Triathlon Deaths

Sudden cardiac arrest is the primary cause of death in triathlon; it usually strikes during the swim. In the span of three weeks in 2008, three male triathletes suffered fatal attacks during the swim. Their ages were sixty, fifty-two, and thirty-two.

There have been nearly thirty deaths in triathlons since 2004, as recorded by the national governing body USA Triathlon. Close to 80 percent of these fatalities occurred during the swim. The average age of those who died was forty-three years.

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Medical researchers have no definitive explanation for this phenomenon because in a few cases, autopsies revealed no blocked arteries; instead, researchers have several theories. “The combination of apparent good health and a negative autopsy suggests a fatality caused by abnormal heart rhythms,” Dr. Pamela Douglas, a Duke University cardiologist who has studied triathletes, told the New York Times.

Another researcher, Dr. Michael Ackerman, a cardiologist and the director of the Windland Smith Rice Sudden Death Genomics Laboratory at the Mayo Clinic in Rochester, Minnesota, told the Times that swimming may trigger a certain type of cardiac arrhythmia caused by a genetic condition called long QT syndrome. About 1 in 2,000 people is born with a heart condition that causes a glitch in the heart’s electrical system, and the most common of these is called long QT syndrome, after the telltale interval on an electrocardiogram. The long QT heart recharges itself sluggishly between beats, and that delay sets up the potential for a skipped beat.

So what causes the skipped heartbeat during the first leg of the triathlon? Is it caused by the adrenaline rush of racing? Inexperience in open water? An accidental kick to the body from another swimmer?

“It’s not that swimming is horrendously dangerous and running is not,” according to Dr. Ackerman. “It’s really a perfect storm that needs to happen. It requires a second hit, something to irritate it, and we know that swimming is one of those triggers, but it’s not going to be the absolute trigger.” An expert could detect most cases of long QT syndrome on an electrocardiogram, Dr. Ackerman said.

Dr. Kevin Harris of the Minneapolis Heart Institute Foundation and his colleagues presented a paper at the American College of Cardiology 2009 Scientific Sessions that reported that the risk of sudden death in the triathlon was 1.5/100,000 participants, a “notinconsequential” risk that is nearly double the risk of sudden death in marathon runners. Comparatively, a study by Dr. Donald Redelmeier (University of Toronto, Ontario) of more than three million marathon runners showed the rate of sudden cardiac death to be 0.8/100,000 participants.

Harris told the media there was no significant difference in the death rates in the different triathlon distances. But he added something of particular note: “Maybe what’s going on is that you’re getting less well-conditioned athletes or more novice athletes, although what’s interesting is that we know of only a couple of athletes where this was their first triathlon.”

By the time a triathlete suffers a heart attack in the mass frenzy of the swim, it’s often too late to save him or her, even with nearby lifeguards. So it’s up to the individual to decide if he has signs or symptoms that might trigger sudden cardiac arrest, such as a family history of heart disease. A checkup before participating in a triathlon makes perfect sense.

And therein lies the irony: triathlon’s popularity is driven by a continuing revolving door of new participants who are eager to prove to themselves, family, friends, and colleagues at work that they are “fit.” Yet there’s something markedly wrong with this scenario. First, the meaning of health is self-limiting and wrong if one only considers fitness as its sole criterion. One cannot be healthy while diseased. Additionally, neither youth nor middle-age athleticism automatically confers health. Death comes when something goes wrong—some problem causes the heart to stop, a blood vessel clogs, or some other pathology causes death. Second, most of these problems are preventable. Third, we must differentiate between those young athletes who die in their twenties, teens, and younger, and those in their thirties, forties, and older age-groups who make up the majority of competitive endurance athletes. Fourth, whenever the issue of fatality surfaces following a sudden death in a race, the lifestyle habits of the person are almost never mentioned as a possible cause—especially those factors that can contribute to heart disease, including diet, stress, and even overtraining.