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10 Things Your Primary Care Doctor Does That Should Make You Run for the Hills
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Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
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Too much of a good thing? Transient heart dysfunction seen in young marathon runners.
This was the interesting study of the week for me, let's see what you think. No question both in San Diego and Los Angeles my clinics were busy right after marathons with electrolyte disturbances and seizures, joint aches and swelling among other things. As someone who runs (not marathons) and has marathoner-envy I found this interesting.
A group from the Department of Medicine at the University of Manitoba presented results at the American Thoracic Society that showed right ventricular systolic dysfunction occurs after athletes run a marathon, but the phenomenon reverses itself within 1 week of the race and does not appear to damage the heart muscle. The researchers used cardiac magnetic resonance imaging (cardiac MRI) to evaluate the effects of marathon running on the heart in 14 amateur athletes who competed in the 2008 Manitoba Marathon.
Who did they study? Patients with preexisting cardiovascular risk factors such as diabetes, hypertension, smoking, high cholesterol, and a family history of heart disease were EXCLUDED from the study. These were young (mean age 33) healthy runners, eight male and six female. Of the 14 athletes, 10 were moderately trained (defined as running fewer than 40 miles a week) and 4 were highly trained (defined as running more than 40 miles a week).
What did they do for this study? The researchers evaluated cardiac biomarkers (blood tests like troponin, CPK) at baseline, immediately following the race, at the time of the cardiac MRI, and 1 week after the marathon.
All of the participants had undergone a baseline cardiac ultrasound (cardiac echo) 1 week before the marathon and 1 week after the marathon. Cardiac MRI was performed in all study participants within 5 days after the marathon.
What did they see in the marathon runners? Echocardiography (ultrasound) and cardiac MRI demonstrated that right ventricular area decreased significantly to 43% from a baseline of 64%. Significant changes in left ventricular (LV) and right ventricular (RV) diastolic filling were also observed, and those changes persisted up to 1 week post marathon.
After completion of the marathon, all of the participants experienced significant elevations in serum myoglobin, creatine kinase, and troponin T, blood tests used to detect damage to the heart. HOWEVER, though the cardiac troponin and other blood tests were elevated the researchers did NOT notice any changes in the cardiac MRI that suggested myocardial necrosis (death of heart tissue) and rather they believe this is just release of troponin from the heart muscle cells.
Why is this happening in the heart of these marathon runners? I don't know, and neither do the authors of this study. Whether the abnormalities occur in circulation to the lungs and result in right ventricular dysfunction on echocardiography and Cardiac MRI or affect the myocardium directly is not known.
Should we change the way we are doing things? More studies are ongoing from this group to delineate the mechanism of these findings. It is interesting and we need to know exactly what is going on in the heart when we push ourselves like this and is it bad for our heart? I would agree with the authors of this study that we should not discourage people from exercising or running or even running marathons, as long as they train properly and have consulted their physicians.
Stay tuned.
Dr O.
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I assume you mean that RV volume decreased ( not area). Don't understand baseline of 64%. What was the baseline? Are you saying that their RV volume was 64% of normal before running the marathon and it decreased further. If so, it may have signified chronic and acute dehydration at least in part.
It's well known that marathon runners release all kinds of enzymes during the run so that's not a surprise. No one has ever showed routine heart damage during running except with a catastrophe such as a heart attack or severe rhythm disturbances, often due to electrolyte imbalance.
J Sherman MD
I'd love to see something done on the Female Athlete Triad- it's SO serious, and so few people really know about it...
1. If you start to feel any pain (especially chest pain) immediately stop and take a few breathers. This will help you get some more oxygen to think more clearly and could possibly prevent you from having a heart attack.
2. Make sure you are eating right and taking care of yourself. If you do a lot a running (i.e. 40 miles a week) stay in personal contact with a dietitician.
3. If you develop any discomfort or pain during or after a run talk to your doctor about it.
4. If you suddenly start having chest pain or feel light-headed immediately get help.
5. Always remember to stretch before and after you run and make sure you always wear comfortable running shoes, cell phone, water bottle, etc.