Nov. 21, 2011 -- Those exhilarating moments when marathoners sprint to the finish line on pure adrenaline can prove fatal to vulnerable hearts, a veteran marathon medical director said today.
Taking an 81-milligram baby aspirin and avoiding caffeine on race day -- especially supercaffeinated energy drinks -- are simple ways that marathon runners can reduce the chances their hearts will give out at race's end, like those of two men who collapsed Sunday at the 8th Philadelphia Marathon, said Dr. Lewis G. Maharam, board chairman of the International Medical Directors Association.
"Runners are not bullet-proof," said Maharam. No matter how young or outwardly healthy they feel, runners should undergo an annual physical where a doctor can screen for hidden heart ailments and advise them on ways to reduce the odds of dying.
Both Philadelphia victims were initially said to have suffered apparent heart attacks, although they might have succumbed to sudden death from other cardiac causes, such as fatal heart rhythms. Jeffrey Lee, a 21-year-old University of Pennsylvania senior from Cerritos, Calif., collapsed at the finish line of the Philadelphia Half Marathon and died at Hahnemann University Hospital, The Daily Pennsylvanian reported today. Lee, who was studying both nursing and business, had finished the course in one hour and 58 minutes.
"We grieve that such a young and promising life has been taken from us so suddenly," Penn President Amy Gutmann said in a statement. "At times like these we must come together as a community to mourn our loss and support the loved ones of Jeffrey Lee and one another."
The other victim, a 40-year-old man whose name has not been released, also died at Hahnemann after collapsing less than a quarter-mile from the finish line, according to witness accounts. Medics "were compressing his chest continually for at least 10 minutes or more," said Sally Solis-Cohen, of Wyndmoor, Pa., who was about 25 yards away while waiting to see her daughter Emily, 23, finish her first Philadelphia Marathon. "Pretty much the folks who were around me ... and I figured that he was likely dead on the course," she said.
"If he had been running the full marathon, then he was a really strong runner because it happened about 20 minutes before I crossed the finish line," said Emily Solis-Cohen, who completed the race in 3:47 and described conditions as "sunny and a lot warmer than usual...reaching the 60s at the end."
The course for the Philadelphia Marathon, whose website uses the slogan "Best: Time of Your Life," runs past some of the most famous historic landmarks in the City of Brotherly Love, including the Liberty Bell and the home of Betsy Ross, who stitched the first American flag.
More people may seem to be losing their lives while competing in marathons, although the absolute risk of dying has remained stable at one out of every 50,000 entrants, explained Maharam, past medical director of the New York Road Runners Club and the New York City Marathon. We are just hearing about more deaths because more people are participating in an increasing number of marathons and half-marathons. "There's a marathon or half-marathon every week, where 20,000 to 30,000 people are running, but the statistic hasn't changed," he said.
Some runners' hearts are particularly vulnerable to an adrenaline surge that occurs when they first spot the finish line, a location Maharam called "The X Spot," which he said "comes from the excitement of knowing you're going to finish."
Maharam said he makes sure that paramedics are placed at that spot in each of the races in which he's involved. "I've had 10 successful resuscitations at my events this year at the X-spot because it goes down right in front of the paramedics."
He explained that excessive caffeine can make the heart muscle susceptible to ill effects of the adrenaline rush. So, too can the impact of running a half-marathon, which can dislodge small amounts of artery-blocking plaque, cutting off blood flow to a microscopic area of the heart muscle and leaving it more vulnerable to an erratic and ultimately fatal heart rhythm triggered by the adrenaline.
When this happens, "the heart stops and they go unconscious," he said.
Endurance Athletes Should Be Aware of Risks, Preventive Steps
Last year, the marathon medical directors' group issued recommendations for preventing sudden death among runners and walkers. Intense bouts of exercise can lead the muscles to release enzymes that promote blood clotting and reduce the blood supply to the heart muscle, the group said. Endurance athletes should be properly hydrated, consume sufficient salt and avoid nonsteroidal anti-inflammatory medications commonly taken for pain, muscle sprains and other sports injuries.
Some studies suggest that caffeine consumption becomes risky at about 200 milligrams, the amount contained in two "diner-size" cups of coffee. A cup at Starbucks contains 320 milligrams, "which is too much," Maharam said.
Although the evidence for caffeine restriction remains anecdotal, he said, "it's a no-brainer to limit caffeine." He said that taking a baby aspirin also may elicit skepticism from cardiologists, but "it just may save a life."
Several veteran marathoners have died in recent months. Jorge Fernandez, a 32-year-old Air Force veteran of the Iraq War, collapsed last weekend soon after crossing the finish line of a half-marathon during the San Antonio Rock 'N' Roll Marathon, where the air was humid and temperatures in the 80s. Although emergency responders tried to resuscitate him, he was pronounced dead at a nearby hospital. A longtime runner who completed the same course last year, Fernandez was pronounced dead at a local hospital.
William Caviness, a 35-year-old North Carolina firefighter and veteran marathoner running to raise money for charity, collapsed 500 yards from the finish line of last month's Chicago Marathon. Although emergency doctors and emergency medical services were able to revive him, he died a couple of hours later. An autopsy proved inconclusive, The Chicago Tribune reported.
Women marathon runners have less plaque in their arteries than male runners, or than sedentary women, researchers from the Minneapolis Heart Institute reported Nov. 14 at the American Heart Association annual meeting. That finding followed a report in 2010 that marathon-running men had more plaque than sedentary men, although those men were older than the women in this year's study, the Minnesota researchers said. Researchers could not account for the gender-based differences.