that the guy was a good runner in high school, college, and beyond. Then this.

Best wishes to his family and athletes.

http://www.pressherald.com/2016/12/12/biddeford-high-track-coach-dies-at-29/

Yeah, what a blow.

The competitive running community is a very small community in comparison to other sports. We all know or have had a coach that has had some positive impact on our lives. We all know or have had a teammate that has also affected our lives positively. To be a coach, a person undoubtedly must have a personality aspect of his/her life that truly wants to see others succeed. A loss of anyone with that kind of personality aspect is a loss not just for their immediate friends and family but the world. A moment of silence for those that have lost their lives at such a young age. Perhaps he had a vision that he would be helping others succeed until old age, unfortunately it was cut short. In his honor, I hope to continue that vision for him.