Clear Eyes, Full (Healthy) Heart, Can't Lose

Let’s get to the heart of it – knowing your cardiac risk is important as an athlete. The good news is that leisurely running – even 5-10 minutes per day, at paces as low as 5 miles per hour, reduces cardiovascular and all risk mortality! However, exercise can increase the risk of sudden  cardiac death for athletes with a pre-existing heart condition. (1) This is why it is important to know if you have, or are at high risk, for a heart condition.

Most high school, collegiate, and professional athletic associations require some form of pre-season screening to assess for cardiac risk. However, the population with the highest prevalence of sudden death among athletes is recreational runner’s, with a rate of 1 in 15,000, while the sudden death rate among marathoners is 1 in 50,000 and among high school athletes is 1 in 100 – 200, 000. (2) Without an institution enforcing cardiac screening, everyday athlete’s such as myself, are on their own to reduce risk of sudden death. In honor of heart month, here is what you can do to know your risk factors, and seek further assessment as needed, to lower your risk of sudden cardiac death.

Knowledge of your family cardiac history is powerful information. This information can be used to inform decisions on whether or not higher-level cardiac screening (like the diagnostic gold standard 2D Echocardiogram) is necessary. Here are some questions from the Massachusetts General Hospital Cardiac Screening Tool about family history that can be helpful when assessing cardiac risk (if you don’t know the answers, ask your family!)

• Do you have a blood relative who has been told that they have a heart condition or arrhythmia (i.e. hypertrophic cardiomyopathy, Wolf Parkinson White, Long QT syndrome, and others)?

• Do you have a blood relative who suffered sudden or unexplained death (especially before age 50) or an event requiring resuscitation (CPR)?

• Do you have a blood relative who required the placement of a defibrillator or pacemaker before age 50?

These questions are most pertinent with close family members such as a parent or sibling. Answers to these questions can be discussed with your primary care provider.

The answers to the above questions, paired with any symptoms, increase concern for an underlying cardiac condition. If you experience any of the following symptoms, especially during or after aerobic exercise, you should immediately tell your primary care provider. Red flag symptoms include:

• Lightheadedness or fainting during exercise

• Chest tightness, pain, or pressure during exercise

• Feeling more winded or having shortness of breath at efforts that normally do not elicit breathlessness, on multiple occasions

• The feeling of your heart racing or fluttering in your chest

If you identify with the above symptoms, and / or answered yes to family history questions, the best next step is to meet with your primary care provider who can use objective tests like bloodwork, blood pressure, and more, to make an informed decision on best next steps. Your provider may recommend a further assessment with a Sports Cardiologist, like Dr. Jonathan Kim, who has spoken about heart conditions in runners on the More Than Miles Podcast. Sports Cardiologists have all the knowledge of a regular cardiologist, but with the additional understanding of the demands, and cardiac differences, in athletes. This perspective will help an athlete with cardiac concerns know their risks, if any, and if any modifications to training may need to be made.

Outside of screening for cardiac conditions, there are other ways to mitigate risk should something happen to you.

• Make sure that someone knows that you are out running and would be able to call for help if you didn’t return. If you live alone, you could text someone when you leave for your run, and when you get back, so that they know you are safe.

• Run in populated areas, or with a buddy, so that if something were to happen to you, someone would see you and be able to call for help. Rapid response saves lives!

• Have medical information on your person. If something were to happen, having information such as medical conditions, allergies, and blood type easily accessible to paramedics can help you get the right care. You should also have emergency contact information listed. This can be on a medical ID bracelet, on your shoelaces, or saved on your phone.
  

I hope that this blog empowered you with knowledge of how to reduce your risk of cardiac events while running! Thanks for reading, and Happy Heart Month!

Dr. Elizabeth Karr PT, DPT

1.    Fanous Y, Dorian P. The prevention and management of sudden cardiac arrest in athletes. CMAJ. 2019;191(28):E787-E791. doi:10.1503/cmaj.190166

2.    Crawford MH. Screening athletes for heart disease. Heart. 2007;93(7):875-879. doi:10.1136/hrt.2005.085365