Now, health matters with Daniel Martin.
It's health matters right here on CN A 938. Welcome aboard everybody. Now, of course, it is very tragic to hear about the recent death of a race participant at the recently concluded Singapore Marathon. The ST Charter Singapore Marathon, the announcement did come out that one individual did die. We're not going to go into details about the cause for this individual, obviously, but we want to understand what people participating in such
events really need to bear in mind before participating. Incidentally, this is the third death in the 23 year history of the race in 2016, a 28 year old British National collapsed and was found to have suffered from sudden cardiac death due to the onset of arrhythmia. In 2011, a 22 year old died after running the half marathon later found to have a heart condition and had died from acute coronary insufficiency. I want to find out more about the heart in particular and taking part in these races.
Welcoming back Dr Reginald Liu, a senior consultant cardiologist at the Harley Street Heart and Vascular Center at Glen Eagles. Doctor Liu it's a pleasure to have you back on the show. Thanks for being here.
Thank you, Daniel. It's great to be back on the show.
So, before we go any further, can we just those two conditions that I described earlier on? Just give me a quick understanding. They're quite different, right? One is sudden cardiac death. One was said to be acute coronary insufficiency, not the same thing.
Yes. Correct. They're both different. Uh both unfortunately can occur in young people and lead to sudden death but quite different things. The the first case you mentioned, the arrhythmia is often due to an abnormal heart rhythm problem or electrical problem that is often genetic in younger people. And it can sometimes be picked up from an ECG or from symptoms if one has it before, before such
a tragic event. The second um case that you mentioned is more an anatomical problem with, with abnormal or anatomical variation of the blood vessels in the person that would, would have been there from birth. So again, that's more of a structural problem. But unfortunately, both can lead to sudden death. So
the thing is if somebody could have an unknown heart condition and still be training regularly fit healthy, active exercising all the time and it never turned up.
That's right. Yes. Yeah. Sometimes the first presentation of such a problem may be sudden collapse or, or sudden death. Uh but often people may have warning signs, some people get very dizzy or feel very strong or abnormal heartbeats during exercise. And that, that's a warning sign that there could be something wrong and that person should probably have a check up beforehand.
We will be talking about the importance of screening later.
That's right. Yes. The other common um or more common problem causing sudden death in younger people that is often undetected. It is a heart muscle problem called cardiomyopathy. Again, these may not be detected until quite late, but they can be picked up from an ECG. So something that that one needs to consider
in is is sudden cardiac death common.
Actually, it's it's very rare. Um The estimates suggest about um about between one and 10 per 100,000 people in the younger people below the age of 35 but of course, rare but tragic if it happens because it's, it's unexpected and usually these people are hit and well, they're not known to have any underlying medical problem.
One of my listeners is whatsapping across and asked this question, why do we always talk about the heart and how come it's not the heat, the heat in Singapore is extremely strong and maybe that's a contributing factor. We do seem to tend to mention the heart situation a lot as well as opposed to environmental factors. So I think that's surprising to a lot of us could the heat exacerbate a heart condition?
Yes, it can do. I mean, certainly having heat very, feel very hot. And um there are other medical problems, not as heart related that can cause people to collapse. Uh But they don't normally cause sudden death. Sudden death is a very specific term that people die within one hour of the onset of symptoms without any clear warning. Whereas people have heat exhaustion, often they're very, very hot, they're dehydrated, they have low thready pulse, but that can
be improved with intravenous fluids. So certainly heat exhaustion can cause you to collapse, but to die suddenly and have no pulse often that is related to a cardiac cause. So
that's ok. So that's the difference. I do wanna read out what happened um at the Charter Singapore Marathon. The statement said that after the completion of the race, the participant required and received intermediate medical attention on site before being transported to the Singapore General Hospital. Let's talk about that. Emergency medical services are at all these major race events with the onset of sudden cardiac death. What is there? No pulse?
Yeah. So usually uh these people who collapse, they, they, if it's a sudden cardiac arrest, then yes, they would, they would have no pulse and they would be unconscious and, and look very pale and it's, it's essential that the emergency medical services are on standby. The the the team would, would have checked for a pulse check for the signs of breathing. Um They would have put on a special uh defibrillator,
electric electrode pads to check the heart rhythm. And likely if the patient or the person had an abnormal rhythm that was ventri fibrillation, they may have administered emergency shock treatments. Um and they would have started cardiopulmonary resuscitation if there was no pulse. So essential that the team were there administered urgent treatment and then send the patient to hospital for uh for a secondary care.
Is it is there is there generally if it is true, sudden cardiac death, is there truly very little that can be done in terms of medical intervention to turn it back or to to, to, to stop it.
Well, the the the success rates or or survival rate from true cardi death outside hospital is very low but things can still be done. Uh I think the first thing is the most important is to have urgent uh facility to check the rhythm and to shock the the heart back to normal if there's a shock or abnormal rhythm. And of course, whilst waiting for emergency treatments, uh one should administer CPR cardiopulmonary resuscitation, try to keep keep the
blood going to the brain to prevent long term brain damage. So, so essential to have urgent treatment, but it can, it can be treated if, if the emergency services are there early and there's a rhythm or um cause that can be reversed.
Another whatsapp whatsapp across 9631193. It says, why do you always hear about it? With marathons. Is there something wrong with the marathon? Is the distance too long? Why didn't they show up in training? Yes, that's why I asked at the beginning as well. Dr Lee, is there something about exertion over such a long distance? Because one would assume people going for these races have been training similar distances or walking up to that distance. Why did it show up prior?
Yeah, I think that's a good question. I mean, there, there, there are certainly different types of exercises that seem to trigger different problems. So endurance sports like the marathon triathlons, they do tend to throw up a different type of heart rhythm problem. I mean, these, these people may have trained and most people do train very carefully for, for, for a number of weeks and months beforehand.
But the additional, you know, the buzz, the excitement, the adrenaline rush during the events,
the masses of people around you as well.
Yes, that's right. There's a whole different environment with the actual race can trigger and one is pushing themselves even harder to try to improve their personal best. All of those can, can tip one over the edge if they have an underlying heart problem on top of that. Um, so it doesn't always show up until the event and, and, and that, that's unfortunately a problem with the endurance type races. But also you hear about other cases like
professional footballers collapse on the pitch. Um, they often they, they have a different problem. They have a heart muscle problem or cardiomyopathy. So it's not necessarily endurance sports that will trigger an event, but some other uh cardiac problem or heart muscle problem that can also trigger a sudden arrhythmia. So there's different subtypes.
What does ejection fraction have to do with any of this?
Uh The ejection fraction is actually a statement of uh or measure of how strong the heart is pumped in or or or the the strength of contraction, normal ejection fraction. It should be more, more than 55%. Uh It's an important parameter because some people have some form of heart problem or heart failure and the ejection fraction is reduced, that will then increase the risk of a dangerous arrhythmia.
And some people are known to have rejection that are reduced and they should certainly refrain or not do any very strenuous or endurance sports. But unfortunately, there's another group of patients, young people who are fit and well, they may have a viral infection or some other acute infection uh just prior to the event.
And that can sometimes attack the heart. The the infection can attack the heart and reduce the ejection fraction, which will then put them at risk of an event as well if they were to do any running whilst they were still unwell. So one always has to be mindful. Even young people with no prior history of poor ejection fraction can still be at risk.
Isn't that though? The reason I ask is, could it not be an important number or, or figure for us to all know, is it very easy to determine one's ejection fraction? Or is it very challenging?
It's uh quite straightforward. Uh We usually, most doctors will look at the ejection fraction and measure it through an ultrasound of the heart called an echocardiogram. So it's actually quite straightforward. It does involve a specialist test and usually uh one of the uh cardiologist would have to read the report and, and come up and measure the ejection fraction.
Uh But certainly, I think it's, it's a useful parameter to have as well as even just a basic ecg that many people do as part of a health check up. Also gives some useful information on arrhythmias and, and risk of any underlying inherited heart rhythm problem.
So let's talk about that and whether or not we can minimize the risk of something like this through proper screening before major races like this. Is that advisory, is that important for these athletes or aspiring athletes or, or race enthusiasts to bear in mind? Go for a check before?
Mm. I think that's a very good question and it's still a very controversial topic. Uh And the reason is that uh some people would not want to do a checkup because they're worried what they, they may find or not sure how to interpret the results. Uh But certainly
from a medical point of view. It does make sense if one's gonna do endurance sports or something very strenuous or if one hasn't exercised for a long time and starts to do more regular exercise, it makes sense to do some basic tests just to be sure there's no obvious on the line problem. And the basic, you know, simple tests that are noninvasive could include an ecg uh, echocardiogram to check the ejection fraction and check the heart muscle
and um maybe a treadmill test. And some people when they exercise, we, we pick up other things on the treadmill test. But of course, there's issues with, with access to such tests, with interpretation and with what to do with the result that may be abnormal, but the patient or person may not yet have any symptoms. So that opens up a whole extra dimension that one has to consider
if somebody were taking was regularly doing marathons and they've taken the test one time. Is that enough to cover them for a couple of years or should you check before every major race?
Yeah, I think that the baseline ecg uh if it's completely normal, that will be uh essentially reassuring. Um that there's no uh there's no obvious problem at that stage. Um But, and the echocardiogram as well, if that's normal, completely normal with no heart muscle problem, then that's also
very reassuring. Uh So I don't think one necessarily needs to repeat those tests before every race unless one developed new symptoms or say someone is, has been unwell one or two weeks before the race with a recent infection or cough or fever. Then it might be worth having a check up before going through a strenuous or long race.
Doctor Li, you also mentioned earlier on, for example, it's even happened in other sports. The football, we're not just isolating it to the marathon, um, team sports, field sports, it does come up as well. It has occurred.
Yes. Yes, that's right. And uh and athletes and you know, on the field, uh uh people playing football, basketball that they can collapse suddenly as well. So I think that the same applies. One can consider screening for these uh heart problems even though rare, but they can be picked up from screening tests. So what to do
from
there.
So it's very hard for us to tell whether are we talking about exertion due to long exertion or is it about short sharp bursts of exertion or is it all the same?
So it depends on the underlying heart problem. Um So certainly, um short sharp bursts are potentially dangerous for those who have heart muscle thickening because when you, when you suddenly exert yourself and push yourself really hard, the the thickened heart muscle can, can actually restrict blood leaving the heart going into the brain and, and people collapse on that.
Uh But long distance running, if you have an inherited heart rhythm problem or abnormal anatomy of the blood vessels of the heart can also increase risk of arrhythmias. So, so not all the same and the different problems depending on the underlying heart problem.
Ok. Gonna end off with this question from one of our listeners. Thank you for accepting across you say apologies if this was covered earlier. But what is the difference between this and a heart attack? Ok. They're quite different. So, yes, Doctor Liu.
Yeah. So good, good question actually, because both sudden death in with the conditions we've mentioned and a heart attack can lead to sudden cardiac death or the person can collapse suddenly with an abnormal dangerous rhythm. The main difference is a heart attack is due to a sudden blockage of the blood vessel outside the heart leading to a acute myocardial infarction. And then that sudden blockage then leads
to the dangerous arrhythmia. Heart attacks tend to occur in older people, particularly above the age of 40. And if they have other risk factors like high cholesterol diabetes, high blood pressure. So certainly we, you know, as cardiologists and general doctors, we often look for risk factors for
heart attack or coronary artery disease. Uh whereas younger people tend to have these other rarer conditions like this, these abnormal heart blood vessels from birth or heart muscle thickening, but the final result both can lead to sudden death.
Doctor Liu, thank you for helping our listeners understand this, this tragic situation. I wish we didn't have to talk about it. Of course, this coming on the heels of a death being announced for one of the participants at the recent Singapore Marathon. And this being the third death in the 23 year history of the Singapore marathon. Dr Reginald Liu was here on health matters, helping us understand
the concept of sudden cardiac death. He's a senior consultant, cardiologist at the Harley Street Heart and Vascular Center, Glen Eagles. And I thank you for your whatsapps and questions that came through before making any decisions. Based on the information in our program, please consult a medical professional.