06 Sep Athletes Should Be Checked For Ventricular Hypertrophy Before Triathalon

MedicalResearch.com Interview with:

Dr. Richard Moon

Richard Moon, MD
Professor of Anesthesiology
Professor of Medicine
Medical Director, Center for Hyperbaric Medicine & Environmental Physiology
Duke University Medical Center
Durham, NC 27710

MedicalResearch.com: What is the background for this study?

Response: For several years we have been investigating the causes of immersion pulmonary edema (IPE, also known as swimming-induced pulmonary edema or SIPE). We determined that during exercise while immersed in cold water pulmonary artery and wedge pressures of individuals who are SIPE-susceptible are higher than normal. This demonstrated that SIPE is a form of hemodynamic pulmonary edema. It is certainly plausible that SIPE could cause death, and indeed a few fatal cases had been reported in the medical literature, mostly in scuba divers. After reading of deaths in young, apparently fit and healthy triathletes we hypothesized that some of these deaths were probably due to  swimming-induced pulmonary edema . It is easy to diagnose SIPE in a living individual, using a stethoscope or chest x-ray/CT. However, since almost anyone who dies from any cause, particularly if attempted resuscitation has occurred, will have pulmonary edema at autopsy. Before concluding that death has occurred due to SIPE, other clues are therefore necessary.

MedicalResearch.com: What are the main findings?

Response: Our studies have strongly indicated left ventricular diastolic dysfunction as a cause of  swimming-induced pulmonary edema , and case series of non-fatal SIPE cases have suggested that LVH is a predisposing factor. Therefore we looked for LVH in the absence of other common causes of sudden death as a possible marker of SIPE. Between October 2008 and November 2015 we identified 58 triathlon-related deaths, of which 42 occurred during a swim. We were able to obtain 23 postmortem reports. Eight deaths occurred due to an identifiable cause, such as coronary disease. We were lucky in that several years ago Dr. Pam Douglas had performed a study of triathletes using echocardiography, and we therefore knew the prevalence of LVH in the triathlete population. Among our triathlon deaths, excessive thickening of the heart muscle was present in a greater proportion than expected. We concluded that since ventricular hypertrophy is a marker of susceptibility to SIPE, many of these deaths may have been caused by SIPE.

MedicalResearch.com: What should readers take away from your report?

Response: From this study and others, we know that hypertension and cardiac conditions such as heart valve disease can predispose to  swimming-induced pulmonary edema . It is therefore prudent to be checked out by a physician before participating in triathlons, particularly for middle aged or older individuals.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Certain medications can prevent IPE in susceptible individuals. Both sildenafil and nifedipine seem to work but studies are needed to determine the best doses. Other studies are needed to examine whether medical screening of triathletes can lead to interventions that will prevent SIPE and its consequences. We also need to study effects on blood pressure control of exercise in cold water.

MedicalResearch.com: Is there anything else you would like to add?

Response: While engaging in heavy exercise in the water, especially during a competitive event such as a triathlon, someone who experiences a cough or excessive shortness of breath should stop immediately and seek medical attention for possible SIPE.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Richard E Moon, Stefanie D Martina, Dionne F Peacher, William E Kraus. Deaths in triathletes: immersion pulmonary oedema as a possible cause. BMJ Open Sport & Exercise Medicine, 2016; 2 (1): e000146 DOI:10.1136/bmjsem-2016-000146

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Last Updated on September 6, 2016 by Marie Benz MD FAAD