Triathlon - an event that combines swimming cycling an running - is becoming one of the fastest growing sports in the UK. Between 2009 and 2015, annual participation rose from 120,620 to 196,3003 - an increase of 63%. Unfortunately, during this time a number of deaths have occurred. A study published this month in Wilderness and Environmental Medicine describes these deaths and the changes in physiology that trigger them.
Between 2009 and 2015, 5 triathlon related deaths were identified in the UK. Victims were men aged between 34 and 56. Four had previously taken part in triathlons. Deaths occurred during swimming (3), cycling (1) and running (1). During the same time period, a further 5 deaths took place in UK athletes competing abroad. This group consisted of 4 men and 1 woman, aged between 27 and 57. All had competed in previous triathlons. Deaths occurred during swimming (2), cycling (1) and running (1). Of the 10 deaths identified in the study, only 1 was the result of a traumatic injury. Cardiovascular disease was cited as a cause or contributing factor in 5 of the remaining deaths.
Coronary artery disease is commonly identified in older athletes who die during physical activity. This study identified a 56 year old male triathlete who collapsed during the run, post mortem examination revealed severe atherosclerosis of left coronary artery and haemorrhage within an atherosclerotic plaque. The victim had previously undergone angioplasty and stenting
Sudden cardiac death (SCD) is an unexpected cardiac death that occurs within 1 hour of symptom onset. In the UK it is responsible for more than 50,000 deaths per year. SCD is the commonest cause of death during physical activities. In older athletes it is largely the result of coronary heart disease, whilst in youngsters the most common causes are hypertrophic cardiomyopathy, congenital coronary artery abnormalities and myocarditis. In a number of athletes, post mortem examination is entirely normal. This condition, now referred to as sudden arrhythmic death syndrome (SADS), replaces previous diagnoses such as sudden adult death syndrome and sudden death syndrome. Recent studies have revealed that on closer scrutiny as many as 50% of first degree relatives of SADS victims have genetic mutations that predispose them to fatal conditions such as long QT syndrome and catecholinergic polymorphic ventricular tachycardia. Given this, there has been a drive in recent years to refer SADS victims to cardiac pathologists for further investigation. This not only establishes a more accurate cause of death, but ensures that family members are screened for inherited diseases and offered appropriate treatment where necessary. Unfortunately, this study reveals that in several instances that this has not been done.
Paul Gallihawk (34) died during the 750m swim leg of the Ocean Lake Triathlon in 2015. Paul had been experiencing dizziness in the months leading up to the triathlon and had been referred to King's College Hospital, London for investigations. After his death he was not referred to a cardiac pathologist. "Immersion" was given as the cause of death. Paul's father was later quoted as saying, "This inquest didn't get us any further - we didn't get the answers we were hoping for."
Much still needs to to done to ensure that those who die during physical activities are thoroughly investigated. Identifying a clear cause of death can not only help relatives understand how their loved one died, but can also identify those who may be at risk from life threatening cardiac events in the future. For further information the study can be found here.