Here at the blog, we’ve talked about a variety of cardiovascular diseases that affect athletes. Coronary artery disease, that can lead to heart attack, is the most common cause of sudden death in athletes over the age of 40.
Years after his death, many will remember Jim Fixx for the contribution he made to the popular enjoyment of running. His story is very compelling. In his mid-thirties, he was overweight (240 pounds), a 2-pack-a-day smoker, and sedentary. But he got the urge to do something healthier….and took up running at age 35. He would lose more than 60 pounds and became an example of how a healthier lifestyle was possible for ordinary folks.
In 1977, Fixx authored “The Complete Book of Running.” At the time, this was the best-selling non-fiction hardcover book ever published. He inspired countless Americans to take up the hobby of running.
Out for a run through the Vermont countryside on July 20, 1984, Fixx was found alongside the road, dead at the age of 52. An autopsy showed that he had severe blockages in all 3 of his coronary arteries….a setup for heart attack or sudden death.
On the face of it, Fixx’s death was stunning. His public persona was the picture of health. Yet we know that at the time of his death he didn’t have a personal physician. In fact, he hadn’t had a physical examination in years….despite his history of obesity and smoking. Moreover, he had a strong family history of coronary artery disease in his family: his father had his first heart attack at age 35 and died of his second heart attack at age 43.
We’ll never know if Fixx’s death was avoidable….but his story provides lessons for all of us middle-aged athletes who are pounding the pavement each day.
In my next post, I’ll talk about the problem of coronary artery disease, along with its risk factors, prevention, and treatment. And I promise to leave our readers with some useful advice on what they can do to prevent a story like Fixx’s.
Flo spent almost 10 years playing volleyball at the highest level. The American team qualified for the 1980 Moscow Olympics, but the Games were boycotted by the American athletes. She would go on to win a silver medal in the 1984 Los Angeles Olympics. After those Olympic Games, Flo moved to Japan, where she played for the professional Daiei team.
Flo died on January 24, 1986 during a volleyball game. She was sitting on the bench, shortly after substituting out, and collapsed suddenly. At first her death was attributed to a heart attack, but an autopsy later showed that she died of aortic dissection that resulted from an undiagnosed condition known as Marfan syndrome.
Marfan syndrome is a rare genetic disorder that affects approximately 1 per 10,000 individuals. The disorder is inherited in autosomal dominant fashion, meaning that you can inherit the disorder from either parent. The defect is in the fibrillin-1 (FBN1) gene that is carried on chromosome 15. The disorder causes abnormalities in the connective tissues of the body, affecting the skeleton, the eyes, and, most importantly, the cardiovascular system. Famous people in history who are thought to have had Marfan syndrome include Julius Caesar, Abraham Lincoln, and Sergei Rachmaninoff, among others.
Individuals with Marfan syndrome have a characteristic appearance, with tall slender stature, long limbs, long fingers, abnormal eye lenses, and sometimes a funnel chest. Indeed, Flo Hyman was 6’ 5” tall when she died, but she had reached the height of 6’ by her 12th birthday. The diagnosis is usually established by these clinical features and a family history of the disease, but genetic testing is now available, if needed, to confirm the diagnosis. There is no cure for this disorder, per se, but with careful medical attention, serious (and potentially life-threatening) complications can be avoided.
For athletes, the problem lies in the cardiovascular features of the syndrome. A variety of problems are found in individuals with Marfan syndrome, including mitral valve prolapse (abnormal closing of the mitral valve), leaking heart valves (aortic valve, mitral valve, tricuspid valve), and arrhythmias. The most important cardiovascular complications with Marfan syndrome are the development of aortic aneurysm (enlargement of the aorta anywhere along its length) and dissection of the aorta (sudden tearing apart of the layers of the aorta, usually associated with high blood pressure). Aortic dissection that occurs suddenly is often fatal before proper medical attention can be obtained.
The two sports where Marfan syndrome is typically found are basketball and volleyball, just by the nature of the disorder being found in unusually tall individuals. But, of course, the syndrome could be present in an athlete competing in any sport. Athletes with the clinical features of Marfan syndrome should be screened for the disorder. Those who are found to have Marfan syndrome will need to work closely with their physician and/or cardiologist to determine whether continued participation is prudent. Affected athletes should have the blood pressure controlled carefully because we know that uncontrolled high blood pressure increases the risk for aortic dissection. These athletes should also be monitored closely for the development of problems with the heart valves and for the development of aortic aneurysm.