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THE RISKS OF SUDDEN DEATH DURING EXERCISE


A lecture for students of exercise science

Gary Moller
DipPhEd, PGDipRehab, PGDipSportMed (Otago), FCE certified . Thompson's Nutrition, Nutra-Life and Kordels Certified Natural Health Consultant

The following is the summary of a detailed explanation with discussion. It is absolutely necessary to attend the seminar itself to gain a good understanding of the complexity and detail involved

Last updated: December 2013

Gary Moller 2003 Gary Moller asserts the moral right to be identified as the author of this work. All rights reserved You must have the permission of the author before reproducing this publication, or any part of it, or storing it in a retrieval system or transmitting it in any form or by other means, electronic, mechanical, photocopying, recording or otherwise.

Gary Moller's website has over 1,300 papers and articles about nutrition, health, fitness, injury prevention, rehabilitation and high performance sports.
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SUDDEN DEATH IN SPORT STATISTICS (USA)


1:200,000 ATHLETES AT RISK PER YEAR HCM PREDOMINANT CAUSE < 35YRS RVD IDIOPATHIC CONCENTRIC LVH CAD PREDOMINANT CAUSE >35YRS MARFANS

R A R E C AU S E S I N AT H L E T E S

MVP WOLFE-PARKINSON-WHITE SYNDROME PROLONGED QT SYNDROME MYOCARDITIS CORONARY VASOSPASM BLUNT CHEST TRAUMA KAWASAKI DISEASE

T H E DA N G E R S O F I N A P P RO P R I AT E E X E RC I S E

EFFECTS OF ISOTONIC EXERCISE ON THE HEART EFFECTS OF ISOMETRIC EXERCISE ON THE HEART VALSALVA MANOEUVRE OR EXERCISES THAT RAISE BLOOD PRESSURE AND/OR LOWER VENOUS RETURN INADEQUATE WARMUP/SUDDEN CESSATION (EG SQUASH GAME) EXTREME HEAT/COLD YOUNG BASEBALL/SOFTBALL PLAYERS AT HIGHEST RISK OF COMMOTO CORDIS

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MEDICAL SCREENING AGE RELATED CONCERNS


CONGENITAL MALFORMATIONS APPROX: 0.2% PREVALENCE IN ATHLETIC POPULATIONS HCM APPROX: 1:500 BUT CAN BE DIFFICULT TO DETECT AND EASILY CONFUSED WITH VENTRICULAR HYPERTROPHY OF ATHLETIC CONDITIONING HCM & CONGENITAL MALFORMATIONS MOSTLY AFFECT YOUNG ATHLETIC POPULATIONS CAD BECOMES PREVALENT CAUSE >35 SO SCREENING EMPHASIS NEEDS TO BE DIFFERENT BETWEEN THESE POPULATIONS BUT IS MASS SCREENING JUSTIFIED?

How detailed?

QUESTIONS RELATING TO SCREENING:


WHO BY? TO WHAT DETAIL? AT WHAT COST?

RELATIVE CONTRAINDICATIONS TO VIGOROUS/COMPETITIVE EXERCISE


ADVISE CAUTION AND MODERATION OF EXERCISE FOR THE

FOLLOWING UNTIL CLEARED BY A DOCTOR:


SUSPECTED OR IDENTIFIED HIGH-RISK CARDIAC ABNORMALITIES HYPERCHOLESTEROLEMIA FAMILY HISTORY OF SUDDEN DEATH MARFANS SYNDROME EXERCISE SYNCOPE PALPITATIONS AND/OR CHEST PAIN

OTHER

DRUG USE ANABOLIC STEROIDS (MAY INCREASE MYOCARDIAL STIFFNESS). BLOOD DOPING MAY INCREASE RISK OF BLOOD CLOT, STRAIN ON HEART DUE TO INCREASED BLOOD VISCOSITY PRESENCE OF NUTRIENT DEFICIENCY KNOWN TO INCREASE RISK SUCH AS MAGNESIUM (COMMON), IRON, MANGANESE, CHROMIUM, SODIUM OR POTASSIUM TO NAME SEVERAL (HOW DOES ONE TEST FOR THESE?).

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ABSOLUTE CONTRAINDICATIONS TO VIGOROUS/COMPETITIVE EXERCISE


ACTIVE INFECTION/FEVER DUE TO BACTERIAL/VIRAL INFECTION UNSTABLE ANGINA ANEURISM AND OTHER CORONARY ARTERY ABNORMALITIES ANY CARDIOVASCULAR CONDITION THAT IS UNTREATABLE OR ASSOCIATED WITH SUDDEN DEATH.

With all of above it may be possible to exercise at very low workloads and may even be beneficial for general health.

MEDICO-LEGAL CONCERNS

SHOULD WE DO PRE-PARTICIPATION EXAMS? IS THERE ANY OBLIGATION IN NZ? IF AN EXAM IS TO BE DONE


IS A PHYSICIAN LIABLE IF A CLEARED ATHLETE DROPS DEAD? WHAT IS THE COLLECTIVE CURRENT STANDARD IN NZ?

By who? To what detail? From what age? Who pays?

DISPLAY AND DISCUSS TWO PRE-PARTICIPATION EXAMINATION MODELS

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REFERENCES

1. MARON, B.J., T.E. GOHMAN, AND D. AEPPLI, PREVALENCE OF SUDDEN CARDIAC DEATH DURING COMPETITIVE SPORTS ACTIVITIES IN MINNESOTA HIGH SCHOOL ATHLETES. J AM COLL CARDIOL, 1998. 32(7): P. 18814. 2. WIGHT, J.N., JR. AND D. SALEM, SUDDEN CARDIAC DEATH AND THE 'ATHLETE'S HEART'. ARCH INTERN MED, 1995. (14): P. 1473-80. 3. MARON, B.J.E., CARDIOVASCULAR PRE-PARTICIPATI ON SCREENING OF COMPETITIVE ATHLETES. CIRCULATION, 1996. 94: P. 850-856. 4. BASSO, C ., ET AL., CLINICAL PROFILE OF CONGENITAL CORONARY ARTERY ANOMALIES WITH ORIGIN FROM THE WRONG AORTIC SINUS LEADING TO SUDDEN DEATH IN YOUNG COMPETITIVE ATHLETES. J AM COLL CARDIOL, 2000. 35(6): P. 1493-501. 5. MARON, B.J., ET AL., SUDDEN DEATH IN YOUNG COMPETITIVE ATHLETES . CLINICAL, DEMOGRAPHIC , AND PATHOLOGICAL PROFILES. JAMA, 1996. 276 (3): P. 199-204. 6. MARON, B.J., ET AL., CLINICAL PROFILE AND SPECTRUM OF COMMOTIO CORDIS. JAMA, 2002. 287(9): P. 1142-6. 7. LINK, M.S ., ET AL., IMPACT DIRECTLY OVER THE CARDIAC SILHOUETTE IS NECESSARY TO PRODUCE VENTRICULAR FIBRILLATION IN AN EXPERIMENTAL MODEL OF COMMOTIO CORDIS. J AM COLL CARDIOL, 2001. 37(2): P. 649-54. 8. LINK, M.S ., P.J. WANG , AND N.A. ESTES, 3RD, VENTRICULAR ARRHYTHMIAS IN THE ATHLETE. CURR OPIN CARDIOL, 2001. 16(1): P. 30-9. 9. LINK, M.S ., B. OLSHANSKY, AND N.A. ESTES, 3RD, CARDIAC ARRHYTHMIAS AND THE ATHLETE. CURR OPIN CARDIOL, 1999. 14(1): P. 24-9. 10. MARON, B.J., ET AL., RESULTS OF SCREENING A LARGE GROUP OF INTERCOLLEGIATE COMPETITIVE ATHLETES FOR CARDIOVASCULAR DISEASE. J AM COLL CARDIOL, 1987. 10(6): P. 1214-21. 11. EPSTEIN, S .E. AND B.J. MARON, SUDDEN DEATH AND THE COMPETITIVE ATHLETE: PERSPECTIVES ON PREPARTICIPATION SCREENING STUDIES. J AM COLL CARDIOL, 1986. 7(1): P. 220-30. 12. LEWIS , J.F., ET AL., PREPARTICIPATION ECHOCARDIOGRAPHIC SCREENING FOR CARDI OVASCULAR DISEASE IN A LARGE, PREDOMINANTLY BLACK POPULATION OF COLLEGIATE ATHLETES. AM J CARDIOL, 1989. 64(16): P. 1029-33.

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