Experienced marathon runners, professional athletes and people who work out religiously are those we expect to be at the top rung of the fitness ladder. So when they suddenly die – like 42-year-old Deutsche Telekom Asia chief executive Lee Wee Sing did during the Osim Singapore International Triathlon – it is a matter of much concern and speculation. Heart diseases are often silent in young people, manifesting only during rigorous exercise, and leading to a cardiac arrest and sudden death. We explore some of the hidden conditions that could spell your final workout.HYPERTROPHIC CARDIOMYOPATHY (HCM)
This is a congenital problem where parts of the heart muscle get thicker, causing difficulty in the pumping of blood. According to a report in the Journal of American College of Cardiology, HCM represented a common cause of sudden death in young and previously undiagnosed male athletes. A person with HCM does not experience any symptoms; the first sign is unfortunately death.
Some people may experience shortness of breath, chest pain, fainting spells or dizziness, which must be taken very seriously and investigated thoroughly. Detailed history taken by a physician about early death in the family due to cardiac reasons may provide a clue to this problem.
CORONARY ARTERY DISEASE (CAD)
While exercise is said to prevent CAD, it could also trigger a heart attack in those who already have fat deposits in the arteries of the heart or the coronaries. Besides, a person who exercises could have other pre-existing risk factors such as high blood pressure, smoking, high cholesterol levels and the like, increasing the overall chances of CAD.
Congenital defects in the coronary arteries can also compromise the blood and oxygen supply to the heart during exercise resulting in anginal pain (chest discomfort), myocardial infarction (death of a part of the heart muscle) or an abnormality in heart rhythm, causing sudden death. Such conditions are more common in the younger population compared to atherosclerotic coronary disease (thickening of the artery wall due to fatty build-up). This can be diagnosed by examining those who experience cardiac complaints like chest pain or fainting spells with a treadmill stress test and coronary angiogram.
MITRAL VALVE PROLAPSE (MVP)
According to a report in the Singapore Medical Journal, MVP is one of the common heart valve problems affecting 5 to 15 per cent of the general population, where the valve separating the left atrium from the left ventricle is floppy. When the left ventricle contracts to pump blood out to the body, some of this blood regurgitates back into the atrium. Usually this is a harmless problem, but in some cases the heart’s electrical system gets hampered, giving rise to arrhythmias in the form of innocent missed beats or improper pumping by the ventricle, which can be fatal. Defibrillation pads used at this stage can put the heart back in its normal rhythm and save the victim’s life.
ARRHYTHMIAS
In most cardiac causes of sudden death during exercise, abnormal rhythm is the final cause of cardiac arrest. This could be due to HCM, CAD or MVP. However, the conduction pathways in the heart responsible for maintaining normal heartbeat can have congenital defects, leading to conduction abnormalities, which could end up fatal. These people experience palpitations and an electrocardiogram (ECG) may pick up some abnormalities. Death due to conduction disorders are tough to diagnose on post-mortem. If in a case of sudden death on exertion and there is no evidence of infarction, inflammation of the wall of the heart or of cardiomyopathy, then it could be assumed that the death was due to arrhythmia.
MYOCARDITIS
Inflammation of the heart can lead to rhythm problems that can cause sudden death. Athletes rarely let fever pose as an excuse for missing a run or a workout. In the rare chance that this fever is due to myocarditis, exercise can trigger a fatal arrhythmia. To be on the safe side, any exertion should be avoided during a fever or when you are recovering from illness.
EXERCISE-INDUCED HYPOGLYCAEMIA
In Type 1 diabetes patients who are on insulin, the increased insulin in the blood can cause lowered blood sugar during, immediately after, or six to 12 hours after exercise. Severe hypoglycaemia can be prevented by not exercising when insulin is peaking and by taking insulin in the subcutaneous fat layer. According to the guidelines of the American Diabetes Association, it is important to carry a fast-absorbed carbohydrate source and to monitor blood glucose regularly before and after exercise. Eat extra carbs before exercise if your blood glucose level is less than 100mg/dl. Any symptoms like fainting or chest pain on exertion, or palpitations with chest pain or breathlessness should be taken as a serious warning signal to see a physician and get a complete examination.
*Article from www.menshealth.com.sg
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