triathlon

PR While Having a Heart Attack

April 9, 2013 By Larry Creswell, MD Leave a Comment

My friend, Sue Aquila, a triathlete and coach at Endurance Corner, wrote the other day to share a story about Cheryl, another of her triathlete/swimmer friends….one with an interesting story about swimming a PR while having a heart attack!

Cheryl was kind enough to share her story here. I’ll add a few thoughts at the end.

In Cheryl’s words….

I shared my story at the W3 reunion two weeks ago, and am sharing it here as my public service announcement.

I am a 46 year old white female. I have never smoked. I exercise every day; some days twice a day. I eat a healthy diet (not a perfect one, but a decent one). For years, my cholesterol hovered around 200, no matter how I changed my diet. I have no family history of heart disease.

I was a competitive swimmer from age 5 through college. Then I slowly took up triathlon. I have always been very physically active.

On March 2, I had a minor heart attack.

Did you know:

Heart disease is the No. 1 killer of women, and is more deadly than all forms of cancer combined?
Heart disease causes 1 in 3 women’s deaths each year, killing approximately 1 woman every minute?
An estimated 43 million women in the U.S. are affected by heart disease?
Ninety percent of women have 1 or more risk factors for developing heart disease?
Since 1984, more women than men have died each year from heart disease?
The symptoms of heart disease can be different in women and men, and are often misunderstood?
While 1 in 31 American women dies from breast cancer each year, 1 in 3 dies of heart disease?
Only 1 in 5 American women believe that heart disease is her greatest health threat?
Women comprise only 24% of participants in all heart-related studies?

from http://www.goredforwomen.org/about-heart-disease/facts_about_heart_disease_in_women-sub-category/statistics-at-a-glance/

On March 2, I went to a masters swim meet. As I was warming up, I stopped when I had this terrible pain in both arms and my shoulders and chest. As I tried to process this, my first thought was I must have really pulled my pec muscles when I did that 25 sprint fly, probably wasn’t warmed up enough. But I have felt muscle pains/strains and this was vastly different. So I thought maybe I compressed a nerve in my neck (in 1999 I had an accident that caused some traumatic injury to my neck, so it is a frequent cause of problems for me). I tried to swim easy, hoping it would go away. It did not. I raced three events anyways in terrible pain.

During the three hours I was at the pool, I cried to myself, but felt like a whiner complaining about it. After three races, I told my husband I had to go home (it was a two hour drive, I was sooo thankful he was with me, I don’t think I could have made it home on my own).

The pain persisted all day with no change. I took a mega dose of Aleve and went to bed, and woke up feeling quite a bit better. I walked my dogs in the morning, and within minutes the pain returned. Again, my first thought was muscle issue, as my dogs are big, and maybe I just re-stressed an already injured muscle (little did I know the muscle I was injuring was my heart). Still in denial about a heart issue, I went to my chiropractor, and she ruled out a nerve or disc problem. I spent 4 more days doing nothing but wondering why every time I started walking for more than a minute, the pain returned. On Friday evening, I finally wised up and called a neighbor who is an R.N. He told me I had to see a doctor, that it most certainly could be my heart.

I considered waiting until Monday and calling a doctor, but saturday morning my anxiety was at an all-time high. I broke down and went to the E.R. Their first question to me, “are you here for chest pain?’ When I answered yes, they went into fast action. I had an EKG and blood tests. The blood test looks for an enzyme called troponin. If troponin is found, it indicates that there was a cardiac event. It takes a week or more for troponin to slowly go away and after 6 days, I still had some. A CT scan ruled out a pulmonary embolism. A cardiologist came to talk with me. Coincidentally, he had been a swimmer, and seemed almost happy to be able to help me, as he didn’t have to rake me over the coals for being overweight, or a smoker.

Based on my story of the Sunday incident and the rest of the week, my current symptoms, my blood test, and my lack of family history of heart disease, he was pretty sure we would find blockage via a heart catheter. My BP was normal, my cholesterol 170, but LDL 100, so that number was higher than desired.

Being Saturday morning, and living in a small city, their heart catheter doc is only called in on weekends, if the heart patient is in a state of emergency. I was not–as long as I was just sitting quietly. So I would likely wait until Monday. I thought I would go home. No! They made me stay. I secretly hoped that someone would have a heart attack that day that required the heart cath doctor to be called in, and 9 pm rolled around and just after my husband had gone home for the night, the doc popped into my room and asked me if I was ready for my cath. I nearly jumped out of my bed. Yes, please! So, the cath team went into action and had me prepped in no time. The heart cath involves insertion of a catheter into your femoral artery, they snake it up into your heart and look around the arteries with a camera. If they find a blockage that they think can be fixed with a stent, they attempt that. In my case, they found a 95% blockage in my right posterior descending artery. Fortunately, a stent was inserted, and the balloon expanded it, and the stent fit properly, the blood started flowing through the artery.

Another 36 hyours in the hospital, and I was released. But not before I amused the staff walking the halls in my running shoes and hospital gown. A healthy heart attack patient gets back at it quickly.

It’s been 4 weeks now. I’ve been slowly resuming easy exercise. My diet, while not bad before, is undergoing a major rehaul. Now that this has happened to me, I look at everything I ate before, and think of it now in terms of my heart’s health. I used to drink a lot of mile, and eat a lot of yogurt. Now, I will cut back, and choose skim milk. I am cutting back or cutting out foods with high cholesterol and saturated fat, even if I didn’t eat them often in the past, they are mainly going to be excluded. I am certain I won’t say no to every food that has some fat or cholesterol, but they will only show up in my diet on very rare occasions.

Please, know the symptoms for a heart attack:

Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.
Pain or discomfort in one or both arms, the back, neck, jaw or stomach.

Shortness of breath with or without chest discomfort.

Other signs, such as breaking out in a cold sweat, nausea or lightheadedness.
As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

from http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Heart-Attack-Symptoms-in-Women_UCM_436448_Article.jsp

Don’t assume, like I did, that because you are an athlete, that it couldn’t possibly be a heart attack. Every minute that some of your heart is deprived of oxygen, heart muscle cells are dying. Get your cholesterol and blood pressure checked regularly, and keep the numbers in the good range. Be wise about your health. Be smart about your heart.

My Thoughts

We often think of heart attack as a man’s problem. It’s important to remember that women also have heart attacks and their symptoms may not be “classic.”

It sounds like Cheryl’s story has a good ending….she was eventually diagnosed and treated for her coronary artery disease. Good endings often depend upon prompt action, though. Don’t delay. If you have any concern about the possibility of a heart attack, seek medical attention promptly….and certainly don’t wait to finish the swim meet!

The American Heart Association has a wide variety of helpful educational offerings about heart attack, coronary artery disease, and many other topics. Check out the AHA website especially for their Life’s Simple 7 program that guides individuals in 7 easy, concrete steps to safeguard their heart health.

Related Posts

1. Cardiac Arrest? Heart Attack? Heart Failure? Learn the differences between these heart problems.
2. Caution! Five Warning Signs You Shouldn’t Ignore
3. Two Stories. Two Endings. Another couple athlete stories with coronary artery disease.

Fatal Arrhythmias in Open Water Swimming: What’s the Mechanism?

March 10, 2013 By Larry Creswell, MD Leave a Comment

We’ve talked preveiously here at the blog about the general issue of sports-related sudden cardiac death (SCD). And we’ve also talked about the specific issue of swimming fatalities during triathlons and open water swims.

But what triggers a sudden, fatal arrhythmia during open water swimming?

The answer isn’t known and perhaps it will never be known with certainty. But a recent report from a group of scientists in the U.K., though, suggests a very plausible mechanism. Their idea is worth considering.

What’s been learned from studies on runners?

As I’ve mentioned previously here at the blog, sports-related SCD has been best studied in the setting of long-distance running events. Last year, Dr. Kim and colleagues in Boston reported on a decade-long study of runners with race-related SCD [1]. These investigators found that fatalities during marathons are not distributed uniformly along the race distance. Instead, they predominate duirng the final 3 miles or so. And interestingly, fatalities during half marathon events also predominate during the closing miles. But why?

In the running population, we know from autopsy studies that the majority of victims have some sort of (often previously unknown) heart disease. And something happens during the closing miles of the race. In the words of the investigators, their “findings suggest that demand ischemia (i.e., ischemia due to an imbalance between oxygen supply and demand) may be operative in exercise-related acute coronary events during long-distance running races.” The leading hypothesis is that this mismatch in blood (or oxygen) supply and demand in the heart occurs when the runner picks up the pace, producing an adrenaline surge and increased physiologic demands on the heart, once the finish line is mentally within sight.

Based on this hypothesis, the International Marathon Medical Directors Association issued an advisory in March, 2010 that recommended, among other things, that athletes “not sprint the last part of the race unless you have practiced this in your training.”

The concept here is that a susceptible heart (in a susceptible athlete) is triggered at a particular moment in the race to have a fatal arrhythmia because of a specific trigger. The surge hypothesis might not explain all running race-related deaths, but is a plausible explanation for the physiology behind the majority of the deaths that occur late in a race.

It’s very likely that the same concept is in play in triathlon-related sudden cardiac death.

What’s going on in triathlon?

In triathlon, athletes have died at any point during the race–from the first few strokes of the swim through the final strides of the run. And a couple athletes have collapsed with SCD even a few hours after the finish. But the majority of deaths have occurred during the swim. USA Triathlon issued a report last year that summarizes these facts.

What might be the trigger for sudden cardiac arrest during the swim portion of a triathlon?

Recently, two researchers in the U.K.–Michael Shattock and Michael Tipton–have offered a new hypothesis that they have labeled autonomic conflict [2,3]

To understand their hypothesis, we first need to talk for a moment about some features of the heart’s physiology.

Sympathetic and Parasympathetic Influences

One component of our nervous system is called the autonomic system. This portion of the nervous system is involuntary, responding to internal and external stimuli below the level of our consciousness. The autonomic nervous system has 2 different divisions–the sympathetic and parasympathetic systems. Each of these divisions can operate independently, often with opposite effects on the body’s organs, including the heart.

We often think of the sympathetic nervous system as being excitatory–providing the so-called “fight or flight” response. When activated, the sympathetic nervous system has several effects on the heart: an increase in heart rate, vasodilation of the coronary arteries (leading to more blood flow), and increased contractility (contraction strength) of the heart muscle. And importantly for athletes, activation of the sympathetic nervous system also increases the blood flow to the skeletal muscles, decreases blood flow to the abdominal organs, and opens up the airways of the lungs.

In contrast, the parasympathetic nervous system has an inhibitory effect on the heart, acting to restore a baseline heart rate after sympathetic activation and by slowing electrical conduction in the specialized areas of the heart’s electrical system known as the sino-atrial (SA) node and the atrio-ventricular (AV) node. In well-trained endurance athletes, the parasympathetic nervous system is often highly developed, and is one cause of a very low resting heart rate.

A Hypothesis

Drs. Shattock and Tipton have proposed a mechanism where sudden activation or sudden increase in activation of both the sympathetic and parasympathetic nervous systems can produce a fatal arrhythmia. This idea is supported by studies in isolated hearts as well as in healthy volunteers.

Let’s say that an athlete’s heart might be predisposed to an arrhythmia because of one or more anatomic or physiologic conditions such as: congenital or inherited long QT syndrome, coronary artery disease, myocardial hypertrophy, ischemic heart disease, or pathologic hypertrophy (eg, hypertrophic cardiomyopathy).

During an open water swim, an athlete’s sympathetic nervous system is activated because of physical exertion, (relatively) cold water temperature, anxiety, or even anxiety or overcompetitiveness. The parasympathetic nervous system is activated because of facial wetting, water entering the mouth, nose, and pharynx, and extended breath holding–and particularly so, just at the moment of breaking a breath hold. At that very moment, there can be maximal parasympathetic activation.

These scientists suggest that this autonomic conflict–between the sympathetic and parasympathetic nervous systems–is what triggers a sudden, potentially fatal arrhythmia.

It’s Plausible

This is a plausible hypothesis. It fits with the observations that have been made on victims of sudden cardiac death during open water swimming. And it fits with the general concept of a susceptible heart and an arrhythmia trigger that seems to be in play in victims of SCD in other sports.

References

1. Kim JH et al. Cardiac arrest during long-distance running races. N Engl J Med 2012;366:130-140.

2. Shattock MJ, Tipton MJ. ‘Autonomic conflict’: a different way todiedu ring cold water immersion? J Physiol 2012;590:3219-3230.

3. Tipton MJ. Sudden cardiac death during openwater swimming. Br J Sports Med 2013. Online in advance.

2. Athletes, sudden death, and CPR

Some Thoughts on The Escape from Alcatraz Triathlon

March 5, 2013 By Larry Creswell, MD Leave a Comment

It was a sad day Sunday at the Escape from Alcatraz Triathlon. As you may know, 46-year-old triathlete, Ross Ehlinger, died during the event. I thought I’d share some thoughts about the race. I was there.

I can clearly remember reading about the Escape from Alcatraz Triathlon for the first time back in 2005, the year I took up triathlon. I thought it was absolutely incredible that large numbers of athletes could actually make the swim from Alcatraz Island to San Francisco to start the race. Knowing that no prisoner was ever confirmed to have escaped, I had thought that the swim was impossible.

But of course, that’s the lure.

I did the race for the first time in 2007 and I’ve been back for the race in 2011, 2012, and again this year. It’s an extraordinary race for many reasons, including the epic 1.5-mile swim across San Francisco Bay and the breathtaking scenery for the bike and run portions of the event. It’s no wonder that the race attracts a field from across this country and around the world. Each year it’s the lucky winners of an entry lottery who get the chance to Escape.

The race is usually held in early June, but this year the race was moved to early March. I understand that, because of this summer’s America’s Cup yacht races in San Francisco Bay, it was impossible to hold the race at its usual time. I personally have enjoyed the cool temperatures for this race in June, but even I was concerned about the possibility of poor weather with the March 3rd date.

The weekend in San Francisco actually brought unseasonably warm temperatures. I was surprised. Several of the employees at my hotel remarked how lucky we were with the good weather. Nonetheless, the water temperature was very cold. I went for a practice swim (in my wetsuit) at the Aquatic Park on Friday before the race and lasted only 18 minutes before getting out, freezing cold. We’d learn from the race officials that the water temperature was in the low 50’s. As it turns out, the temperature in the Bay is almost always in the low 50’s, regardless of the time of year.

The night before the race, I laid in bed thinking about the swim and safety. I was even a little bit worried about my own safety. It’s a challenging swim.

Race morning brought cloudy skies, low cloud or fog cover, ~50-degree temperature, and a brisk wind into the Bay from the direction of the Golden Gate Bridge.

The trip out to Alcatraz Island on the San Francisco Belle for me and the nearly 2000 athletes lasted about an hour. The ride was smooth and there was the usual banter between racers about the swim, sighting, and the race in general. We learned from the boat announcer that there was a 4 km per hour outward current. To put that into perspective, I’d bet that 80%+ of the field is unable to swim 4 km per hour….so for almost everyone, it would be impossible to swim back to the boat if you changed your mind! We also got advice from the boat announcer that, because of no swim warm-up, we ought to put things “into 5th gear” when we entered the water and get away from the boat quickly. I thought that was odd advice. We learned that there would be 100+ boats/kayaks in the Bay to provide assistance if needed.

The start of the race was delayed because of the (unexpected) passage of a cruise ship between us and shore. The up-to-40 year olds start first, then the older folks, including me. I was among the first of the older competitors to jump off the boat into the water. And off I went.

There was moderate surface chop because of the wind. And with the wind coming from the right, there was inherent difficulty for swimmers, like me, who breathe to the right side. There were also several foot swells. As you swam “across the river” toward shore, there would be times when you were in a gulley, with water all around you….and other times when your were “surfing” at the top of a swell. The conditions were the most challenging of my 4 Alcatraz races. I was worried enough….and focused enough….on the mechanical aspects of swimming, that I didn’t really notice the water was cold. I remember thinking early on that it would be a difficult day for most of the swimmers. Little did I know.

I finished the swim in just over 35 minutes, 6th for my M50-54 age group and 127th overall. I’d learn later that 22 of ~140 athletes in my age group took longer than an hour. There were a lot of swimmers who took longer than an hour. I went on to enjoy the rest of the race, appreciating the cheers from my family who were there, and really appreciating the chance to be a part of the event. I can remember noticing that the competitors in the race seemed much more spread out than usual. When I was returning from the bike portion, there were still athletes just starting the bike, more than 2 hours after the start of the race. And similarly, when I was finishing my (rather slow) run, some 3 hours and 40 minutes after the start, I noticed that there were still athletes just starting out on the run.

Back at the hotel shortly after the race, I learned the sad news that one of the competitors had died during the swim. Ross Ehlinger, 46 years old, married, father of three. The online edition of the Austin Statesman had a touching article yesterday about Ross and his family.

Initial news reports have provided some information about the incident, but I must say that reports have sometimes been conflicting. The race reported that Ross was rescued from the water less than a minute after he had jumped into the water, that he received CPR during transportation to shore, and that he could not be resuscitated. The Race Director, Bill Burke, commented early that the rescuers suspected a heart problem as the cause.

There is a very poignant account on Facebook by a fellow competitor, Richard Iazzetta, on how he came across the lifeless victim during the swim, and along with 2 other swimmers, provided assistance during the rescue. Richard, Calley, and Matt are heroes here. We owe them our thanks.

I understand that an autopsy is being performed and that the results will be reported publicly in due time. And perhaps those autopsy findings will shed some light on what happened. I also suspect that bystander accounts will become available and, if the incident truly happened in the first minute (and so, fairly close to the boat), there might be videotape footage from the boat that captured the event. Until all of the available information is gathered, we can at best speculate about what happened.

I got a couple media inquiries yesterday that were focused on the recent USA Triathlon study of event fatalities. The final report from that study is useful reading for all triathletes. In a nutshell, the majority of triathlon fatalities occur during the swim and most are thought to be due to sudden cardiac arrest…a fatal arrhythmia. But there are a handful of potential causes for a death during the swim portion, including trauma, stroke, seizure, pulmonary embolism, and “ordinary” drowning. I wrote a short article at Endurance Corner that summarizes my take on things.

There seemed to be a chorus yesterday about the poor race conditions and questions about whether those conditions may have contributed in some way to the victim’s death. At this point, we just don’t know.

From the standpoint of fatalities, the Escape from Alcatraz has a remarkable safety record. This is the first fatality in the 33-year history of the event. That safety record speaks to the quality of the event management by IMG and the race direction by TriCalifornia and, more recently, Premier Event Management. Over the years, tens of thousands of competitors have jumped off the boat into icy cold water and made their way safely to shore….in spite of cold water temperatures and challenging conditions.

The race reported that about 150 swimmers had to be rescued during Sunday’s race, either to be carried to shore or repositioned to a safer spot on the course to complete their swim. This is apparently a much higher number than usual and it does raise questions about the preparedness of the athletes as well as safety planning by the race organizers.

We ought to learn something from Sunday’s tragedy. We owe it to our triathlon community. And we now owe it to Ross Ehlinger and his family.

Dan Empfield wrote an article yesterday at Slowtwitch entitled “Dare You to Move.” He gets at the idea of doing something. I agree.

I’ll borrow here from the USAT report….

If you’re an athlete, I’d encourage you to:
1. Visit your doctor for a physical examination with an emphasis on your heart health. Do this before you train or compete.
2. Consult with your doctor about warning signs like chest pain/discomfort, shortness of breath, light-headedness, blacking out, or palpitations.
3. Your health, fitness level, and preparation should guide your choice of race or event. Be certain that your race plan is consistent with your health, fitness level, and preparation.
4. Practice and prepare for an open water swim. San Francisco Bay is not for first-timers.

If you’re a race director or event organizer, I’d encourage you to:
1. Place a primary emphasis on athlete safety. Ensure that the safety plan, unique to your event, takes into consideration all features that can impact athlete safety.
2. The safety plan for the swim should be extraordinarily robust, allowing nearly instant recognition of the lifeless swimmer and providing for early CPR and defibrillation.
3. Hold a mandatory safety briefing where athletes can be provided information about the expected conditions and the safety resources that will be available.

I’d urge you to do something. Personally. And make plans today to do it.

Wrap-Up from USAT RD Symposium 2013

January 21, 2013 By Larry Creswell, MD Leave a Comment

I spent the past couple days at the 2013 USAT Race Director Symposium in Colorado Springs. I had the chance to attend last year’s meeting and I’m thankful to the USAT folks for the opportunity to return to this year’s Symposium. Let me share some of the safety-related highlights:

A Common Problem

The Symposium was held at the Cheyenne Mountain Resort in Colorado Springs and the Resort offered van service from the airport. The USAT Symposium was not the only meeting at the hotel, and I shared the van with a woman who was attending a different meeting. We exchanged travel stories and talked about each other’s meetings. When she learned that I’d be speaking about athlete fatalities, she shared that she had a daughter who was a runner and recalled a story about a local athlete who had died during a running race.

The issue of race-related fatalities is obviously not confined to the sport of triathlon.

CPR Class

The Symposium began on Thursday afternoon and included a 2-hour class in CPR. This was an outstanding addition to the program. I took note last year that the organizers of the Boston Marathon, in conjunction with the American Heart Association and American Red Cross, offered a short CPR class for runners, family members, and other supporters at their 2012 event. We all benefit from a high prevalence of bystanders who know CPR. In a comprehensive study of sudden cardiac arrest at half marathon and marathon running events, Dr. Jonathan Kim and his colleagues last year reported that the survival rate was nearly 30%, due entirely to the availability of prompt bystander CPR and prompt defibrillation. This is in sharp contrast to the rather dismal survival rates of ~10% that are typically reported for out-of-hospital cardiac arrest.

Growth in Triathlon

On Friday morning Rob Urbach, USAT CEO, reported on the growth in the sport of triathlon–growth that is represented in the number of participants, annual members, and events. As it turns out, the assembled group of Race Directors represented more than 60% of last year’s races nationally–accounting for more than 350,000 finishers. The growth in our sport is both an opportunity and a challenge. With this growth, we’ll need an ever-increasing commitment to the issue of race safety.

John Korff

Friday morning’s keynote speaker was John Korff, owner and organizer of the New York City Triathlon. He’s a terrific story-teller. And with more than a decade of experience with that event as well as with last year’s Ironman New York race, he had a lot of stories to tell. And while most of those stories were amusing (in a New York sort of way), he also shared a little bit about the personal side of having athlete fatalities in those events.

Race-related fatalities have certainly captured the public’s attention–particularly in large media markets like New York. It’s that attention, particularly after athlete deaths in 2011 that prompted USAT’s recent review of race-related fatalities.

My Talk

I was invited to share with the Race Directors the USAT final report on athelte fatalities during 2003-2011. I’ve written previously about this issue here at the blog and also in a column at Endurance Corner.

I’d call your attention to the final report which is available in its entirety at the USAT website. This is, by far, the most comprehensive look at the issue of event-related fatalities in triathlon. And while there may well be questions that still deserve our investigation, there is a bunch of useful information to help guide us as we try to improve in the area of race safety. It’s useful reading for athletes, race directors, and virtually anbody involved in the sport.

The last 2 pages of the final report outline a vision of Shared Responsibility for Race Safety, where athletes, event organizers, and USAT all have a role. For each of these groups, there is a concise set of recommendations that may help to reduce the fatality rate going forward. I truly believe that all of the viable strategies that are likely to have a favorable impact are included in that short list.

Safety Planning

We heard from Andy Emberton, Operations Manager, Communications Director, and Risk Manager for World Triathlon Corporation (WTC), the folks that own the Ironman series of races. Andy offered very practical advice for incident management (including fatalities among others) and explained in detail how careful event and safety planning were essential. An ounce of prevention! It’s clear that WTC has placed an emphasis on race safety and has gained tremendous experience over the years with large, long-distance triathlon events in a large number of venues throughout the world.

Bill Burke

The Saturday program included a great talk by Bill Burke, the owner of Premier Event Management in New Orleans. Bill has had the opportunity to serve as race director for a bunch of large, high profile races including the New Orleans 70.3, Nation’s Triathlon, Hy-Vee Triathlon, Escape from Alcatraz Triathlon, New York City Triathlon, Ironman New York, and the Olympic Trials for 2004 and 2008, among others.

He also has a unique history of having dealt with 10 athlete fatalities at his races over the years. When I’ve talked with groups about the issue of race-related fatalities, I’ve often worried that the discussion of statistics often removes the human side of this issue. Bill did a terrific job of describing the very human aspects of these tragic events. He told the individual stories of 8 of those athletes, sharing a little bit about their athletic and personal history together with the details of how their race-day deaths unfolded. You couldn’t help but have a tear in your eyes. For the assembled Race Directors, he shared his insights about careful event and safety planning as well as interacting with surviving family members after the incidents.

A Few Thoughts

All organized sports, and particularly the endurance sports, will continue to need to address the issue of event-related fatalities. Organizations such as the International Marathon Medical Directors Association and USA Swimminghave issued reports on this topic. As the scientific community continues to learn about the causes–and opportunities to prevent–sports-related sudden cardiac arrest, we should work to incorporate these findings in our efforts to improve race safety.

USA Triathlon Fatality Incidents Study

October 26, 2012 By Larry Creswell, MD 6 Comments

Yesterday, USA Triathlon (USAT) released a report entitled “USA Triathlon Fatality Incidents Study.” The report details the experience with race-related fatalities at USAT-sanctioned races and events from 2003 through 2011.

I’ve written previously here at the blog (August 2011 and January 2012) and also in my column at Endurance Corner about my involvement this past year with this USAT project.

While the report may leave some questions unanswered and might stimulate further investigation, this represents the most detailed look yet at this issue. The facts are presented along with recommendations for improved race safety, centered around a theme of “shared responsibility”–where athletes, race directors, and USAT all play an important role.

The report is worthwhile reading. I hope that you’ll read the report and share the findings with your family members and fellow athletes.