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Matters of health crucial ahead of Nairobi Marathon
Sports and recreational exercise are recognised ways of preventing and
treating heart disease as well as other diseases such as diabetes and
hypertension.
Despite this beneficial role however some people can suddenly collapse and
die while engaging in sports or recreational exercise. This can occur in fully
conditioned sportsmen at the peak of their sporting careers and sometimes in
tragically dramatic circumstances such as televised sporting activities.
Statistics compiled mainly in the West, show the prevalence of athletic
deaths to be in the range of 1:100,000 in high school athletes, being
disproportionately higher in male athletes. In older athletes or sportsmen the
prevalence ranges from 1:7500 to 1:15000 adults. In marathon runners one death
in 50,000 participants has been reported.
These statistics indicate that death during sports or exercise is relatively
infrequent. However, when it occurs, it raises enormous concern and anxiety
among the public, sports administrators and the medical fraternity.
There has been great interest in what is the actual mechanism that mediates
exercise-induced sudden cardiac death. The consensus now is that under the
strain of exercise, a heart with some structural abnormality develops a lethal
heart rhythm, which is incompatible with proper function of the heart.
Who is at risk? The conditions causing such lethal arrhythmias in young
athletes under 35 years of age include previously undiagnosed heart muscle
diseases, congenital anomalies of the blood vessels supplying the heart
(coronary arteries), inflammation of heart muscle by viruses among many others.
For athletes and recreational exercisers above the age of 35 years, the main
cause is usually unrecognized acquired disease of the coronary arteries
(coronary artery disease). This is a condition in which these very important
life supporting pipes called the coronaries, are gradually blocked by
accumulation of fat like material on their walls.
This causes a narrowing and finally cause total obstruction of blood flow in
the affected artery. Partial blockage may cause exercise induced chest pain or
rhythm disturbances, while total blockage causes the well-known devastating
heart attack.
Heart attacks don't strike like lightning. In most cases it is possible to
predict where (who) they will strike. Over the years certain conditions called
risk factors found in some people, have been studied and found to be the
precursors of heart attacks.
The major factors known to have a strong association with coronary artery
disease are cigarette smoking, diabetes, hypertension and high blood cholesterol
levels. Other major factors and rather interesting in view of this discussion is
sedentary lifestyle or lack of exercise and obesity!
Regular moderate exercise is clearly beneficial but may carry a small
increase in risk during the duration of exercise. This transient risk during
exercise is neutralised by the overall improvement in long-term survival enjoyed
by moderate regular exercisers. Obesity predisposes one to many diseases such as
diabetes and hypertension, which in turn become risks for development of heart
disease.
Screening for cardiovascular diseases before any serious programme of
competitive sport or exercise is therefore important.
Cardiovascular pre-participation screening is done at four levels.
The first is the studying of personal and family health history.
This interview includes any historical evidence of conditions that are known
to cause sudden collapse or death. Such history includes occurrence of chest
pain, fainting (syncope), or near fainting and episodes of unexpected shortness
of breath or fatigue during exercise.
Family history of conditions known to run in families such as hypertrophic
cardiomyopathy (HCM), dilated cardiomyopathy or abnormal heart rhythm among
others is noted. Any positive finding in the above items places the athlete in a
category that calls for more intensive testing. Then comes a physical
examination.
This includes a general examination to detect physical evidence of heart
disease such as stigmata (signs of) very high familial cholesterol, or marfans
syndrome (condition in which affected persons are very tall with long limbs and
fingers among other features).
Specific attention is focused on the heart where the heart is listened to
with the athlete in both lying and standing positions to detect certain types of
murmurs. Feeling of all peripheral pulses to detect change in volume or timing
is important. Blood pressure is taken in the seated position.
Then there is non-invasive testing.
This is a test that detects the heart's electrical activity from the body
surface and can immediately diagnose some of these conditions.
Then there is a more specialised ultrasound based scan of the heart which
shows the anatomical features of the heart allowing an accurate assessment as to
whether the heart is normal or not. Only a few athletes would end up requiring
this test.
Those athletes suspected to have congenital coronary artery anomalies or
athletes over 35 years-of-age are subjected to an exercise stress test. This
test is also recommended for those wishing to start regular exercise programmes
for lifestyle change if they are over 40 years-of-age.
This is also particularly if they have never exercised seriously before, or
have previously mentioned coronary risk factors.
Those with known heart conditions need a supervised exercise stress test
inorder to get an exercise prescription indicating how much they can exercise
without endangering themselves.
Then there is invasive testing.
Very few, with suspicion of coronary artery anomalies (arteries supplying the
heart muscle) may require selective coronary angiography. This is a test done
under local anesthesia and involves visualising the coronary arteries. This is a
very accurate test.
For those intending to engage in the forthcoming marathon, it is important
for one to have a fairly good idea that they are healthy and condition
themselves well for the event by adequate preparation. For the organisers it is
important to have in place and at strategic points along the route adequate
resuscitation equipment and trained personnel to deal with such cardiovascular
emergencies.
-The writer is a heart and blood vessel specialist
Sports and recreational exercise are recognised ways of preventing and
treating heart disease as well as other diseases such as diabetes and
hypertension.
Despite this beneficial role however some people can suddenly collapse and
die while engaging in sports or recreational exercise. This can occur in fully
conditioned sportsmen at the peak of their sporting careers and sometimes in
tragically dramatic circumstances such as televised sporting activities.
Statistics compiled mainly in the West, show the prevalence of athletic
deaths to be in the range of 1:100,000 in high school athletes, being
disproportionately higher in male athletes. In older athletes or sportsmen the
prevalence ranges from 1:7500 to 1:15000 adults. In marathon runners one death
in 50,000 participants has been reported.
These statistics indicate that death during sports or exercise is relatively
infrequent. However, when it occurs, it raises enormous concern and anxiety
among the public, sports administrators and the medical fraternity.
There has been great interest in what is the actual mechanism that mediates
exercise-induced sudden cardiac death. The consensus now is that under the
strain of exercise, a heart with some structural abnormality develops a lethal
heart rhythm, which is incompatible with proper function of the heart.
Who is at risk? The conditions causing such lethal arrhythmias in young
athletes under 35 years of age include previously undiagnosed heart muscle
diseases, congenital anomalies of the blood vessels supplying the heart
(coronary arteries), inflammation of heart muscle by viruses among many others.
For athletes and recreational exercisers above the age of 35 years, the main
cause is usually unrecognized acquired disease of the coronary arteries
(coronary artery disease). This is a condition in which these very important
life supporting pipes called the coronaries, are gradually blocked by
accumulation of fat like material on their walls.
This causes a narrowing and finally cause total obstruction of blood flow in
the affected artery. Partial blockage may cause exercise induced chest pain or
rhythm disturbances, while total blockage causes the well-known devastating
heart attack.
Heart attacks don't strike like lightning. In most cases it is possible to
predict where (who) they will strike. Over the years certain conditions called
risk factors found in some people, have been studied and found to be the
precursors of heart attacks.
The major factors known to have a strong association with coronary artery
disease are cigarette smoking, diabetes, hypertension and high blood cholesterol
levels. Other major factors and rather interesting in view of this discussion is
sedentary lifestyle or lack of exercise and obesity!
Regular moderate exercise is clearly beneficial but may carry a small
increase in risk during the duration of exercise. This transient risk during
exercise is neutralised by the overall improvement in long-term survival enjoyed
by moderate regular exercisers. Obesity predisposes one to many diseases such as
diabetes and hypertension, which in turn become risks for development of heart
disease.
Screening for cardiovascular diseases before any serious programme of
competitive sport or exercise is therefore important.
Cardiovascular pre-participation screening is done at four levels.
The first is the studying of personal and family health history.
This interview includes any historical evidence of conditions that are known
to cause sudden collapse or death. Such history includes occurrence of chest
pain, fainting (syncope), or near fainting and episodes of unexpected shortness
of breath or fatigue during exercise.
Family history of conditions known to run in families such as hypertrophic
cardiomyopathy (HCM), dilated cardiomyopathy or abnormal heart rhythm among
others is noted. Any positive finding in the above items places the athlete in a
category that calls for more intensive testing. Then comes a physical
examination.
This includes a general examination to detect physical evidence of heart
disease such as stigmata (signs of) very high familial cholesterol, or marfans
syndrome (condition in which affected persons are very tall with long limbs and
fingers among other features).
Specific attention is focused on the heart where the heart is listened to
with the athlete in both lying and standing positions to detect certain types of
murmurs. Feeling of all peripheral pulses to detect change in volume or timing
is important. Blood pressure is taken in the seated position.
Then there is non-invasive testing.
This is a test that detects the heart's electrical activity from the body
surface and can immediately diagnose some of these conditions.
Then there is a more specialised ultrasound based scan of the heart which
shows the anatomical features of the heart allowing an accurate assessment as to
whether the heart is normal or not. Only a few athletes would end up requiring
this test.
Those athletes suspected to have congenital coronary artery anomalies or
athletes over 35 years-of-age are subjected to an exercise stress test. This
test is also recommended for those wishing to start regular exercise programmes
for lifestyle change if they are over 40 years-of-age.
This is also particularly if they have never exercised seriously before, or
have previously mentioned coronary risk factors.
Those with known heart conditions need a supervised exercise stress test
inorder to get an exercise prescription indicating how much they can exercise
without endangering themselves.
Then there is invasive testing.
Very few, with suspicion of coronary artery anomalies (arteries supplying the
heart muscle) may require selective coronary angiography. This is a test done
under local anesthesia and involves visualising the coronary arteries. This is a
very accurate test.
For those intending to engage in the forthcoming marathon, it is important
for one to have a fairly good idea that they are healthy and condition
themselves well for the event by adequate preparation. For the organisers it is
important to have in place and at strategic points along the route adequate
resuscitation equipment and trained personnel to deal with such cardiovascular
emergencies.
-The writer is a heart and blood vessel specialist
