Letter to the Editor Br J Sports Med: first published as 10.1136/bjsm.23.2.133-a on 1 June 1989. Downloaded from

Silent ischaemia and vigorous exercises per cent. Droste and Roskamm found that asympto- matic patients had a much higher pain threshold than T. Hartvig Jensen, S. Christensen, E. Darre, P. Holmich their symptomatic counterparts". This is consistent and F. Jahnsen. Copenhagen, 26 January 1989 with a high pain threshold in highly trained athletes Sir and, with a well developed coronary collateral system, may explain why 50 per cent of sudden deaths in vig- Sudden death in highly trained athletes during orous exercise occur in runners who are previously organized competitive exercise is very infrequent, asymptomatic. considering the large number of participants" 2. Sudden death during exercise may be unavoidable, Sudden death in running has been de- but its incidence can be reduced by giving our proper scribed3 but few reports have tried to relate sudden information, especially to elderly runners. Any dis- death during vigorous exercises to age4'5. comfort four weeks before a marathon race (or other We report a previous healthy 56-year-old man who vigorous programmes) should lead to medical examin- had a cardiac collapse Iduring the 'Wonderful ation. Furthermore, runners with a known family his- ' 1987. He was a highly trained tory of arteriosclerotic heart disease should be referred athlete who had completed eleven previous marathon for a medical examination including ECG, treadmill races and never been treated for cardiovascular test, and blood lipids. disease. After 36 km of the race he suddenly collapsed with- out warning. Resuscitation was initiated at once and the race medical staff reached the patient after three References minutes. Ventricular fibrillation was diagnosed and 1 Tunstall Pedoe, D.S. Sudden death- preventable or DC defibrillation was successful. On hospital admis- inevitable Brit J Sports Med 1984, 18, 293-4 sion ten minutes later he was alert, cardiovascularly st- 2 Vuori, I. Kardiovaskulare risker i samband med mo- able and denied any chest pain prior to collapse. tion Nord med 1984, 99, 174-6 Coronary enzymes were elevated 3 Steffny, M. Dritter Marathon-toter in Hamburg Spiri- slightly (CKMB, don 1987, 4, 8 LDH) and ECG was compatible with an inferior sub- 4 Maron, B.J., Epstein, S.E., Roberts, W.C. Causes of endocardial infarction. Echocardiography was nor- sudden death in competitive athletes I Am Coll Cardiol mal. The patient was discharged uneventfully after 1986, 7(1), 204-14 four days. Although cardiac enzymes are increased 5 Maron, B.J., Roberts, W.C., McAllister, Rosing, D.R., http://bjsm.bmj.com/ with physical streSS6, permanent ECG changes even Epstein, S.E. Sudden death in young athletes Circula- without chest pain favour the diagnosis of myocardial tion 1980, 62(2), 218-229 infarction7. 6 Sylven, J.C.H., Jansson, E., Brandt, S., Kallner, A. When reviewing the literature and the above men- Specificitet of cardiac enzymes in diagnosis of chest tioned case it is our impression that the cause of pain in marathon runners Lancet 1983, 24(31), 1505 sudden death in exercise is mainly due to silent is- 7 Smith, W.G., Cullen, K.J., Thorburn, I.O. Electro- chaemia among competitors over 35 years old. Maron cardiograms of marathon runners in 1962 Common- et al. have described causes of sudden death in com- wealth Games Brit Heart J 1964, 26, 469-477 on September 29, 2021 by guest. Protected copyright. 8 Bassler, T.J. Marathon running an immunity to petitive athletes and concluded that in athletes over 35 athersclerosis Ann NY Acad Sci 1977, 301, 579-92 years old 75 per cent of sudden deaths were related to 9 Cohn, P.F. Seminar on asymptomatic coronary artery arteriosclerotic heart disease. They rarely resulted disease J Am Coll Cardiol 1983, 1, 922-3 from the congenital heart conditions more common in 10 Langou, R.A., Huang, E.K., Kelly, E.K., Cohen, L.S. younge