Invincible athlete's death renews cardiac questions

Published: Sunday, May. 24, 2009 - 12:09 am | Page 3L
Last Modified: Sunday, May. 24, 2009 - 1:48 pm

Every time an elite athlete dies suddenly from heart failure while competing – and thankfully, that doesn't happen often – disbelief and concern are the dominant reactions.

Such was the case Wednesday when triathlete, former professional cyclist and ex-Davis resident Steve Larsen, 39, collapsed and died on a track in Bend, Ore., during interval training with 40 other runners. Medical examiners ruled the death the result of sudden cardiac arrest; an autopsy is pending.

"I don't know a fitter human being," fellow triathlete Matt Lieto told the Bend Bulletin. "I always thought of him as invincible."

Larsen's death, coming not so long after the sudden cardiac arrest deaths of Ryan Shay during the 2007 Olympic Marathon trials and Adam Nickel just after finishing 18th in the Little Rock (Ark.) Marathon in 2008, has made some wonder about the health and safety of athletes in endurance sports.

Those raising concerns also point to the 1984 death of so-called running guru Jim Fixx, who wrote the best-seller "The Complete Book of Running" and dropped dead on the road of cardiac arrest.

Medical researchers and exercise scientists have long studied the effects of exercise on the heart.

A study presented this month at the International Conference of the American Thoracic Society in San Diego showed that marathon runners' heartbeats and ventricle pumping capabilities had abnormalities immediately after the race. But follow-up tests by University of Manitoba (Canada) researchers showed the runners had no signs of permanent injury to the heart.

The study rebuts a 2006 study in the journal Circulation that showed heart abnormalities among 60 non-elite participants in the Boston Marathon.
While tests on Larsen's heart are pending, nearly all the other athletes who have died suddenly were later proved to have preexisting genetic conditions, such as an enlarged heart or a coronary artery anomaly.

Dr. Barry Maron of the Minneapolis Heart Institute Foundation, who has studied sudden death in athletes for three decades, says about 125 athletes under age 35 succumb to sudden cardiac death every year.

In many cases, athletes had no previous indication of heart problems. Even those who had been alerted to heart abnormalities – such as Shay, who was diagnosed with a slightly enlarged heart when he was 14 – were given clearance and clean bills of health from physicians to pursue endurance sports.

Toxicology tests on Shay, who was 28 when he died Nov. 3, 2007, at the five-mile mark of the Olympic trials, determined that he had an irregular heartbeat from an enlarged and scarred heart. The scarring, doctors said, looked as if it was an "old" injury to the muscle. Shay had pneumonia when he was 14, but doctors aren't sure whether that was a cause of scarring.

"Tough scars can set up abnormal electrical currents," Dr. Paul Thompson, a Hartford cardiologist specializing in heart disease among athletes, told the New York Times in 2008. "If normal conductivity gets blocked, it can result in fast, abnormal rhythms, and a person can die."

Experts, therefore, say Shay's death could not be linked to the so-called athlete's heart syndrome – undetectable hereditary conditions like a thickening of the muscle called hypertrophic cardio- myopathy.

That condition first gained national attention in 1990 when Loyola Marymount University star basketball player Hank Gathers collapsed and died during an NCAA tournament game. NBA player Reggie Lewis, 27, died three years later of a condition similar to Shay's – an enlarged and scarred heart. Nickel, the Arkansas marathoner, was later found to have artery dysplasia, a narrowing of the arteries that restrict blood flow.
The doctor who performed Nickel's autopsy, Charles Kokes, told the Arkansas Democrat- Gazette that an electro- cardiogram could have detected the condition.

American Heart Association guidelines for cardiac screenings for young athletes (high school age) call for an extensive medical history questionnaire and tests that check for high blood pressure and heart murmurs. Some medical professionals believe it should include a more thorough heart test. An Italian study in the Journal of the American College of Cardiology reported that EKGs can reduce the risk of sudden cardiac death by nearly 90 percent. (Italy has had routine EKG screening for athletes since 1982.)

In the United States, the National Basketball Association in 2007 started echocardiograms and EKGs for all players.

But most doctors say that endurance athletes don't need EKGs unless their doctors find reason to suspect problems.

A study from French researchers released Wednesday showed a link between people with an excessive increase in heart rate prior to engaging in exercise and those at risk of sudden cardiac death at a later point.

"Few measurements in medicine are as inexpensive and as easy to obtain in large general populations as to measure the heart-rate difference between resting and being ready to perform an exercise test," said Dr. Xavier Jouven from Hopital Europeen Georges Pompidou, Paris, in a statement.

The researchers followed non-elite athletes (7,746 male civil servants) for 23 years. They compared resting heart rate with that measured just before they rode a stationary bicycle. Eighty-one of the subjects died from sudden cardiac death during the two- decade followup.

Experts caution that the number of sudden deaths during endurance sports still is small. The Boston Globe reported that for every 1 million marathon racers, four to eight die each year. For triathletes, the numbers jump to 15 out of a million. The increase, posits Minneapolis Heart Institute researcher Dr. Kevin Harris, might have to do with problems from cold water in the swimming portion.

There is some good news on the research front, though: Stanford University researchers found that runners ages 50 and older had significantly less heart disease than non-runners and showed a lower number of physical disabilities as they aged.