Salanson dies of heart failure

[Herb Dershowitz]

French cyclist died of heart failure, doctor says

June 6, 2003DRESDEN, Germany (AP) -- A promising French cyclist found dead in his hotel room by a
teammate died of heart failure, doctors said Friday. Fabrice Salanson was found dead next to his
hotel bed on Tuesday. He was preparing for the Tour of Germany, which started the same day.
Dr. Jan Dressler of the University of Dresden medical institute said the 23-year-old rider's
death was probably caused by his heart enlarging and the coronary vessels failing to pump
enough blood.

``According to what we've discovered thus far, the French cycling professional Fabrice Salanson died
a natural death,'' Dressler said. No drugs or banned substances were found in the body, district
attorney Juergen Schaer said Friday. Salanson, who turned pro in 2000 and was regarded as one of his
country's biggest cycling talents, was found by roommate Sebastien Chavel.

 

[J999w]

>Dr. Jan Dressler of the University of Dresden medical institute said the 23-year-old rider's death
> was probably caused by his heart enlarging and the coronary vessels failing to pump enough
> blood.
>

That doesn't make sense to me ... he can race a bicycle at the professional level, but his heart
doesn't have enough reserve to keep him alive while sleeping ???

I don't buy it.

jw milwaukee

 

[Clovis Lark]

J999w <[email protected]> wrote:
>>Dr. Jan Dressler of the University of Dresden medical institute said the 23-year-old rider's death
>> was probably caused by his heart enlarging and the coronary vessels failing to pump enough
>> blood.
>>

> That doesn't make sense to me ... he can race a bicycle at the professional level, but his heart
> doesn't have enough reserve to keep him alive while sleeping ???

Heart enlargement is usually a result of pulmonary insufficiency. He could have died anytime. He
just chose to go quietly in his sleep (not screaming like the passengers in his car)

> I don't buy it.

death is for free, always has been. last I heard it is readily available for all.

> jw milwaukee

 

[Tom Kunich]

"J999w" <[email protected]> wrote in message news:[email protected]...
> >Dr. Jan Dressler of the University of Dresden medical institute
said the
> >23-year-old rider's death was probably caused by his heart
enlarging and the
> >coronary vessels failing to pump enough blood.
> >
>
> That doesn't make sense to me ... he can race a bicycle at the
professional
> level, but his heart doesn't have enough reserve to keep him alive
while
> sleeping ???
>
> I don't buy it.

You don't have to buy anything. There is a likelyhood that this guy advanced to far too fast. His
muscles and lungs grew faster than his cardio system. Might have been a genetic problem but more
likely just trying to get too good too fast.

I wonder how long he'd been racing at pro level and top amateur.

 

[Robert Chung]

"J999w" <[email protected]> wrote in message news:[email protected]...
> >Dr. Jan Dressler of the University of Dresden medical institute said the 23-year-old rider's
> > death was probably caused by his heart enlarging and
the
> >coronary vessels failing to pump enough blood.
> >
>
> That doesn't make sense to me ... he can race a bicycle at the
professional
> level, but his heart doesn't have enough reserve to keep him alive while sleeping ???
>
> I don't buy it.

Sudden cardiac death in elite endurance athletes is actually a well-known (though thankfully rare)
event. Do a medline search.

One issue is that elite endurance athletes have such big changes in cardiac morphology that normal
standards for screening sick people get screwed up. An ECG pattern that in you or me would set off
flashing lights and alarms is often (but sadly, evidently not always) benign in an elite athlete.

 

[Mike Murray]

"Dr. Jan Dressler of the University of Dresden medical institute said the 23-year-old rider's death
was probably caused by his heart enlarging and the coronary vessels failing to pump enough blood."

Sounds like what he is describing is hypertrophic cardiomyopathy also called idiopathic hypertrophic
subaortic stenosis (IHSS). This is a condition where the heart muscle thickens just below the
opening of the aortic valve. This thickened area narrows the effective area of the aortic valve and
causes a stenosis, or stricture, in the flow of blood. There is always a pressure drop after a
stricture in flow. Since the opening for the coronary arteries are just past the aortic valve this
can decrease the perfusion pressure (the differential pressure across the coronary arteries) and
decrease coronary blood flow. This condition can be made worse with athletic training because that
causes more thickening of the heart muscle wall, but it is something that you are born with not
something that you get from training. Patients can be without symptoms until they have a sudden
cardiac death, presumably from ventricular arrhythmia. The only thing that doesn't fit is that when
people with this disorder have sudden cardiac death it is generally after a brief episode of
exercise, not in their sleep like Salanson.

--
Mike Murray

 

[Realdean]

I also don't buy it, but being in the medical field, and assuming no foul play or illegal use of
drugs, here is my view..............Dying in one's sleep from "heat failure" in a person that is not
over weight, physically in shape and probably had a sleeping heart rate of 40bpm or less is rare
unless a catestrophic event were to occur. This leaves only 2 possibilities. There might have been
an electrolyte imbalance that caused an arrythmia or he had a blood clot that spontaneously occurred
in a large coronary artery. The later can happen to anyone at any time and that's the reason that a
baby aspirin a day is so critical for all adult to take. The former is unlikely unless his diet and
fluid intake was redically altered form previous race preparation. Either scenario could probably be
ruled out on autopsy. Soemthing is not kosher............................dean

 

[Us]

would seem to do with a "catastrophic" lose of blood pressure. Under work load the blood pressure is
ok because the heart rate is up. as a corallary when sleeping the heart rate drops to low resulting
in BP crash and death.....

>>Heart enlargement is usually a result of pulmonary insufficiency. He could have died anytime. He
>>just chose to go quietly in his sleep (not screaming like the passengers in his car)
>>
>
>
> Hold the phone.
>
> Pulmonary insufficiency? Again, if you are able to pedal a bicycle at 50kph, how do you _suddenly_
> have insufficient oxygen to supply the demands of the heart. Coronary artery spasm, perhaps, but
> that's not what the 'MD' reported.
>
> I agree that his heart was probably enlarged, but this in itself doesn't cause it to stop beating.
> Surely, if he heart was that 'sick', wouldn't the irregular heart beats be detected in his check
> ups? (doesn't France have the most stringent medical controls in the profession?). If it was
> 'purely congestive heart failure' as claimed ... he didn't have any symptoms of shortness of
> breath, chest pain, swollen ankles (signs of heart failure) ??
>
> If it was my family member, I'd look for a second opinion.
>
> FWIW.
>
> jw milwaukee

 

[J. Michael Lepp]

I agree with the possibility of IHSS, however I think we all should step back and realize we are
reading a newspaper report with layman interpretation. We are trying to read into this. I have
worked with European cyclists and had medical records sent and all of the terminology differs
slightly from American versions. The term "heart failure" means different things. Most often it is a
chronic condition that can be caused by many different causes (ie cardiomyopathy, damage from a
heart attack, long standing hypertension). Persons in heart failure can be susceptible to fatal
arrhythmias (which was most likely this cyclists cause of death). It is possible to have a mild
cardiomyopathy that causes a serious arrhthmia. This arrhythmia can occur under exertion and at
rest. It is also possible to have cardiomyopathy and still perform strongly. Many of you may
remember ex USPS/Lotto rider Stive Vermaut who retired earlier this year following diagnosis of a
serious arrhythmia (probably from a mild cardiomyopathy and/or damage to his heart muscle from a
previous illness). He was performing very well (I think top 30 in TDF) and having worked with
Stive's case here in th states, drugs were not an issue. Fortunately, Stive's arrhythmia was
diagnosed early and medication etc will allow him to live a healthy life albeit without competitive
cycling. By the way, I also thimk the comment about the French not screening athletes is off-base.
Nico Mattan had a very benign arrhythmia during his screening a few years back and he was not
permitted to ride again until (after a visit to US for further testing) it was proven that this
abnormality was benign. If anything the pre season physicals were quite stringent.

Finally, did not Salanson ride the TDF in the last couple of years? If I am not mistaken, they
perform a cardiac ultrasound on all starters. A significant cardiomyopathy would possibly shown up
on this test if it was done properly. However, the hypertophy in and athletic heart can sometimes
mask cardiomyopathy. "Mike Murray" <[email protected]> wrote in message
news:%YfEa.864519$OV.812187@rwcrnsc54...
> "Dr. Jan Dressler of the University of Dresden medical institute said the 23-year-old rider's
> death was probably caused by his heart enlarging and
the
> coronary vessels failing to pump enough blood."
>
> Sounds like what he is describing is hypertrophic cardiomyopathy also
called
> idiopathic hypertrophic subaortic stenosis (IHSS). This is a condition
where
> the heart muscle thickens just below the opening of the aortic valve.
This
> thickened area narrows the effective area of the aortic valve and causes a stenosis, or stricture,
> in the flow of blood. There is always a pressure drop after a stricture in flow. Since the opening
> for the coronary
arteries
> are just past the aortic valve this can decrease the perfusion pressure
(the
> differential pressure across the coronary arteries) and decrease coronary blood flow. This
> condition can be made worse with athletic training
because
> that causes more thickening of the heart muscle wall, but it is something that you are born with
> not something that you get from training. Patients can be without symptoms until they have a
> sudden cardiac death, presumably from ventricular arrhythmia. The only thing that doesn't fit is
> that when people with this disorder have sudden cardiac death it is generally after
a
> brief episode of exercise, not in their sleep like Salanson.
>
> --
> Mike Murray
>

 

[Realdean]

All this talk of ihss, or and enlarged heart relative to coronary circulatory capacity is really
only relavent during STRESS conditions.
(ie. that's where the steroid filled football player falls over during spring training and the
catecholamines being kicked out by the adrenal glands trigger coronary vasoconstriction,
conduction abnormallity or in the case of IHSS spasm of the heart tissue)....That's no
comparison to a cyclist who is sleeping in a deep state of rest. Again, I am new to cycling and
don't even know this Salanson guy, but the report of his death is very strange (again, in light
of the fact that no drug use is being reported)...............dean

 

[David Ryan]

Herb Dershowitz wrote:
>
> French cyclist died of heart failure, doctor says

"heart failure" = "we have no idea"

Everybody dies of heart failure. It's a symptom, not a cause. Something causes the heart to fail.
When they can't figure out what it is, they just put "heart failure" on the certificate because they
have to put something.

 

[Kurgan Gringion]

"David Ryan" <[email protected]> wrote in message news:[email protected]...
> Herb Dershowitz wrote:
> >
> > French cyclist died of heart failure, doctor says
>
> "heart failure" = "we have no idea"
>
> Everybody dies of heart failure. It's a symptom, not a cause. Something causes the heart to fail.
> When they can't figure out what it is, they just put "heart failure" on the certificate because
> they have to put something.

When I was in the dorms, one of the dudes put a lot of ex-lax in another dude's beer.

Dude #2 got very sick and had to go to the hospital. The hospital pumped out his stomach and put him
on an IV overnight.

Their explanation for his malady? Stomach Virus.

Basically because they didn't know what it was.

 

[Kyle Legate]

J999w wrote:
>
> I agree that his heart was probably enlarged, but this in itself doesn't cause it to stop
> beating. Surely, if he heart was that 'sick', wouldn't the irregular heart beats be detected in
> his check ups?
>
This is what I was wondering earlier.

There are different types of heart enlargement. There is the enlargement resulting from pulmonary
insufficiency (highly unlikely in Salanson's case) and there is the enlargement that is common to
endurance athletes. I'm sure a pathologist can tell the difference.

 

[Darren S.]

"Clovis Lark" <[email protected]> wrote in message
news:[email protected]...
> J999w <[email protected]> wrote:
<snip>
> Heart enlargement is usually a result of pulmonary insufficiency. He could have died anytime. He
> just chose to go quietly in his sleep (not screaming like the passengers in his car)

Pulmonary insufficient a cause of enlarged hearts in young, fit athletes? Where are you getting this
from? In young athletes death from "heart faliure" is usually due to hypertrophic cardiomyopathy.

D.

> > I don't buy it.
>
> death is for free, always has been. last I heard it is readily available for all.
>
> > jw milwaukee

---
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Version: 6.0.483 / Virus Database: 279 - Release Date: 5/19/2003

 

[Mike Murray]

This statement couldn't be any more incorrect as heart failure refers to a specific entity and not
to just the situation where the heart stops, or fails.
--
Mike Murray MD

"David Ryan" <[email protected]> wrote in message news:[email protected]...
> Herb Dershowitz wrote:
> >
> > French cyclist died of heart failure, doctor says
>
> "heart failure" = "we have no idea"
>
> Everybody dies of heart failure. It's a symptom, not a cause. Something causes the heart to fail.
> When they can't figure out what it is, they just put "heart failure" on the certificate because
> they have to put something.

 

[David Ryan]

My mother was once diagnosed with "heart failure." By the time the doctors almost killed her with a
digitalis overdose that put her in the hospital for two weeks, I suggested that it might be related
to a thyroid condition supposedly cured with an "atomic cocktail" 40 years before. Sure enough it
had come back and she needed a second one. She recovered from the digitalis, her heart returned to
normal and she is still living.

So, Doc, tell me about it.

Mike Murray wrote:
>
> This statement couldn't be any more incorrect as heart failure refers to a specific entity and not
> to just the situation where the heart stops, or fails.
> --
> Mike Murray MD
>
> "David Ryan" <[email protected]> wrote in message news:[email protected]...
> > Herb Dershowitz wrote:
> > >
> > > French cyclist died of heart failure, doctor says
> >
> > "heart failure" = "we have no idea"
> >
> > Everybody dies of heart failure. It's a symptom, not a cause. Something causes the heart to
> > fail. When they can't figure out what it is, they just put "heart failure" on the certificate
> > because they have to put something.

 

[Mike Murray]

Thyrotoxicosis, the pathologic condition of high thyroid levels, is a uncommon cause of heart
failure. Most often heart failure is caused by primary heart diseases that decrease the pumping
capability of the heart. Less commonly, heart failure is caused by increased demand on a heart that
has more normal pumping function. Thyrotoxicosis is an example of this. Other examples are sepsis,
fluid overload and some drug overdoses. Separating out the difference between these two things can
be difficult to do without invasive testing.

Digitalis was, in the recent past, standard therapy for heart failure. In most cases it has now been
superceded by better drugs. One reason why the other drugs are better is because digitalis has a
very narrow therapeutic window the toxic level overlapping into the therapeutic level. Digitalis
toxicity was common and a major problem with use of the drug.

The bottom line is that it sounds as though you mom actually did have heart failure which was caused
by thyrotoxicosis. Lowering the thyroid level by treating her with radioactive iodine removed the
cause for the heart failure.

--
Mike Murray

"David Ryan" <[email protected]> wrote in message news:[email protected]...
> My mother was once diagnosed with "heart failure." By the time the doctors almost killed her with
> a digitalis overdose that put her in the hospital for two weeks, I suggested that it might be
> related to a thyroid condition supposedly cured with an "atomic cocktail" 40 years before. Sure
> enough it had come back and she needed a second one. She recovered from the digitalis, her heart
> returned to normal and she is still living.
>
> So, Doc, tell me about it.
>
> Mike Murray wrote:
> >
> > This statement couldn't be any more incorrect as heart failure refers to
a
> > specific entity and not to just the situation where the heart stops, or fails.
> > --
> > Mike Murray MD
> >
> > "David Ryan" <[email protected]> wrote in message news:[email protected]...
> > > Herb Dershowitz wrote:
> > > >
> > > > French cyclist died of heart failure, doctor says
> > >
> > > "heart failure" = "we have no idea"
> > >
> > > Everybody dies of heart failure. It's a symptom, not a cause. Something causes the heart to
> > > fail. When they can't figure out what it is, they just put "heart failure" on the certificate
> > > because they have to put something.

 

[Rope <-- Huh?]

There you go, get a freakin' doctor to say that we should all take an aspirin a day.

I guess when I feel a little sick I should take some cough medicine, when I feel an itch, benedryl,
when I have an upset stomach I should take some pepto, when I feel sad I should take some prozak.

Or maybe I will let my body take care of it and treat itself so I don't become dependent on medicine
for every little thing that ails me. I haven't taken any medicine for over 8 years, and I feel
better than ever,

oh well,

Rope

"realdean" <[email protected]> wrote in message
news:[email protected]...
> I also don't buy it, but being in the medical field, and assuming no foul play or illegal use of
> drugs, here is my view..............Dying in one's sleep from "heat failure" in a person that is
> not over weight, physically in shape and probably had a sleeping heart rate of 40bpm or less is
> rare unless a catestrophic event were to occur. This leaves only 2 possibilities. There might have
> been an electrolyte imbalance that caused an arrythmia or he had a blood clot that spontaneously
> occurred in a large coronary artery. The later can happen to anyone at any time and that's the
> reason that a baby aspirin a day is so critical for all adult to take. The former is unlikely
> unless his diet and fluid intake was redically altered form previous race preparation. Either
> scenario could probably be ruled out on autopsy. Soemthing is not
> kosher............................dean

 

[Warren]

In article <[email protected]>, Rope
<[email protected]> wrote:

> There you go, get a freakin' doctor to say that we should all take an aspirin a day.
>
> I guess when I feel a little sick I should take some cough medicine, when I feel an itch,
> benedryl, when I have an upset stomach I should take some pepto, when I feel sad I should take
> some prozak.
>
> Or maybe I will let my body take care of it and treat itself so I don't become dependent on
> medicine for every little thing that ails me.

Yeah, a little aspirin to thin the blood-what could be good about that? Our ancestors didn't need no
doctors or preventive medicine and they lived to the ripe old age of 57. Sounds good to me.

-WG

 

[Realdean]

warren <[email protected]> wrote in message news:<100620031526190384%[email protected]>...
> I know I'm responding to someone with NO KNOWLEDGE about about
pharmacology but for what its worth hear it goes...........Aspirin DOES NOT THIN THE BLOOD! It DOES
prevent platelet aggregation, which is a good thing especially if someone is stupid enough to
needlessly take epo shots. Low dose aspirin (81mg per day)therapy interferes with the bodies
cycloxygenase system that causes vasoconstriction and platelet aggregation whereas the evidence
suggests that taking higher doses might in fact negate this benefit. In any event, statistically for
non-diabetic patients the best 2 things that anyone can do to live a long and healthy life is (1)
take a baby asdpirin a day and (2) keep your cholesterol as low as possible. Doing these 2 tings
outways the benefits of taking vitamins, antioxdants, controling weight, exercising , stoping
smoking and the list goes on.