How to get your heart scanned
Credit: Daniel Seex
Training > Injuries

Why athletes should get their hearts checked

While triathlon is a great way of staying in shape, we also need to be checking that our hearts are fit for purpose too, says Tim Heming. Here he explains why it's important and how to get it checked

Last month’s column questioned whether triathlon is going soft and made the case that only when we turn up for long-distance races equipped with fundamental skills and requisite fitness levels will race directors be instilled with the confidence to let events proceed in testing conditions.

The emphasis was on building the physical foundations of endurance that, a genetically gifted few notwithstanding, take time and dedication. But there is another area, more critical still, where we should be meticulous – making sure our heart is tickety-boo, not a ticking time bomb. 

That might be a blunt metaphor, but while we’re quick to look for remedy and rehab for a calf tear or hamstring strain, cardiac health is all too often shied away from and put on the back burner for a later date.

The numbers taking up triathlon span the generations and the average age of those racing longer distances is increasing, so why aren’t more of us being screened for potential issues?

Perhaps it’s because it seems anathema that exercise, against the backdrop of an increasingly obese world, could be the trigger for a life-threatening emergency. Or maybe it’s the knowledge that most cardiac arrests in triathlon happen when relatively fresh in the swim, which impresses that our fate is in the lap of the gods.

Yet while there will also be triathletes subconsciously thinking they’re bulletproof, it’s worth noting that only half of those who have heart attacks display standard risk factors such as high cholesterol, diabetes, high blood pressure and a family history of issues. Burying our heads in the sand is, of course, unhelpful, not just to ourselves, whose life might be dramatically altered or even ended, but to loved ones left behind, and race crews, who breathe a sigh of relief every time the last bike leaves T1. 

How to get your heart checked

There are steps we can and should take. Screening is more accessible than it’s ever been, the technology improving, and the understanding of cardiologists analysing scans of an athlete’s heart more advanced. In 2017 the ITU, the international governing body, introduced compulsory screening for all its junior athletes to identify those at risk of sudden cardiac death due to an electrical or structural heart abnormality. It’s been adopted by the British Triathlon Federation, who ask triathletes to provide a ‘Fit to Compete’ form signed by their GP.

But it doesn’t have to stop with the elite. Considering our time investment in training and how much we spend on flashy carbon, puts into context a couple of hours spent being checked out and the price of a scan. 

Not all heart issues are the same. Atherosclerosis is a build-up of plaque in the arteries, a cardiomyopathy is where the heart muscle itself is abnormal. It means it’s a topic relevant to infrequent and frequent exercisers alike. So take responsibility. Speak to your GP, explain your participation in endurance sport – including the cold-water swimming – and discuss next steps. Whether an ECG or Coronary CT angiography, you could be buying a lot more than peace of mind.


 
 

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Mark Dayer

Couldn't agree more. But I am a cardiologist.

When you are younger, then cardiac deaths tend to be due to inherited conditions, such as hypertrophic cardiomyopathy or long QT syndrome.

When you are older, then deaths tend to be due to coronary artery disease, so the screening that needs to take place varies with age.

During triathlons, however, when you die it's typically drowning or trauma when you fall off your bike.

And activity reduces your risk of death compared with inactivity (although there are concerns about extreme exertion). Sudden cardiac deaths during events are vanishingly rare (about 1:100,000). But not zero.

So that's why I do events (but have had a cardiac CT scan).

timiji

I couldn't agree less, but then I'm a researcher in Cardiac Rehabilitation. The Canadian Cardiology Society and the American Heart Association have guidelines around "getting your heart checked"... and for the most part, the overall issue is more a comprehensive physical than a specific heart check. Reduce your modifiable risk factors - many are addressed by exercise - but remember that fitness is just one aspect of health.

The expense and risk of false positives (and false negatives) from stress ECG and/or stress CT/MRI/Echo outweigh the rare possibility of uncovering a true positive... for Americans, save your money. For the rest of us, make better choices about the appropriate use of your health care system.

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