Toronto marathon runner dies during race



You're confusing the word sad, with the word predictable.
 
The rate is about 1 in 150/200,000 contestants. That is rare enough
to only happen a couple times a year and make the news.
In recent years there have been some electrolyte imbalance deaths in
young
women who drank too much water. This case sounds more likely a
possible heart attack.
 

> The rate is about 1 in 150/200,000 contestants. That is rare enough
> to only happen a couple times a year and make the news.

The bad news:
- the death estimate is actually one per 50,000 marathon entrants.

The good news is:
- post mortems on 4 causualties revealed running didn't destroy their hearts
but rather uncovered 'weak links' in their cardiac systems which could not
stand up to several hours of strenuous, continuous exercise.

Some suggest:
- about 34% of physicians who run the Boston Marathon believe that people
should undergo an exercise stress test before beginning a strenuous exercise
programme.
- Distance eventers should look for signs of heart trouble during the race.

These are excerpts from a good article:
http://www.pponline.co.uk/encyc/0679.htm

Of concern:
- the risks are for marathoners or people participate in other forms of
exercise which last for three hours or more. The person who died in Toronto
did so at the 20km point in the half marathon.

KNOW THE RISKS.
 
Bill Topee wrote:
>>The rate is about 1 in 150/200,000 contestants. That is rare enough
>>to only happen a couple times a year and make the news.
>
>
> The bad news:
> - the death estimate is actually one per 50,000 marathon entrants.
>
> The good news is:
> - post mortems on 4 causualties revealed running didn't destroy their hearts
> but rather uncovered 'weak links' in their cardiac systems which could not
> stand up to several hours of strenuous, continuous exercise.

I don't see how that's any consolation. Such a person might live to a
good old age if only they'd somehow known to avoid prolonged strenuous
exercise.

>
> Some suggest:
> - about 34% of physicians who run the Boston Marathon believe that people
> should undergo an exercise stress test before beginning a strenuous exercise
> programme.

I'm confused about what in particular such tests can discover. Didn't
Bill Clinton recently have heart troubles after testing OK?
 
timeOday wrote:
> Bill Topee wrote:
>
>>> The rate is about 1 in 150/200,000 contestants. That is rare enough
>>> to only happen a couple times a year and make the news.
>>
>>
>>
>> The bad news:
>> - the death estimate is actually one per 50,000 marathon entrants.
>>
>> The good news is:
>> - post mortems on 4 causualties revealed running didn't destroy their
>> hearts but rather uncovered 'weak links' in their cardiac systems
>> which could not stand up to several hours of strenuous, continuous
>> exercise.
>
>
> I don't see how that's any consolation. Such a person might live to a
> good old age if only they'd somehow known to avoid prolonged strenuous
> exercise.
>
>>
>> Some suggest:
>> - about 34% of physicians who run the Boston Marathon believe that
>> people should undergo an exercise stress test before beginning a
>> strenuous exercise programme.
>
>
> I'm confused about what in particular such tests can discover. Didn't
> Bill Clinton recently have heart troubles after testing OK?


OK (replying to my own post) the article linked elsewhere in the thread
has a good section on relevant tests:

<http://www.pponline.co.uk/encyc/0679.htm>

------------------------------------------------------


This brings us to the issue of screening: could you take a test which
might reveal that your heart was vulnerable to trouble during strenuous
exercise? The relevant test in this case would, of course, be an
exercise stress test, during which an ECG reading is taken as you run at
increasing intensities on a treadmill. These 'exams' can frequently
unmask fat-filled coronary arteries.
Unfortunately, the tests do not have a very high predictive value since
as many as 63% of those who 'fail' a stress test actually have
completely normal cardiovascular systems(9). Furthermore, the rate of
such 'false positives' among endurance athletes can be 100% (ibid),
because the natural thickening of the heart in response to endurance
training changes ECG readings!
....
The risk of dying during a stress test is a matter for debate, but has
been estimated at anything between 1-in-20,000(11) and 1-in-500,000
tests(12). As you can quickly calculate for yourself, if the true stress
test death rate happened to be 1-in-25,000 and the true marathon death
rate stayed at 1-in-50,000, and if stress testing was used to 'screen'
marathon entrants, two people would be killed during stress testing for
every one athlete potentially saved!
There's more! The vast majority of individuals who die during or shortly
after exercise would have had completely normal stress tests, even if
the tests were given the day before they died (13). Some experts believe
that stress testing can only detect about 20-25% of the likely victims
of sudden, exercise-related death.
 
Bill Topee wrote:
> The good news is:
> - post mortems on 4 causualties revealed running didn't destroy their hearts
> but rather uncovered 'weak links' in their cardiac systems which could not
> stand up to several hours of strenuous, continuous exercise.

Early in my program - our scheduled long run was 8 miles, I only
went 6 miles because of GI distress - I ended up in the ER due to
"discomfort" after one run. I doubted it was a heart attack but I
was aware of the possibility that it was exactly that type of
exercise-induced irregularity.

I ended up getting a stress test and convinced the cardiologist to
let me push it to my sprint pace. Nothing showed up and that made
me feel much more confident about continuing the program. I also
knew that my doctor wouldn't have ordered one earlier because of
the false positive rate.

Coincidently this happened just after I bought my HRM. I was
still in the denial stage but after this event I followed to book
formula for a few weeks. I only adjusted my limits after my
Bolder Boulder run showed a HR at least 10 bpm higher than what
the books said.
 
timeOday wrote:
> Unfortunately, the tests do not have a very high predictive value since
> as many as 63% of those who 'fail' a stress test actually have
> completely normal cardiovascular systems(9). Furthermore, the rate of
> such 'false positives' among endurance athletes can be 100% (ibid),
> because the natural thickening of the heart in response to endurance
> training changes ECG readings!

In this case you also want to know the false negative rate. I
would rather be overcautious because I was falsely warned of
problems than be dead because I was falsely told there wasn't a
problem.
 
It seems to me I heard somewhere that rick++ wrote in article
<[email protected]>:

>The rate is about 1 in 150/200,000 contestants. That is rare enough
>to only happen a couple times a year and make the news.
>In recent years there have been some electrolyte imbalance deaths in
>young
>women who drank too much water. This case sounds more likely a
>possible heart attack.

We always forget to ask how many out of 150/200,000 would have died
doing other things like golf, yard work, or even TV watching during the
same number of hours per year.
--
Don
[email protected]
 
<< You're confusing the word sad, with the word predictable. >>

Au contraire!

_______
Blog, or dog? Who knows. But if you see my lost pup, please ping me!
<A
HREF="http://journals.aol.com/virginiaz/DreamingofLeonardo">http://journal
s.aol.com/virginiaz/DreamingofLeonardo</A>
 
Bear G wrote:
> timeOday wrote:
>
>> Unfortunately, the tests do not have a very high predictive value
>> since as many as 63% of those who 'fail' a stress test actually have
>> completely normal cardiovascular systems(9). Furthermore, the rate of
>> such 'false positives' among endurance athletes can be 100% (ibid),
>> because the natural thickening of the heart in response to endurance
>> training changes ECG readings!
>
>
> In this case you also want to know the false negative rate. I would
> rather be overcautious because I was falsely warned of problems than be
> dead because I was falsely told there wasn't a problem.

Overcautious as in limiting yourself to shorter runs? Even if the test
is probably wrong?

Or further testing? I didn't post the paragraph about that:

----------
This high frequency of 'wrong calls' is troubling, not only because of
the inaccuracies associated with stress testing it reveals but because
many of those with false positive results are then subjected to more
rigorous and invasive medical procedures, including thallium stress
testing (in which a dye is placed in the bloodstream during exercise) or
coronary catheterisation (in which a long tube is snaked through blood
vessels into the heart). These tests are expensive and not without risk;
in fact, coronary catheterisations may be riskier than marathons!
 
Don Kirkman wrote:
> It seems to me I heard somewhere that rick++ wrote in article
> <[email protected]>:
>
>
>>The rate is about 1 in 150/200,000 contestants. That is rare enough
>>to only happen a couple times a year and make the news.
>>In recent years there have been some electrolyte imbalance deaths in
>>young
>>women who drank too much water. This case sounds more likely a
>>possible heart attack.
>
>
> We always forget to ask how many out of 150/200,000 would have died
> doing other things like golf, yard work, or even TV watching during the
> same number of hours per year.

From the link the other guy posted:
<http://www.pponline.co.uk/encyc/0679.htm>

"In fact, any athlete who participates in a strenuous test of endurance
lasting about three hours or more has an increased chance of dying
during - and for 24 hours following - the exertion, even when the
athlete's chance of a death-door knock is compared with the risk
incurred by a cigarette-smoking, sedentary layabout who spends the same
24 hours drinking beer and watching TV."
 
timeOday wrote:
> Bear G wrote:
>> In this case you also want to know the false negative rate. I would
>> rather be overcautious because I was falsely warned of problems than
>> be dead because I was falsely told there wasn't a problem.
>
> Overcautious as in limiting yourself to shorter runs? Even if the test
> is probably wrong?

"Shorter runs" goes up to half marathons.

Anyway there may be some confusion on the terminology. "False
positive" is when the test says you have a problem but you don't.
"False negative" is when the test says you're fine but you
aren't.

We don't know what the false negative rate is - it's often wildly
different than the false positive rate and the FDA will usually be
biased towards higher false positive rates than false negative
ones since the philosophy is that a false positive can be detected
by subsequent tests, but a false negative will usually be the
final word.
 
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