Jump to content
Sign in to follow this  
AA7

Deaths in Triathlons - A Possible Cause

Recommended Posts

51 minutes ago, more said:

Can u translate into English please? 

Left ventricular hypertrophy (LVH) was found in a high proportion of autopsies performed on people that died during a race. In turn this can lead to pulmonary oedema, which is fluid on the lungs, a life threatening condition. The left ventricle is the main pumping chamber of the heart, when it becomes enlarged, it doesn't function as it should. LVH can be caused by high blood pressure, obesity or sleep apnoea.

Moral of the story. As suspected, many of the people that have died had underlying cardiac conditions. Get yourself checked out, especially if you have those other risk factors listed above. 

  

  • Thanks 1

Share this post


Link to post
Share on other sites
1 hour ago, AA7 said:

Left ventricular hypertrophy (LVH) was found in a high proportion of autopsies performed on people that died during a race. In turn this can lead to pulmonary oedema, which is fluid on the lungs, a life threatening condition. The left ventricle is the main pumping chamber of the heart, when it becomes enlarged, it doesn't function as it should. LVH can be caused by high blood pressure, obesity or sleep apnoea.

Moral of the story. As suspected, many of the people that have died had underlying cardiac conditions. Get yourself checked out, especially if you have those other risk factors listed above. 

  

Hopefully this will stop people blaming race directors and water safety people for not doing a good enough job. 
 

 

Share this post


Link to post
Share on other sites

These are deaths that occurred from 2008-2015. I feel like there has been quite a few since then too. Maybe it's just because we're more likely to hear about them through social media.

Share this post


Link to post
Share on other sites

LVH is sometimes referred to as athlete's heart. It's an adaptation to heavy exercise:

https://academic.oup.com/ehjcimaging/article/10/3/350/2396955

My doc told me I have it, and that overall it's a good thing. I'm going to take this new info back to him and see what he says. It is fairly described as an underlying cardiac condition, but it's also a physiological change that's a consequence of our sport.

  • Thanks 1

Share this post


Link to post
Share on other sites

The root cause is athletes not seeing their doc for a regular check up. Guilty of that myself sometimes. The blood pressure thing isn't just for oldies either. You won't nessearily notice your blood pressure climbing over a period of time, but it can have a major impact as described in this paper and any literature on strokes. 

Get a check up, keep yourself healthy and race happy. Might save your loved ones from a bit of grief as well. 

  • Like 2

Share this post


Link to post
Share on other sites
3 hours ago, steve said:

LVH is sometimes referred to as athlete's heart. It's an adaptation to heavy exercise:

https://academic.oup.com/ehjcimaging/article/10/3/350/2396955

My doc told me I have it, and that overall it's a good thing. I'm going to take this new info back to him and see what he says. It is fairly described as an underlying cardiac condition, but it's also a physiological change that's a consequence of our sport.

Exactly right.

You can have enlarged ventricle that still pumps efficiently. But the alternative is a chunky heart that is a crap pump. An echo or stress echo can identify any issues. 

 

Edited by AA7
  • Like 1

Share this post


Link to post
Share on other sites
23 hours ago, steve said:

LVH is sometimes referred to as athlete's heart. It's an adaptation to heavy exercise:

https://academic.oup.com/ehjcimaging/article/10/3/350/2396955

My doc told me I have it, and that overall it's a good thing. I'm going to take this new info back to him and see what he says. It is fairly described as an underlying cardiac condition, but it's also a physiological change that's a consequence of our sport.

Is this doctor of yours a cardiologist? If not do as AA7 says... see a specialist 

20 hours ago, AA7 said:

Exactly right.

You can have enlarged ventricle that still pumps efficiently. But the alternative is a chunky heart that is a crap pump. An echo or stress echo can identify any issues. 

 

What I found interesting in that study was a couple of them had stents! Beware the mid life crisis reform! It's good to change your lifestyle but extreme changes I think are risky. Intensity and volume need to gradually increased. And again if you've had heart issues get a specialist's advice and have a discussion about risks vs benefits. There are no guarantees or 100% reliable formulae. 

The other aspect of interest to me was the immersion aspect. As I understand it is a hardwired adaptation so when we stick our heads in water the heart rate slows to help conserve oxygen. I'm wondering if this also plays a part - it seems so. I seem to hear of more heart attacks during the swim than any other leg. 

 

Edited by Slowman
Fix damn autoincorrect errors
  • Thanks 1

Share this post


Link to post
Share on other sites
21 minutes ago, Slowman said:

And again if you've had heart issues get a specialist'so advice and have a discussion about risks vs benefits. There are no guarantees or 100% reliable formulae. 

This! 

I was born with four congenital abnormalities which have over the years required various  repairs, I always make a rule of consulting my cardiac care team before making any drastic changes

23 minutes ago, Slowman said:

IThe other aspect of interest to me was the immersion aspect. As I understand there is a hardwired adaptation so when we stick our heads in water the heart rate slows to help conserve oxygen. I'm wondering if this also plays a part - it seems so. I seem to hear of more heart attacks during the swim than any other legal. 

 

This is interesting, I've always wondered if athletes blinded by the red mist of racing  have accidentally gone into hypoxia and if this is a contributor to cardiac arrest?

 

 

Share this post


Link to post
Share on other sites

Yes I was wondering along the same lines. If it is a factor perhaps hypoxic training would help or switching back to one sided breathing from bilateral when redlining. Speculation based on speculation - not a solid base, need more studies to investigate further of course.

  • Like 1

Share this post


Link to post
Share on other sites

not sure how 'fit' some of those persons that had passed away in triathlons were though. I have doubts 

Share this post


Link to post
Share on other sites

Perhaps a small percentage. The ones I've heard about (15) and the two I've witnessed in 34 years in the sport, were more to do with panic/anxiety resulting in elevated HR causing heart attack. The anxiety/panic brought on by a variety of factors ie. Cold water, weak swimmer, fear of open water and the list goes on. That total of 17  is world wide, not just Australia. There's definitely a lot more that I haven't heard of. 

Note that not all of those heart attacks I've heard about resulted in death. 9 of them survived. One that I witnessed here in Melbourne in early 90's is still around. his heart attack was brought on by panic in open water and an already present heart condition he didn't know about. 

 

Share this post


Link to post
Share on other sites

Seems my wife's heart issues are most likely a dodgy mitral valve, causing blood regurgitation.  She is on beta blockers, which really limit her performance.

Interestingly, the mitral valve is not so much of a problem on the bike as it is running.  She really struggles running.

We 'train' together now, and if she has not taken a beta blocker that day, her HR is always about 20 bpm above mine at the same speeds.  If she has taken the beta, our HRs are very similar, but she really struggles.  On the bike, she can go with me, but not on the run (& my running has been almost non-existent for 7 yrs).

Not sure what she can do other than valve surgery.  She was always winning her AG in fun runs (e.g Gold Coast, Hobart), but will they consider her a surgery candidate, given she is still extremely fit, but performance now limited?

I worry she will have a major heart incident.

Share this post


Link to post
Share on other sites
15 minutes ago, ComfortablyNumb said:

Seems my wife's heart issues are most likely a dodgy mitral valve, causing blood regurgitation.  She is on beta blockers, which really limit her performance.

Interestingly, the mitral valve is not so much of a problem on the bike as it is running.  She really struggles running.

We 'train' together now, and if she has not taken a beta blocker that day, her HR is always about 20 bpm above mine at the same speeds.  If she has taken the beta, our HRs are very similar, but she really struggles.  On the bike, she can go with me, but not on the run (& my running has been almost non-existent for 7 yrs).

Not sure what she can do other than valve surgery.  She was always winning her AG in fun runs (e.g Gold Coast, Hobart), but will they consider her a surgery candidate, given she is still extremely fit, but performance now limited?

I worry she will have a major heart incident.

Surgery is definitely an option once it gets to a certain point of incompetence. That's obviously something to be delayed as long as possible. If it doesn't affect normal, everyday living, they would be reluctant to fix it yet.

Share this post


Link to post
Share on other sites
1 hour ago, Greyman said:

Perhaps a small percentage. The ones I've heard about (15) and the two I've witnessed in 34 years in the sport, were more to do with panic/anxiety resulting in elevated HR causing heart attack. The anxiety/panic brought on by a variety of factors ie. Cold water, weak swimmer, fear of open water and the list goes on. That total of 17  is world wide, not just Australia. There's definitely a lot more that I haven't heard of. 

Note that not all of those heart attacks I've heard about resulted in death. 9 of them survived. One that I witnessed here in Melbourne in early 90's is still around. his heart attack was brought on by panic in open water and an already present heart condition he didn't know about. 

 

Elevated HRs per se do not cause heart attacks.

Share this post


Link to post
Share on other sites
18 minutes ago, ComfortablyNumb said:

Seems my wife's heart issues are most likely a dodgy mitral valve, causing blood regurgitation.  She is on beta blockers, which really limit her performance.

Interestingly, the mitral valve is not so much of a problem on the bike as it is running.  She really struggles running.

We 'train' together now, and if she has not taken a beta blocker that day, her HR is always about 20 bpm above mine at the same speeds.  If she has taken the beta, our HRs are very similar, but she really struggles.  On the bike, she can go with me, but not on the run (& my running has been almost non-existent for 7 yrs).

Not sure what she can do other than valve surgery.  She was always winning her AG in fun runs (e.g Gold Coast, Hobart), but will they consider her a surgery candidate, given she is still extremely fit, but performance now limited?

I worry she will have a major heart incident.

yeah, I know the feeling. I had a stent a few years ago and am on a low dosage of beta blocker. I dont know if it is a side effect, but sometimes my legs get abnormally tired.  

I still manage to do long runs and uptempo and 400's though.Heart rate is very difficult to get up over 145

Share this post


Link to post
Share on other sites
On 26 January 2020 at 6:21 PM, AA7 said:

Elevated HRs per se do not cause heart attacks.

Only quoting what the medical report outcomes as reported. stated. 

Share this post


Link to post
Share on other sites

Whilst article is interesting I think the information is vague and whilst I certainly agree that everyone should have regular checkups, this seems to be a little on the extremely low risk side. 

  • in 7 years there were 58 deaths recorded across 2 continents where the person was either training for or competing in a triathlon.
  • How many people actually swim in those continents let alone race triathlons (not sure if open water swimming was included)
  • 23 postmortem reports obtains (@40%) with (6 exceed normal values of wall thickness and 15 having large hears mass).  Note: nothing indicates that the 6 are part of the 15.  Its also possible that the person has had this state their entire life.
  • was present in a greater than the expected proportion of triathletes who died during the swim portion and find that it maybe a significant cause of death.

My frustration with studies like this is that it indicates that its unsafe to swim or exercise.  There doesn't seem to be any indication of whether the person has other medical conditions that attribute to the outcome.  To me they literally are looking at an outcome, the state of the person at that point and not necessarily studying, if there are other symptoms ore events that have led to the outcome. 

Like others said, panic attacks, getting belted / kicked in the swim, accidentally swallowing a mouthfull of water that then triggers panic attack.

  • Like 1

Share this post


Link to post
Share on other sites

I have enlarged ventricles, I have an annual cardiac ultrasound & tracing and review (by specialist cardiac imaging tech and consultant cardiologist) backed up by periodic stress tracing and MRI (but he deems me at risk as two of my four children have ICDs doe to HCM) so far my results are "athletic enlargement"  & "keep doing what you do and avoid caffeine". 

My research suggests to me (and not google either, peer-reviewed health journals etc) that some of the things they told us when we were younger are true - 

don't exercise when unwell, a good diet, proper sleep, and a regular check-up (PS the 2 of my kids with probs both had affinities for "energy drinks")

Share this post


Link to post
Share on other sites
On 29/01/2020 at 11:56 AM, Blobby said:

Whilst article is interesting I think the information is vague and whilst I certainly agree that everyone should have regular checkups, this seems to be a little on the extremely low risk side. 

  • in 7 years there were 58 deaths recorded across 2 continents where the person was either training for or competing in a triathlon.
  • How many people actually swim in those continents let alone race triathlons (not sure if open water swimming was included)
  • 23 postmortem reports obtains (@40%) with (6 exceed normal values of wall thickness and 15 having large hears mass).  Note: nothing indicates that the 6 are part of the 15.  Its also possible that the person has had this state their entire life.
  • was present in a greater than the expected proportion of triathletes who died during the swim portion and find that it maybe a significant cause of death.

My frustration with studies like this is that it indicates that its unsafe to swim or exercise.  There doesn't seem to be any indication of whether the person has other medical conditions that attribute to the outcome.  To me they literally are looking at an outcome, the state of the person at that point and not necessarily studying, if there are other symptoms ore events that have led to the outcome. 

Like others said, panic attacks, getting belted / kicked in the swim, accidentally swallowing a mouthfull of water that then triggers panic attack.

The medical condition that appears to be attributing to it is LVH, that is the conclusion from their study. Of course it isnt a huge number to study, because fortunately, death is triathlons is rare. And I dont think they're saying it is unsafe to swim or exercise.

Share this post


Link to post
Share on other sites
On 29/01/2020 at 12:56 PM, Blobby said:

Whilst article is interesting I think the information is vague and whilst I certainly agree that everyone should have regular checkups, this seems to be a little on the extremely low risk side. 

  • in 7 years there were 58 deaths recorded across 2 continents where the person was either training for or competing in a triathlon.
  • How many people actually swim in those continents let alone race triathlons (not sure if open water swimming was included)
  • 23 postmortem reports obtains (@40%) with (6 exceed normal values of wall thickness and 15 having large hears mass).  Note: nothing indicates that the 6 are part of the 15.  Its also possible that the person has had this state their entire life.
  • was present in a greater than the expected proportion of triathletes who died during the swim portion and find that it maybe a significant cause of death.

My frustration with studies like this is that it indicates that its unsafe to swim or exercise.  There doesn't seem to be any indication of whether the person has other medical conditions that attribute to the outcome.  To me they literally are looking at an outcome, the state of the person at that point and not necessarily studying, if there are other symptoms ore events that have led to the outcome. 

Like others said, panic attacks, getting belted / kicked in the swim, accidentally swallowing a mouthfull of water that then triggers panic attack.

Yes, I read through it with a skeptical mind and found there were quite a few holes, but I didn't have the time to put it down on paper. The other thing to look at is the determination of heart condition based on heart weight and their determination of "normal". I came away thinking that the study was pretty useless from stats perspective, bordering on anecdotal given the piss poor numbers and their attempts to present them as a percentage - remember 1% of 100 is 1 but 1 out of 1 is 100%....

Share this post


Link to post
Share on other sites
2 hours ago, PeterW said:

Yes, I read through it with a skeptical mind and found there were quite a few holes, but I didn't have the time to put it down on paper. The other thing to look at is the determination of heart condition based on heart weight and their determination of "normal". I came away thinking that the study was pretty useless from stats perspective, bordering on anecdotal given the piss poor numbers and their attempts to present them as a percentage - remember 1% of 100 is 1 but 1 out of 1 is 100%....

I think they're well aware of some of the limitations of their study, which is why their statements were, 'may be a possible cause' and 'should be explored further'. Due to the nature of their study, it isn't very easy to recruit subjects obviously.

Edited by AA7

Share this post


Link to post
Share on other sites

So LVH as a result of:

  • a long term history of endurance sport
  • genetically caused improper protein synthesis (leads to inefficient cardiac muscle which leads to hypertrophy - which can lead to reduced stroke volumes or even sudden valve distortion (ie fatal))
  • Other physiological or genetic factors (diabetes, chronic high blood pressure (suggested by aortic narrowing in 70% of their postmortems )

Others have suggest that an increase in LV stroke volume compared with a relatively greater rise in RV stroke volume during aquatic exertion, esp open water, has also been suggested to increase the  peripheral vascular resistance due to: prone positioning, immersion, a cold environment and systemic hypertension may exacerbate stroke volume mismatch.

Personally (and my research fields are primarily: education / IT / Business - but with a keen personal interest in health after nearly 40 years in tris and with a GP mum and pharmacist sister) I'd suggest that though they found "LVH—a marker of SIPO susceptibility—was present in a greater than the expected proportion of triathletes who died during the swim portion" this might be just as true for all deaths in otherwise undiagnosed individuals with the codicil that when things go wrong in open water the speed and efficacy of assistance is diminished (you are more likely to die than if it happened at a shopping center). But perhaps they just need more space to broaden their response (journal column inches being a precious commodity). 

as they say - further research into this area seems justified :) 

and here is another one for you:  rate of pulmonary edema during swimming in wetsuit v non-wetsuit events ( in plainer English: lungs filling with fluid caused by the increased pressure in the capillaries forcing a mismatch in the ejection RV v LV - with the difference anding up in the lungs).

Edited by trifun

Share this post


Link to post
Share on other sites

You've gotta go hard on these medicos to get a result.

My wife nearly walked out of the cardiologist today with the advice to take indigestion tablets & a bill for $160....until I impressed upon him that she was really struggling in training, had slowed down dramatically very quickly, and we wear HR monitors which show her HR consistently 20 above mine on piddly little runs she used to smash & I've not been able to run for 7yrs....hence something more than indigestion seems to be going on?

So instead, she is going to John Hunter Hospital to have her mitral valve scanned internally!

How many people die because they don't educate themselves about the condition and ask the hard questions of the over-paid  'expert'?

Share this post


Link to post
Share on other sites
2 hours ago, ComfortablyNumb said:

You've gotta go hard on these medicos to get a result.

My wife nearly walked out of the cardiologist today with the advice to take indigestion tablets & a bill for $160....until I impressed upon him that she was really struggling in training, had slowed down dramatically very quickly, and we wear HR monitors which show her HR consistently 20 above mine on piddly little runs she used to smash & I've not been able to run for 7yrs....hence something more than indigestion seems to be going on?

So instead, she is going to John Hunter Hospital to have her mitral valve scanned internally!

How many people die because they don't educate themselves about the condition and ask the hard questions of the over-paid  'expert'?

Agree, a few years ago my wife had been coughing considerable for weeks and I finally cracked it and took to emergency.  They ran a range of tests and after about 4 hours were going to release her with no real reason to the problem.  I argued with them for some time, a specialist came by and I pushed them as to a diagnosis and if they couldn't what other tests could be run, as I was convinced there was a problem.

There was 1 more test using nuclear dye (and can't be tested regularly).  I convinced him to run the test and it showed that she had blood clots on her lungs - which to this day we have no idea why, but at least we were able to get the proper treatment.

We know our bodies better than most, so anything that is abnormal needs to be checked out and you need to be convinced that the diagnosis is reasonable or get a second opinion.

 

  • Thanks 1

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...
Sign in to follow this  

×
×
  • Create New...