Abstract
Life-Threatening Events During Endurance Sports
Endurance sports have become increasingly popular in the last decade, with an estimated 500 000 runners finishing a marathon in the United States in 2011. While moderate daily activity is correlated with improved health outcomes, there is a small but significant risk associated with endurance sports. Two of the well-recognized causes of death during endurance sports are arrhythmic death and heat stroke; however, arrhythmic death is much more popular among the research and medical community. The goal of the current study was to determine what percentage of adverse and life-threatening events were due to cardiac causes versus heat stroke.
The investigators performed a retrospective study of 14 endurance running races in Tel Aviv, Israel, from 2007 to 2013. There are 2 running races per year in Tel Aviv with distances of 10 km, half marathon, and full marathon. The races take place near the Tel Aviv Medical Center, ensuring that all serious medical problems are seen at this tertiary care facility. The investigators collected data from race officials and race medical crews as well as retrospective hospital data. Of the 137 580 runners included in this study, serious adverse events (defined as hospitalization or death) occurred in 23 athletes, including 2 fatal events. Of the 23 events, 2 were due to cardiac events and 21 were due to heat stroke. The 2 cardiac events included a single-vessel myocardial infarction that was successfully treated and a supraventricular tachycardia requiring ablation. Of the 21 heat stroke cases, 2 were fatal, and 12 required either cardiopulmonary resuscitation or intensive care unit admission. There were an additional 42 cases of heat exhaustion that required hospital admission to floor units.
During an endurance running event in warm climates, the investigators found a 10-fold increased risk of serious adverse events due to heat stroke versus cardiac arrhythmias. The investigators emphasize the need to educate the public, race medical providers, and surrounding medial facilities to quickly recognize and treat heat stroke. Limitations of the study include the retrospective design and a single race location.
(J Am Coll Cardiol. 2014;64:463–469). L Yankelson, B Sadeh, L Gershovitz, et al.
Prepared by Matthew Stewart, MD, University of Utah Emergency Medicine Global Health Fellow, Salt Lake City, UT, USA.