Half marathon and heart attack: What’s the connection? Precautions to follow during long distance running

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OCTOBER 19, 2023

Running is considered a heart-healthy exercise and cardiologist say there is a minimal chance of getting a heart attack during marathons.

What could have been a possible win turned into a tragedy when 51-year-old Asheesh Kumar Garg collapsed while running Delhi Half Marathon on Sunday. Garg had a heart attack when he was 50 metres away from the finishing line. He was unresponsive and without pulse when CPR was initiated on him. He revived after getting treatment in ICU of the medical base camp, however, after being shifted to a nearby hospital, he succumbed to the second cardiac arrest and died. Cardiac deaths in gyms, in concerts, and even while driving, are on rise for the past many years and this has made many cautious about indulging in heavy exercises. Running, however, is considered a heart-healthy exercise and cardiologist say there is a minimal chance of getting a heart attack while running. However, there are many hidden factors that could lead to collapsing while during a marathon.

“As per a paper in reputed international journal, incidence rates of cardiac arrest and sudden death during long-distance running races were 1 per 184,000 and 1 per 259,000 participants, respectively. We estimate that this translates into 0.2 cardiac arrests and 0.14 sudden deaths per 100,000 runner-hours at risk, using average running times of 4 and 2 hours for the marathon and half-marathon, respectively. Event rates among marathon and half-marathon runners are relatively low, as compared with other athletic populations, including collegiate athletes (1 death per 43,770 participants per year), 23 triathlon participants (1 death per 52,630 participants), and previously healthy middle-aged joggers (1 death per 7620 participants). These data suggest that the risk associated with long-distance running events is equivalent to or lower than the risk associated with other vigorous physical activity,” says Dr Vivudh Pratap Singh, Senior consultant – Interventional Cardiology, Fortis Escorts, Okhla Road, New Delhi.

“Cardiac arrest, most commonly attributable to hypertrophic cardiomyopathy or atherosclerotic coronary disease, occurs primarily among male marathon participants; the incidence rate in this group increased during the past decade. The absolute number of race-related cardiac arrests each year increased over the past decade. This is best explained by the parallel increase in participation. Second, men were more likely than women to have cardiac arrest and sudden death,” adds Dr Singh.

What may have caused the runner’s death? Here are possible causes

Dr Neeraj Jain, Director-Internal Cardiology, Medical Director – Metro Hospital, Faridabad says the death of the runner could have been caused due to various factors and it is essential to understand that individual circumstances, medical history, and pre-existing health conditions also play a significant role in such cases.

“It’s important to emphasize that running is generally a safe and healthy activity, but individuals should be aware of their personal health status and take appropriate precautions, as outlined in the previous response. If someone is concerned about their health or experiences any unusual symptoms while running, they should seek immediate medical attention. Routine medical check-ups can also help identify and manage underlying health conditions that might pose a risk during physical activity,” says Dr Jain.

Some possible reasons for the death of a runner as explained by Dr Jain:

Cardiovascular issues: Sudden cardiac events, such as a heart attack or arrhythmia, can occur during or after a run, especially in individuals with undiagnosed heart conditions or a family history of heart disease.

Heat-related illnesses: Overheating, heat exhaustion, or heat stroke can be life-threatening, especially when running in extremely hot and humid conditions without proper hydration and cooling strategies.

Hyponatremia: This is a condition in which the blood’s sodium levels become dangerously low due to excessive fluid intake. It can be a risk for runners who consume large amounts of water during a race without replacing lost electrolytes.

Dehydration: Severe dehydration can lead to various complications, including kidney damage, which can be fatal if not addressed.

Overexertion: Pushing the body too hard, especially without adequate training, can lead to exhaustion and, in severe cases, organ failure.

Exacerbation of underlying health conditions: Individuals with pre-existing medical conditions, such as asthma, diabetes, or certain musculoskeletal issues, may be at risk if they do not manage their conditions properly while running.

Accidents and injuries: Runners may be at risk of falls, collisions, or accidents while running on uneven terrain or in areas with traffic.

Unknown medical conditions: In some cases, runners may have undiagnosed health conditions that suddenly manifest during a run, such as a ruptured aneurysm or a severe allergic reaction.

Prevention tips to follow before long-distance running

“A number of factors, including fatigue, emotional stress, dehydration, and heat stroke, as well as the accumulation of lactic acid and dyselectrolytemia in the blood throughout the race, can significantly contribute (to heart attack) and can be the possible reason of marathon runners collapsing close to the finish line,” says Dr. Sanjat Chiwane, Director, Cardiology, Max Hospital Gurgaon.

Dr. Chiwane shares heart-friendly tips to follow before running a marathon:

1. Pay attention to your body: It will provide you with indications and hints. If you experience any of the following signs while exercising or training such as: lightheadedness, upper body discomfort, shortness of breath, or chest pain, call your doctor right away.

2. Examine your family’s history: If there have been any unexpected cardiac deaths in your family, be informed about it. To better assist you, share your medical history with your doctor and undergo routine pre-health screenings.

3. Keep your cholesterol levels within a healthy and safe range. It’s crucial to keep your coronaries clear. If your doctor prescribes a statin to decrease your cholesterol, take it.

4. Warm-up and cool-down: Make sure to warm up properly before your run and cool down at the end of the race. This promotes healing and gets your body ready for the physical strain.

Dr. Jain adds more precautions to the list for avoiding strain on heart while running.

5. Consult your healthcare provider: Before starting any long-distance running program, it’s crucial to consult your doctor, especially if you have pre-existing heart conditions or risk factors for heart disease. They can provide personalized advice and perform any necessary tests to assess your heart health.

6. Build a strong foundation: If you’re new to running, start with shorter distances and gradually increase your mileage over time. This will help your body adapt to the demands of long-distance running and reduce the risk of injury.

7. Stay hydrated: Dehydration can put extra stress on the heart, so be sure to drink enough water before, during, and after your run, especially in hot or humid conditions.

8. Pay attention to your heart rate: Monitor your heart rate during your runs. You can use a heart rate monitor to help you stay within your target heart rate zone. This can help you avoid overexertion.

9. Know your limits: Listen to your body. If you experience chest pain, dizziness, shortness of breath, or any other unusual symptoms, stop running and seek medical attention immediately.

10. Cross-train: Incorporate other forms of exercise, such as strength training and flexibility exercises, into your routine. This can help improve overall fitness and reduce the risk of overuse injuries.

11. Consider a heart-healthy diet: Maintaining a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins can support your cardiovascular health. Limit your intake of saturated and trans fats, sodium, and added sugars.

12. Get adequate rest: Ensure you’re getting enough sleep and allowing your body to recover between long runs. Sleep is essential for overall health, including heart health.

13. Avoid running in extreme conditions: Running in extremely hot or cold weather can strain your cardiovascular system. Be cautious and adapt your running schedule accordingly.

14. Wear appropriate gear: Invest in good-quality running shoes that provide proper support and cushioning. Dress in moisture-wicking clothing to prevent overheating and chafing.

15. Stay aware of your surroundings: Pay attention to your environment, especially if you’re running in unfamiliar areas. Watch out for traffic, uneven terrain, and other potential hazards.

16. Regularly monitor your progress: Keep track of your running distance, pace, and any changes in your fitness levels. This can help you set realistic goals and avoid overtraining.

Remember that everyone’s fitness level and health status are unique. If you have any concerns about your ability to engage in long-distance running, it’s essential to discuss your plans with a healthcare professional. They can provide guidance tailored to your individual circumstances.


Courtesy:  Hindustan Times / PTI