Toronto marathon runner dies during race

Discussion in 'General Fitness' started by Bill Toupee, Oct 17, 2004.

  1. Bill Toupee

    Bill Toupee Guest

    Tags:


  2. You're confusing the word sad, with the word predictable.
     
  3. rick++

    rick++ Guest

    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.
     
  4. Bill Topee

    Bill Topee Guest


    > 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.
     
  5. timeOday

    timeOday Guest

    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?
     
  6. timeOday

    timeOday Guest

    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.
     
  7. Bear G

    Bear G Guest

    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.
     
  8. Bear G

    Bear G Guest

    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.
     
  9. Don Kirkman

    Don Kirkman Guest

    It seems to me I heard somewhere that rick++ wrote in article
    <f7422d8e.04101807[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]
     
  10. Her One

    Her One Guest

    << 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>
     
  11. timeOday

    timeOday Guest

    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!
     
  12. timeOday

    timeOday Guest

    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."
     
  13. Doug Freese

    Doug Freese Guest

    "Miss Anne Thrope" <[email protected]> wrote in message
    news:[email protected]
    > You're confusing the word sad, with the word predictable.


    That's way below the belt, even for you..
     
  14. Bear G

    Bear G Guest

    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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