The 14th Congress of the European Society of Cardiology in Barcelona: Athletic training may cause attack

ATHLETES who train to the limit may run the risk of sudden death, the congress was told. Their high level of fitness may itself be the trigger for a major heart attack.

Dr Celia Oakley, of Hammersmith Hospital in London, said sports doctors faced a serious dilemma on how to advise leading athletes in whom they could detect thickened heart muscle.

The problem, Dr Oakley told the congress, was that thickened heart muscle was one indicator of familial hypertrophic cardiomyopathy, the type of heart disease which can strike the young. Another indication is a faulty gene, but only half of those in whom the gene defect is detected suffer from the condition, she said.

It was sometimes very difficult for doctors to decide whether athletes had thickened muscle because they were at risk of sudden death from this condition or because their heart muscle had adapted because they were very fit. But if they are in the group which has the hidden disease, exercising could bring on a fatal heart attack.

'Sudden, unexpected death is especially dramatic and tragic when it involves an athlete during athletic activity,' Dr Oakley said. 'The instance of such deaths is very low but the most common abnormality found in the heart of such athletes is hypertrophic cardiomyopathy.

'It is sometimes very difficult to be certain whether or not an athlete has adaptive or pathological hypertrophy and this is particularly true of black athletes, who both excel in sport and who also have the highest incidence of sudden death during athletic activity. Athletic training and even ordinary exercise may not be beneficial for everyone.'

Elderly people who suffer major heart attacks do as well as younger patients when doctors make strenuous efforts to keep them alive.

Doctors at the congress were told that the decision to give full heart resuscitation to patients should not be made on the basis of age alone. Some hospitals decide that very old people admitted after heart attacks should not be subjected to high levels of technological intervention.

Doctors from Guy's Hospital, London, and William Harvey Hospital, Kent, followed 148 patients who received cardiopulmonary resuscitation (CPR) to keep their hearts and lungs working until they had recovered enough to cope without help.

They found that age did not affect the chances of survival after CPR. The underlying reason for the heart attack was a much more important factor in predicting whether or not patients survived.

In fact, in the small study the youngest patients, those under 40, who had a major heart attack were less likely to survive after resuscitation. Of the 14 patients who survived to be discharged from hospital, five were over the age of 70 and five were over 80.