I can share some follow-up about Andrew Naylor, the triathlete who died during the swim portion of the Ironman New York triathlon on August 11, 2012.
Recall that Naylor, 43 years old, was rescued near the conclusion of the 2.4-mile swim in the Hudson River by watercraft EMS professionals, received CPR, was transferred to shore and then on to a New Jersey Hospital where he was pronounced dead.
This athlete’s death received considerable attention in both the American and worldwide press, due not only to the high-profile nature of the innagural Ironman event in New York but also the fact that the athlete was originally from the U.K. and had travelled from Hong Kong to participate in the event.
Although an autopsy was performed after the incident, the findings were not made public–or at least they hadn’t been reported in the American media–and there has been little follow-up reporting on this incident until last week. At an inquest held in the U.K., and reported in The Daily Mail and other outlets, it was disclosed that the autopsy showed severe blockage in one of the coronary arteries that was responsible for a “heart attack” during the swim. The coroner recorded the death as accidental. Experts testifying at the inquest suggested that Naylor was probably unaware of his heart condition and that he would probably not have died if he had not participated in the triathlon.
Let me start by saying that there are often details lost in translation in a case like this. The original autopsy report, in its entirety, would certainly be valuable and worth sharing.
Several features of this case are interesting, though. First, recent investigation into the causes of death during running events has shown that “heart attack”–or, acute myocardial infarction (MI), in medical terminology–is rarely responsible, even if athlete victims sometimes do have evidence of blockages in the coronary arteries, or coronary artery disease (CAD). For triathlon, specifically, less autopsy information has been made available, but I’m not aware of other cases of triathlon race-related acute MI. Instead, the race-related cardiac deaths are related to sudden arrhythmias–an electrical problem–rather than sudden, complete blockage of a coronary artery–a plumbing problem.
A second interesting feature of this athlete’s death relates to the swim itself. I’ve written previously here at the blog about the efforts this year by World Triathlon Corporation (WTC), the producers of the Ironman-branded triathlon events, to improve swim safety, particularly during the race start. Traditionally, the Ironman triathlon events have begun with a so-called mass start, in which the entire group of participants, sometimes numbering more than 2000, starts the race at the same time when the gun goes off. As you might imagine, it would be difficult to identify and rescue a lifeless swimmer at the beginning of a race that began with a mass start. In the case of last year’s Ironman New York triathlon, though, the participants began their race by jumping into the Hudson River from a barge, in somewhat of a rolling start. WTC is trialing a variety of swim start methods at their events this summer to determine what might be best from a safety and logistics standpoint. It’s worth mentioning that the small handful of athletes who have died over the years during an Ironman swim, much like Naylor, were rescued long after the start of the race.
The third interesting feature of this case is the fitness level of the victim. The myth is often perpetuated that the athletes who die at running or triathlon races are somehow not fit or unprepared for the race in some way. Naylor was an exceptional athlete, even if he wasn’t a long-time triathlete. He was a talented runner, with a personal-best time of 2:32 in the 2009 London Marathon that was good enough for 74th place.
A couple thoughts about prevention….and these thoughts come on a day where we’ve learned that former President George W. Bush had a coronary stent placed because of CAD discovered during an annual check-up yesterday. As we age, our risk of having unrecognized CAD increases. That likelihood is related to a set of risk factors such as sex, smoking history, blood pressure, blood cholesterol/lipid levels, etc. And it’s possible to have important CAD but have no typical symptoms such as exertional chest pain or discomfort. That’s the rationale for screening tests like a stress test or a calcium scoring cardiac CT scan. As one of the doctors who testified at Naylor’s inquest said, this particular athlete’s problem with CAD was very treatable had it been known.