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BBC News
2 days ago
- Health
- BBC News
Cycling grandad 'grateful' to be alive after heart rate skyrocketed
A 74-year-old grandad who had an alarming wake-up call when his heart rate skyrocketed while cycling has said he is "so grateful" to be enjoying the sport again after being fitted with a life-saving medical Cookson from Lancashire had been training at the Manchester Velodrome when he fainted, and later discovered he had a serious heart condition. "I came off and looked at my sports watch which read 'new heart rate record – 238 bpm' and I thought 'oh, that's not good'. And it wasn't going down," he Cookson has since been fitted with a implantable defibrillator to prevent future episodes and told other cyclists "if you get the opportunity for a health check, take it". Mr Cookson, a former head of British and world cycling bodies, saw his heart rate hit 238 beats per minute after the training session in Manchester in said: "I was cycling and started feeling strange. I didn't know if I was in a dream, if I was asleep – then I hit the floor."The veteran rider fainted and had to wait about 15 minutes for his heart rate to return to normal. At the time of his collapse, he had been fitted with a heart monitor as he was one of 108 men taking part in a study of the hearts of older male endurance athletes. 'Stop riding' Researches from the University of Leeds were able to record exactly what was happening to his heart during the incident, and warned him to immediately stop said: "The next day, I got a call. They said, 'Stop riding your bike, don't do anything more strenuous than walking until we can get you in here because we think you need an ICD [implantable cardioverter defibrillator].'"It was revealed he needed the device because he had experienced ventricular tachycardia, an abnormally fast heartbeat where the ventricles do not pump blood around the body effectively, which can lead to cardiac arrest. Mr Cookson has since returned to cycling after being fitted with the implantable defibrillator, which will shock his heart if an abnormal rhythm reoccurs. The university's study found nearly half of older male endurance athletes over 50 had scarring in their hearts which increased the risk of these episodes. Dr Peter Swoboda led the British Heart Foundation-funded study and said the results "shouldn't put people off regular exercise" as the study focused on a select group and not all had scarring. He said: "In our study, the athletes who experienced dangerous heart rhythms often had symptoms first."I'd encourage anyone who experiences blackouts, dizziness, chest pain or breathlessness, whether during sport or at rest, to speak to their doctor and get it checked out."Mr Cookson said: "When I started out in cycling, people thought that taking part in endurance sport would as good as guarantee your heart would stay healthy. "Over the past few years, we've learnt that it's not quite that simple." Listen to the best of BBC Radio Lancashire on Sounds and follow BBC Lancashire on Facebook, X and Instagram. You can also send story ideas via Whatsapp to 0808 100 2230.
Medscape
03-07-2025
- Health
- Medscape
Elite Rowers Face Lasting Atrial Fibrillation Risk
Former world-class rowers have an elevated risk for atrial fibrillation (AF) in the years after retirement, according to an observational case-control study. Researchers found 1 in 5 former Olympic, world, or national-level Australian rowers aged 45-80 years had the heart rhythm anomaly. The ex-rowers, who had competed for at least 10 years, were nearly seven times more likely to have been diagnosed with AF compared to a control group. During a follow-up period of around 4 years, new cases of AF were also higher among the ex-rowers (6.3% vs 2.3%), according to the researchers, who published their findings last month in the European Heart Journal . 'As a clinician, I was not surprised that rowers experienced more AF,' said André La Gerche, PhD, MD, a cardiologist and head of the Heart Exercise And Research Trials Lab at the Victor Chang Cardiac Research Institute and St Vincent's Hospital in Melbourne, Australia, and senior author of the study. 'However, I was very surprised by the magnitude of the difference. Furthermore, I learnt that the risk persists years after retirement and is not just due to genetic factors.' André La Gerche, PhD, MD The findings are 'consistent with prior research demonstrating that endurance athletes — especially highly trained endurance athletes — seem to have this higher risk of AF,' said Gregory Marcus, MD, MAS, a cardiac electrophysiologist and the inaugural Endowed Professor of Atrial Fibrillation Research at the University of California, San Francisco. Gregory Marcus, MD, MAS 'These numbers nudge me in the direction of more aggressively screening for AF specifically in masters-aged rowers, such as with the use of Holter monitors or wearable devices approved to detect AF,' said Jeffrey Hsu, MD, an assistant professor of medicine in the Division of Cardiology at the David Geffen School of Medicine at the University of California, Los Angeles. Jeffrey Hsu, MD La Gerche and his team captured data from 121 former rowers — 75% men, all White, with a median age of 62 years — who were matched with more than 11,000 control individuals from the UK Biobank who had never rowed and had varying fitness levels. The ex-rowers had similar rates of ischemic heart disease and diabetes as did the control individuals, but lower blood pressure. They also were less likely to have ever smoked. The athletes showed persistent changes in cardiac function after retirement. Ex-rowers had larger left ventricles, lower heart rates, longer PQ intervals, and longer QT intervals compared to control individuals. The research, 'raises the question of whether certain types of intensive exercise — like elite-level competitive rowing — leads to long-lasting, perhaps even irreversible, enlargement of the cardiac chambers,' Hsu said. Genetics factored into the risk for AF among both groups. While the prevalence of rare variants in genes associated with cardiomyopathy was low across the study, the combined risk for individual genes associated with AF was a strong predictor of the disease in both athletes (odds ratio [OR], 3.7) and nonathletes (OR, 2.0). The proportions were similar between them ( P = .37), indicating genetics did not fully account for the increased risk in the ex-rowers, La Gerche said. Marcus flagged a few factors that may have skewed the results. The former athletes tended to be tall, White, and in many cases, drank more alcohol than control individuals — all of these factors increase the risk for AF. Because the ex-rowers volunteered for a cardiovascular study, selection bias could have skewed prevalence higher, Marcus said. After a sensitivity analysis, ex-rowers still had a 2.5-fold higher risk for AF in the case of a 100% selection bias. La Gerche emphasized the findings shouldn't dissuade clinicians from encouraging regular exercise or high-level sports training. 'The overall health outcomes of these rowers are generally superb,' La Gerche said. 'Rather, this highlights an important 'Achilles heel' that requires attention and, ideally, effective prevention strategies so that sports can be enjoyed by more people, more often.' The study was funded by the National Health and Medical Research Council. La Gerche, Hsu, and Marcus reported having no relevant financial conflicts of interest.
Medscape
13-05-2025
- Health
- Medscape
Good News and Sobering News on Cardiac Risks in Marathoners
This transcript has been edited for clarity. Michelle L. O'Donoghue, MD, MPH: Hi. I am Dr Michelle O'Donoghue, reporting for Medscape. Joining me today is Dr Aaron Baggish. He's a professor of medicine at the University of Lausanne in Switzerland and is the former director of the Massachusetts General Hospital's Cardiovascular Performance Program. Thanks for joining me, Dr Baggish. Aaron L. Baggish, MD: Michelle, it's a real pleasure. Thank you for having me. SCD in Endurance Events O'Donoghue: You've been at the forefront of focusing on athletes and both their ability to participate in competitive sports as well as better understanding outcomes for athletes who may have underlying cardiac conditions that could put them at increased risk for sudden cardiac death during participation sports. Baggish: This has been a 20-year journey for me, but it's really only been in the past 10 years that the field of sports cardiology has firmly gelled. We're now seeing this as an accepted part of the entire cardiovascular offering, if you will, from a high-level service provider, like where you work at Brigham and Women's Hospital or Mass General. It's been really fun to be a part of that. O'Donoghue: I'd like to talk a little bit more about that journey over time, but most recently, focusing in on some of the data that you presented at the American College of Cardiology and focusing on the incidence of sudden cardiac arrest in people participating in long-distance running — mostly, of course, marathons, but also half-marathons, so those types of endurance events. Would you tell us a little bit more about that? Baggish: I'd be pleased to. At this year's American College of Cardiology (ACC) meeting, we had the opportunity to present the RACER 2 data, which are a look at cardiac arrest incidence and survival rates over the past 13 years in the United States. Before delving into those data, it's worth sharing the background for this. In 2012, we published the first RACER study, which very much set the benchmark for what was happening for the first decade of the century in the United States. That provided some baseline incidence statistics. We were at that point able to establish that the survival rate for runners that had cardiac arrest on the course was roughly 30%.Importantly, we learned about why people lived and why they died. One of the most important things being that most of these events occur very late in the race, within sight of the finish line. After RACER was published, as I think you know, I was fortunate enough to be working in the capacity as medical director for the Boston Marathon and tried hard with colleagues all over the country to take some of what we learned in RACER and translate it into better rationale for doing the RACER 2 study was to see if that work had made a difference. O'Donoghue: What were the topline findings that you presented? Baggish: There was both a sobering story and a good news story. The sobering story was that the actual incidence of cardiac arrest over the past 20 years really hasn't changed much. Most specifically, for the highest-risk group who are men who run the marathon distance, which is 26.2 miles or 42 kilometers, depending on which system you use, roughly 1 in 100 runners will succumb to cardiac arrest. This, as maybe we'll talk about later, is a wake-up call for us to think about more in the primary prevention space. The really exciting finding in RACER 2 is that we had essentially seen a 50% improvement in survival. Back with the first study, that was a 30% survival rate. Now, we see a 70% survival rate. This can really be attributed to a small list of important interventions. O'Donoghue: What kind of interventions are we talking about?Is it about availability of defibrillators or other? Baggish: It's two things. What we learned from RACER is that immediate bystander cardiopulmonary resuscitation (CPR) and timely access to external defibrillation were perfect predictors of survival. What we did after RACER is make a concerted effort to make certain that those two things were available in as many race circumstances as possible. When we looked at our predictors of survival in RACER 2, there was now almost uniform application of defibrillators and CPR. This translated into much better outcomes. From HCM to CAD and a Paradigm Shift in Guidelines O'Donoghue: Many people think to themselves that it's people who perhaps have underlying conditions such as hypertrophic cardiomyopathy who succumb to these types of events during a long-distance race. What did you actually observe? Baggish: In RACER 2, it was very interesting, and this represented a shift from RACER in which hypertrophic cardiomyopathy was indeed the most common finding either at autopsy after death or on clinical evaluation after survival. We saw a shift in RACER 2, and some of this shift may be due to the way evaluations are done now or the way autopsies are clearly, the dominant cause of cardiac arrest is simple atherosclerotic coronary disease among typically older athletes. O'Donoghue: That is perhaps just a nice segue as we think about the participation of people who might have underlying cardiac conditions such as hypertrophic so long, there used to be somewhat of a blanket recommendation for many people to not participate in competitive sports. How has that changed over the past several years? How are we thinking about that now? Baggish: This is a really exciting paradigm shift in the way we care for active many decades, based largely on appropriate concern about pushing the body hard with an underlying heart problem, the approach has been to limit and take away competitive sport participation from all people that have that condition. Quite frankly, this was an understandable but old-school approach, which was really based in paternalisticmedicine. What's happened over the past decade is there have been data series showing that exercise is actually much safer than we expected among people that have this condition, including relatively high levels of competitive exercise. While the risk is not zero, and certainly there is still a risk assessment situation that needs to occur every time the diagnosis is made, we've moved away fromlimiting people universally and have entered into an era where shared decision-making between the doctor and the patient has become the recommended practice. O'Donoghue: That is actually an important shift, as you phrase it, from that former paternalistic approach, but for many people it was really devastating to be told that in fact they could never participate in any type of competitive sport in their done a nice job of also highlighting how that could lead to depression and have many consequences that perhaps the physician at the time was not always keeping in mind. Baggish: As you highlight, Michelle, shared decision-making is not about unchecked autonomy. It's not telling every person to go forth and do whatever they want without thought and consideration. I think the part of the equation that's been missing for so many years is the downside of taking physical activity away from people after a cardiac diagnosis. This can have not only health implications but also have social, academic, and occupational implications. We now see both sides of the equation. What we do with the patient athlete when a new diagnosis is established is work with them and often times other people that are important to them — whether it's family members, teammates, coaches, administrators — whoever it is to come up with the right decision that balances both their medical risk and their personal preferences and values. O'Donoghue: As we think about shared decision-making, I know that one area of your research has been looking at survival rates, not only for long-distance runners but also, for instance, for youth participating in competitive sports who may unfortunately have a sudden cardiac death, albeit very rare. If a defibrillator, for instance, is available, where somebody is participating in a sport and somebody does receive an appropriate shock, do we know the survival rates for those individuals and perhaps this puts more of a focus even on the pediatric population? Higher Risks in Underserved Populations Baggish: Also presented at the recent ACC meeting was a look at what happens in the National Collegiate Athletic Association (NCAA). The focus of that paper, which I also had the privilege of being involved in, was a clear documentation of the fact that survival rates have improved in that population as well.I personally don't think that has anything to do with more effectively screening people out of sport who have heart conditions. What it has to do with is having robust emergency action plans. In colleges and universities — and this is trickling down into high school and youth sports, as it should— it's now become clear that if you are going to oversee young people participating in sport, or even older people for that matter, that the most important thing you can do is have a well-developed and rehearsed emergency action plan, which again, is about two simple things. It's immediate CPR and access to a defibrillator, ideally within 3 minutes of collapse. O'Donoghue: If I'm correct, one of the observations in that particular analysis that was done was that race appeared to be a predictor of worse survival. Is part of that related to perhaps lack of either defibrillator access or education on the front of that type of emergency action plan you're talking about, including CPR? Baggish: I think so. I want to be clear that we have many unanswered questions about the impact of social determinants of health, structural racism, all of the terms that we're now more familiar with as they translate into outcomes and athletes. What I see is the next 5-10 years of very important work is to better understand why this is what we're seeing and also figure out ways to reduce those care gaps. I don't think it has anything to do with the intrinsic biology of how people self-report their race. I think it has to do with the environments in which they live and practice sport, and some insufficiencies in some places where people from typically underserved populations tend to be. O'Donoghue: Thanks for highlighting these important points. As you say, there's the good news aspect of this that, for people who have this type of complication, either during youth competitive sports or endurance athletes, fortunately, it does appear that overall survival is improving. Hopefully, as we continue to have cost reduced for things like defibrillator access and continuing to work on education, that we can continue to improve those rates even further. Baggish: I'm hopeful that will represent the future. I think there's still a large amount of science to be done to help us understand this issue of racial disparities and how they translate it to differential is not unique to sports cardiology. This is across all aspects of cardiovascular medicine. I'm excited to see where that goes in the next 5-10 years. O'Donoghue: Thanks again for joining me today. Signing off for Medscape, this is Dr Michelle O'Donoghue.
