Sudden cardiac death during exercise

I know we've discussed this before - but there is a new study reported in today's British Medical Journal here which might change our minds a bit.

Basically, in Italy there has been a mandatory screening programme for competative sportspeople looking for cardiac anomalies to try to cut down on the sudden deaths in athletes/sportspeople which grab the headlines from time to time.

We in the UK have always played down teh value of them, but a trawl back through the data of all the tests they have done in Italy over 5 years (30 000+!) has shown that a small but significant number of them (126) have no anomalies on resting ECG, but something important showing up on an ECG done on a treadmill. In 56 of them these were described as potentially fatal. That's about 1 in 500, which is more than I ever thought.

So - what do we think we should do about it? Is that enough of a pick-up to merit a screening program? It's certainly a higher rate than many conditions we screen for already, and a cheap and safe test. The study doesn't look at death rates - but I'm not sure about the ethics of letting it run that far somehow!

Any thoughts?

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Comments

  • popsiderpopsider ✭✭✭
    It'd be nice if there was a free or cheap test that was optional - I'd be against anything compulsory as I imagine it would put people off competitive sport.    While 1 in 500 having a potentially fatal condition sounds shocking how many actually die of sudden cardiac failure due to the condition - a lot less than 1 in 500 sportspeople I'd  have thought. 
  • If I had it I would rather not know to be honest unless there was something that could be done to prevent it from happening - I would be distraught if I had to give up exercise..... at least I would go quickly.

    Just MHO

  • Is there any point to this thread?

    Some people have heart conditions....whether they run or not.

    I dislike this kind of scare-mongering........just get out there and run!

    If anybody is concerned about their health before they begin a running programme they should know the sensible thing to do is to have a medical check-up.

    Your question of "what shall we do about it? Does it merit a screening programme?"..........Get Real!

  • Feel the Pain - Yes -there is a point. I am, as far as I can know, real. People ask me about this as part of my job.

    Why do you think that this is scaremongering? It's a factual report, based on the experiences of a country which funds it's healthcare differently to ours. They seem to be finding dangerous conditions better than we do, and report a way that we could improve.

    If you do decide to go for a medical check up then you won't get the test outlined above - but you would in Italy or (I think) France. This should concern us,since the test seems to be of some value. You may not wish to think about it - fine - but it crops up often enough on these boards that others might wish to do so.

  • Good thread BTB.

    I attended a sports medicine conference recently where this subject was discussed.

    A small % have gene defect that predicts them to sudden cardiac death. However the cardiac events some people have are brought on by exercise, so anything that raises awareness of such issues is in my view beneficial.

    An example: in last year's London marathon - ok, exceptionally hot etc - BUT 75% of people treated by the medical services had ECG patterns showing mild myocardial infarctions (heart attacks). Why?....

    The conditions? Fluid / nutrition? Insufficient training? Genetic predisposition?

    Who knows, but that's too high a statistic to ignore it, I reckon.

    It's not a recent problem either and this article gives some further information for those interested.

  • Thanks for the link Siance. I think the difference between the tests that they review and today's study is that previously tests were done on subjects who weren't doing anything at the time - the Italian test is a stress test, so might begin to pick up those problems you identified where exercise is the precipitating factor.

    Definitely need further study, as you say.

  • Whats the purpose of this thread? Do you want people to be aware that they might have a heart attack when they are out running?

    75% of people treated at the FLM basically had a mild heart attack! What a load of b*llocks!

    Why don't you throw in that the guy who 'invented' the running boom in the USA had a heart attack.

    Running gives 1000s of people a fantastic release and great exercise. No ifs or buts. 

    Think about it....a normal healthy man/woman who is considering taking up running, and theres people like BTB and Siance scaring the shit out of them! ......Hold on a minute mate you might die of a heart attack!!

    Don't worry BTB I'm sure the people who like to worry about everything in life will find this thread 'fascinating'.

  • popsiderpopsider ✭✭✭
    If people get put off running by this thread then they probably weren't going to keep running anyway.    I don't see any harm in discussing it - especially as it is compulsory that you have a test in some countries - no doubt it's the kind of thing that will appeal to campaigners for compulsory cycle helmet use or people who choose their car with reference to the latest crash test results.  
  • Doesn't the Paris Marathon require you to have a valid medical certificate?
  • What does the certificate say?..This person is capable of running 26.2 miles?.....Don't make me laugh.

    Health and Safety Hitlers....Organisers are just covering themselves incase somebody enters thats never ran more than 10mins. and then obviously gets in trouble.

    Jade Goody etc..

  • A good healthy discussion doesn't do anyone any harm.  I don't think BTB or Siance are encouraging people not to run - just stimulating a bit of thought.

    For my two-penneth-worth I find the research quite fascinating.  Doesn't put me off running, cycling or swimming, nor do I like to worry about everything in life. 

  • If you believe this report, less than 0.2% of people 'could' be in danger when there H/B is raised. (BTBs figures 1 in 500).

    They tested people of all ages ranging up to 80yrs old, many  living sedentary lifes. I'd have thought most people who have abused their body all their life and are 60+ will show certain 'problems'.

    One minute they say meats bad for you, then dairy products, then drinking too much water! blah blah blah etc etc.

    Excersise is good for you!.....All reports like this do is keep scientists in a job.

    Screening programme for runners...lol...llol...I'm off to bed I can't take it anymore!

  • FtP - if you've finished this morning's Daily Mail - what's wrong with sharing knowledge? As I said, I think offering to screen folks for exercise induced heart disease should be optional, but should we offer it at all? On the NHS or just privately? Once we have established that there is a way to predict a future problem with reasonable accuracy are we not morally obliged to consider offering it?

    Obviously at least one country thought so, even before these figures were produced - don't be surprised if others do the same in time. Who might then insist on you having the test before letting you race in their country. (The French certificate needs to say that there is no contraindication to sports participation. This may change).

    Of course there might be an EU wide regulation once we have signed up to the constitution...

  • BtB - thanks - I regard that as useful information.
  • I certainly think that providing links to such research are extremely useful and it does open up even more the debate about what healthcare should/could provide.

    I have long argued that a preventative medical approach would in time result in savings to the health budget because potentially major, and expensive, health problems could be detected early enough to have more chance of successful treatment and for less intensive use of resources but that takes a long term approach and is unsuited to political soundbites of reducing waiting lists, providing more resources etc.

    Evidence like this report all adds to the debate about what health care should be about. In the UK if one engages in sporting activity as a means of keeping fit, reducing obesity and the like what kind of imediate support is there on average if one suffers some bio mechanical problem through that sport. Unless very lucky - not a lot!!

  • MuttleyMuttley ✭✭✭

    Assuming that I've correctly understood the initial post and BtB's responses to FtP ...

    You seem to be advocating a screening programme that would identify those who could conceivably suddenly drop dead while exercising.

    If there were to be such screening, I would suggest that it be carried out early in life in the hope of preventing sudden death in youngsters. But at my time of life I'd rather not submit myself to such a test. Having seen relatives die from long drawn-out and very nasty diseases, if I'm going to pop my clogs I'd rather do it quickly and just drop dead with no pain or warning. In fact, a sudden and massive cardiac arrest would be my departure of choice.

  • MartenkayMartenkay ✭✭✭

    <a title="eurheartj.oxfordjournals.org/cgi/content/abstract/23/6/477 " target="_blank">eurheartj.oxfordjournals.org/cgi/content/abstract/23/6/477 </a>might be of interest as it makes a link between "sport" and atrial fibrillation. Excuse me if I say it is not too technical.

    I don't think we want to go down the road that exercise is bad for you. Living is bad for you!

    It is no bad thing to be checked out, know the risks and perhaps improve at your sport by taking appropriate measures.

    Dont' knock health & safety too much think of those who would be upset if something untoward happened to you.

  • "Dont' knock health & safety too much think of those who would be upset if something untoward happened to you."

    ..................or to one's children or grandchildren knowing that a test, costing £24, could reduce the chances of sudden death by  cardiomyopathy during sport by 90%

  • I'm sure all those lard arses out there will love you for telling them that excersise is potentially  'dangerous'.

    Obesity is at record levels and excersise could save the NHS millions. Heart disease( through poor diet and sedantry lifestyle) and cancers kill millions. Do you really think the NHS can afford to screen runners when alot of people don't even keep the sport up for more than a couple of years.

    Contraindicate...I must admit I had to look the word up!......to indicate possible danger!....Does this mean the family can sue the doctor if the runner dies!...Give me a break!

    But hey lets talk about running..... "it can kill you".  Perhaps there should be warnings on the entry form..."Running Kills"

    I don't actually read the Mail...perhaps I should start. All these people that seem to be agreeing with you BTB, have they booked themself in for a test?..Of course they haven't.

    When unhealthy people try and take on a marathon(or any event they haven't trained for) they will have problems. It doesn't take a 5 year study to tell you that.

    Hey I was a little worried this morning when I went out for a steady 50 mins run with my family. Luckily we all came back in one piece, then again we may have had a mild heart attack and not known!

    You concern yourselves about the report, I'll stick to my running (without a test thx).

  • Torque Steer ,....£24 for a test...Where?....Poland!

    A heart exam ..at rest and 'worked' by running on a treadmill!

    A physio costs about £30/half-hour....Who's gonna test you his/her secretary?

  • And I assume heart consultants charge a little more than Physios
  • FtP,

    I had an Echocardiogram carried out privately recently, cost about the same as a set of Orthotics from your Podiatrist !

    A.

  • ftp, next time I have a medical, I'll ask them about getting the ECG done on a treadmill.

    I don't think there's any danger of BtB discouraging "lard arses" as you call them
    because they won't be reading this site anyway.

  • MuttleyMuttley ✭✭✭

    I'm not knocking the idea at all.

    My mother worked in a secondary school for 25 years and in that time they had two instances of teenagers dropping dead on the sports field, from previously undiagnosed heart conditions. If a test can be cheaply and simply administered to identify those at risk in childhood, then it would have benefitted those teenagers.

    But I'm getting on for 50 and tbh don't want to be told I'm susceptible to sudden death during sport. If  I were, I suppose it would have happened by now anyway. Also, if I were I'd probably go back to slobbing and smoking - nothing to lose. And as I said, if it's time to go then I'd rather go suddenly. Once those I leave behind have gotten over the shock, they'll have the pleasure of learning that I'm worth 10 times more dead than I ever was alive!

    <goes off to dig out his old Reggie Perrin tapes>

  • You do that Mike, and if they advise you to stop running will you thank them?...more to the point, will you believe them?

    Will you be having the test because this report as concerned you?

    Or because your trying to score some points in this debate?

    'Lard arses' is probally a bit strong, but I honestly believe that reports like this do more harm than good!.

    Everything should be done to encourage people to get off their backsides and excercise and I feel reports like this are detrimental and inaccurate.

    If someone is concerned then of course they should go to the doctor, but do they really need a 5yr report to tell them?

  • I'm confused to how the test would have 'saved' the teenagers Muttley.

    Would it have condemned them to a sedantry life?

    Or would it have put them on medication for the rest of their life? Or maybe a heart transplant? Or would they just 'know' they are at risk? I'd rather not know. Doctors are always making mistakes. I have 2 kids approaching teen years. I would not want them to have a test, I prefer to let life take its course.

    Some people are scared to do anything these days!...As one person earlier said "life is a risk".

  • "I feel reports like this are detrimental and inaccurate" - what evidence do you have that this report is inaccurate? None. You can't dismiss someone's work because you don't like the results. Likewise, how can it be detrimental? Because it goes against your point of view?! What would you prefer, to bin all research that contradicts your opinion? Have you ever thought, god forbid, that your opinion may be wrong?
  • MuttleyMuttley ✭✭✭

    Well, if the defect can be cured or significantly reduced then it would be beneficial, ftp. But I take your point about it possibly condemning them to a sedentary existence. In fact, the more I think about it, I'm inclined to agree that some things are better not known. I'd be very interested to know if I were at risk of a nasty illness, so I could watch out for the symptoms and take any possible pre-emptive or preparatory action.

    But on the other hand I wouldn't 

    <thud>

  • oh dear I wish people would take the trouble to actually read the stuff instead of headlining off on false trails.

    The cost of £24 was taken from the report and I imagine was extrapolated from the Italian costs as it is given in Euros first and then converted into sterling. Not unlike most units of production costs per unit drop as quantity increases.
    The Italians have been carrying out such tests and have reduced the incidence of death by cardiomyopathy by 90% in sport since 1982 when the tests were first introduced.

    It has nothing to do with lardarses - it is merely a sensible precaution for those not sufficiently self centred to think only about its impact upon themselves.

    Strangely I had both a passive and exercise ECG only last  week for different reasons to this and didn't know of this paper otherwise I may have asked some more questions - it didn't take very long, was supervised by a nursing sister who compared print outs which revealed no abnormality. I imagine ti would have been referred upwards (to a consultant!!) if an abnormality had been detected.

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