Speaker 1: Now,
Speaker 1: health matters with Daniel Martin.
Speaker 2: It's health matters right here on CN A 938. Welcome
Speaker 2: aboard everybody. Now, of course, it is
Speaker 2: very tragic to hear about the recent death of a
Speaker 2: race participant
Speaker 2: at the recently concluded Singapore Marathon. The ST Charter Singapore Marathon,
Speaker 2: the announcement did come out that one individual did die.
Speaker 2: We're not going to go into details about the cause
Speaker 2: for this individual, obviously,
Speaker 2: but we want to understand what people participating in such
Speaker 2: events really need to bear in mind before participating. Incidentally,
Speaker 2: this is the third death in the 23 year history
Speaker 2: of the race in 2016, a 28 year old British
Speaker 2: National collapsed and was found to have suffered from sudden
Speaker 2: cardiac death due to the onset of arrhythmia.
Speaker 2: In 2011,
Speaker 2: a 22 year old died after running the half marathon
Speaker 2: later found to have a heart condition and had died
Speaker 2: from acute coronary insufficiency. I want to find out more
Speaker 2: about the heart in particular and taking part in these races.
Speaker 2: Welcoming back Dr Reginald Liu, a senior consultant cardiologist at
Speaker 2: the Harley Street Heart and Vascular Center at Glen Eagles.
Speaker 2: Doctor Liu it's a pleasure to have you back on
Speaker 2: the show. Thanks for being here.
Speaker 1: Thank you, Daniel. It's great to be back on the show.
Speaker 2: So, before we go any further, can we just those
Speaker 2: two conditions that I described earlier on? Just give me
Speaker 2: a quick understanding. They're quite different, right? One is sudden
Speaker 2: cardiac death. One was said to be acute coronary insufficiency,
Speaker 2: not the same
Speaker 2: thing.
Speaker 1: Yes. Correct. They're both different. Uh both unfortunately can occur
Speaker 1: in young people and lead to sudden death but quite
Speaker 1: different things. The the first case you mentioned, the arrhythmia
Speaker 1: is often due to an abnormal heart rhythm problem or
Speaker 1: electrical problem that is often genetic in younger people.
Speaker 1: And it can sometimes be picked up from an ECG
Speaker 1: or from symptoms if one has it before, before such
Speaker 1: a tragic event. The second um case that you mentioned
Speaker 1: is more an anatomical problem with, with abnormal or anatomical
Speaker 1: variation of the blood vessels in the person that would,
Speaker 1: would have been there from birth.
Speaker 1: So again, that's more of a structural problem. But unfortunately,
Speaker 1: both can lead to sudden death. So
Speaker 2: the thing is if somebody could have an unknown heart
Speaker 2: condition
Speaker 2: and still be training regularly fit healthy, active exercising all
Speaker 2: the time and it never turned up.
Speaker 1: That's right. Yes. Yeah. Sometimes the first presentation of such
Speaker 1: a problem may be sudden collapse or, or sudden death.
Speaker 1: Uh but often people may have warning signs, some people
Speaker 1: get very dizzy or feel very strong or abnormal heartbeats
Speaker 1: during exercise. And that, that's a warning sign that there
Speaker 1: could be something wrong and that person should probably have
Speaker 1: a check up beforehand.
Speaker 2: We will be talking about the importance of screening later.
Speaker 1: That's right. Yes. The other common
Speaker 1: um or more common problem causing sudden death in younger
Speaker 1: people that is often undetected. It is a heart muscle
Speaker 1: problem called cardiomyopathy. Again, these may not be detected until
Speaker 1: quite late, but they can be picked up from an ECG.
Speaker 1: So something that that one needs to consider
Speaker 2: in is is sudden cardiac death common.
Speaker 1: Actually, it's it's very rare. Um The estimates suggest about
Speaker 1: um about between one and 10 per 100,000 people in
Speaker 1: the younger people below the age of 35 but of course,
Speaker 1: rare but tragic if it happens because it's, it's unexpected
Speaker 1: and usually these people are hit and well, they're not
Speaker 1: known to have any underlying medical problem.
Speaker 2: One of my listeners is whatsapping across and asked this question,
Speaker 2: why do we always talk about the heart and how
Speaker 2: come it's not the heat, the heat in Singapore is
Speaker 2: extremely strong and maybe that's a contributing factor. We do
Speaker 2: seem to tend to mention the heart situation a lot
Speaker 2: as well as opposed to environmental factors. So I think
Speaker 2: that's surprising to a lot of us could the heat
Speaker 2: exacerbate a heart condition?
Speaker 1: Yes, it can do. I mean, certainly having heat very,
Speaker 1: feel very hot. And um there are other medical problems,
Speaker 1: not as heart related that can cause people to collapse.
Speaker 1: Uh But they don't normally cause sudden death. Sudden death
Speaker 1: is a very specific term that people die within one
Speaker 1: hour of the onset of symptoms without any clear warning.
Speaker 1: Whereas people have heat exhaustion, often they're very, very hot,
Speaker 1: they're dehydrated, they have low thready pulse, but that can
Speaker 1: be improved with intravenous fluids. So certainly heat exhaustion can
Speaker 1: cause you to collapse, but to die suddenly and have
Speaker 1: no pulse often that is related to a cardiac cause.
Speaker 1: So
Speaker 2: that's ok. So that's the difference. I do wanna read
Speaker 2: out what happened um
Speaker 2: at the Charter Singapore Marathon. The statement said that after
Speaker 2: the completion of the race, the participant required and received
Speaker 2: intermediate medical attention on site before being transported to the
Speaker 2: Singapore General Hospital. Let's talk about that. Emergency medical services
Speaker 2: are at all these major race events with the onset
Speaker 2: of sudden cardiac death. What is there? No pulse?
Speaker 1: Yeah. So usually uh these people who collapse, they, they,
Speaker 1: if it's a sudden cardiac arrest, then yes, they would,
Speaker 1: they would have no pulse and they would be unconscious and,
Speaker 1: and look very pale and it's, it's essential that the
Speaker 1: emergency medical services are on standby. The the the team would,
Speaker 1: would have checked for a pulse check for the signs
Speaker 1: of breathing.
Speaker 1: Um They would have put on a special uh defibrillator,
Speaker 1: electric electrode pads to check the heart rhythm. And likely
Speaker 1: if the patient or the person had an abnormal rhythm
Speaker 1: that was ventri fibrillation, they may have administered emergency shock treatments.
Speaker 1: Um and they would have started cardiopulmonary resuscitation if there
Speaker 1: was no pulse. So essential that the team were there
Speaker 1: administered urgent treatment and then send the patient to hospital
Speaker 1: for uh for a secondary care.
Speaker 2: Is it is there
Speaker 2: is there generally if it is true, sudden cardiac death,
Speaker 2: is there truly very little that can be done in
Speaker 2: terms of medical intervention to turn it back or to to, to,
Speaker 2: to stop
Speaker 2: it.
Speaker 1: Well, the the the success rates or or survival rate
Speaker 1: from true cardi death outside hospital is very low but
Speaker 1: things can still be done. Uh I think the first
Speaker 1: thing is the most important is to have urgent uh
Speaker 1: facility to check the rhythm and to shock the the
Speaker 1: heart back to normal if there's a shock or abnormal rhythm.
Speaker 1: And of course, whilst waiting for emergency treatments, uh one
Speaker 1: should administer CPR cardiopulmonary resuscitation, try to keep keep the
Speaker 1: blood going to the brain to prevent long term brain damage. So,
Speaker 1: so essential to have urgent treatment, but it can, it
Speaker 1: can be treated if, if the emergency services are there
Speaker 1: early and there's a rhythm or um cause that can
Speaker 1: be reversed.
Speaker 2: Another whatsapp whatsapp across 9631193. It says, why do you
Speaker 2: always hear about it? With marathons. Is there something wrong
Speaker 2: with the marathon? Is the distance too long? Why didn't
Speaker 2: they show up in training? Yes, that's why I asked
Speaker 2: at the beginning as well. Dr Lee, is there something
Speaker 2: about exertion over such a long distance? Because one would
Speaker 2: assume people going for these races have been training similar
Speaker 2: distances or walking up to that distance. Why did it
Speaker 2: show up prior?
Speaker 1: Yeah, I think that's a good question. I mean, there, there,
Speaker 1: there are certainly different types of exercises that seem to
Speaker 1: trigger different problems. So endurance sports like the marathon triathlons,
Speaker 1: they do tend to throw up a different type of
Speaker 1: heart rhythm problem. I mean, these, these people may have
Speaker 1: trained and most people do train very carefully for, for,
Speaker 1: for a number of weeks and months beforehand.
Speaker 1: But the additional, you know, the buzz, the excitement, the
Speaker 1: adrenaline rush during the events,
Speaker 2: the masses of people around you as
Speaker 2: well.
Speaker 1: Yes, that's right. There's a whole different environment with the
Speaker 1: actual race can trigger and one is pushing themselves even
Speaker 1: harder to try to improve their personal best. All of
Speaker 1: those can, can tip one over the edge if they
Speaker 1: have an underlying heart problem on top of that. Um,
Speaker 1: so it doesn't always show up until the event and,
Speaker 1: and, and that, that's unfortunately a problem with the endurance
Speaker 1: type races. But also you hear about other cases like
Speaker 1: professional footballers collapse on the pitch. Um, they often they,
Speaker 1: they have a different problem. They have a heart muscle
Speaker 1: problem or cardiomyopathy. So it's not necessarily endurance sports that
Speaker 1: will trigger an event, but some other uh cardiac problem
Speaker 1: or heart muscle problem that can also trigger a sudden arrhythmia.
Speaker 1: So there's different subtypes.
Speaker 2: What does ejection fraction have to do with any of this?
Speaker 1: Uh The ejection fraction is actually a statement of uh
Speaker 1: or measure of how strong the heart is pumped in
Speaker 1: or or or the the strength of contraction, normal ejection fraction.
Speaker 1: It should be more, more than 55%. Uh It's an
Speaker 1: important parameter because some people have some form of heart
Speaker 1: problem or heart failure and the ejection fraction is reduced,
Speaker 1: that will then increase the risk of a dangerous arrhythmia.
Speaker 1: And some people are known to have rejection that are
Speaker 1: reduced and they should certainly refrain or not do any
Speaker 1: very strenuous or endurance sports.
Speaker 1: But unfortunately, there's another group of patients, young people who
Speaker 1: are fit and well, they may have a viral infection
Speaker 1: or some other acute infection uh just prior to the event.
Speaker 1: And that can sometimes attack the heart. The the infection
Speaker 1: can attack the heart and reduce the ejection fraction,
Speaker 1: which will then put them at risk of an event
Speaker 1: as well if they were to do any running whilst
Speaker 1: they were still unwell. So one always has to be mindful.
Speaker 1: Even young people with no prior history of poor ejection
Speaker 1: fraction can still be at
Speaker 1: risk.
Speaker 2: Isn't that though? The reason I ask is, could it
Speaker 2: not be an important number or, or figure for us
Speaker 2: to all know, is it very easy to determine one's
Speaker 2: ejection fraction? Or is it very challenging?
Speaker 1: It's uh quite straightforward. Uh We usually, most doctors will
Speaker 1: look at the ejection fraction and measure it through an
Speaker 1: ultrasound of the heart called an echocardiogram. So it's actually
Speaker 1: quite straightforward. It does involve a specialist test and usually
Speaker 1: uh one of the uh cardiologist would have to read
Speaker 1: the report and, and come up and measure the ejection fraction.
Speaker 1: Uh But certainly, I think it's, it's a useful parameter
Speaker 1: to have as well as even just a basic ecg
Speaker 1: that many people do as part of a health check up.
Speaker 1: Also gives some useful information on arrhythmias and, and risk
Speaker 1: of any underlying
Speaker 1: inherited heart rhythm problem.
Speaker 2: So let's talk about that and whether or not we
Speaker 2: can minimize the risk of something like this through proper
Speaker 2: screening before major races like this. Is that advisory, is
Speaker 2: that important for these athletes or aspiring athletes or, or
Speaker 2: race enthusiasts to bear in mind? Go for a check before?
Speaker 1: Mm. I think that's a very good question and it's
Speaker 1: still a very controversial topic. Uh And the reason is
Speaker 1: that uh some people would not want to do a
Speaker 1: checkup because they're worried what they, they may find or
Speaker 1: not sure how to interpret the results. Uh But certainly
Speaker 1: from a medical point of view. It does make sense
Speaker 1: if one's gonna do endurance sports or something very strenuous
Speaker 1: or if one hasn't exercised for a long time and
Speaker 1: starts to
Speaker 1: do more regular exercise, it makes sense to do some
Speaker 1: basic tests just to be sure there's no obvious on
Speaker 1: the line problem. And the basic, you know, simple tests
Speaker 1: that are noninvasive could include an ecg uh, echocardiogram to
Speaker 1: check the ejection fraction and check the heart muscle
Speaker 1: and um maybe a treadmill test. And some people when
Speaker 1: they exercise, we, we pick up other things on the
Speaker 1: treadmill test. But of course, there's issues with, with access
Speaker 1: to such tests, with interpretation and with what to do
Speaker 1: with the result that may be abnormal, but the patient
Speaker 1: or person may not yet have any symptoms. So that
Speaker 1: opens up a whole extra dimension that one has to
Speaker 1: consider
Speaker 2: if somebody were taking was regularly doing marathons and they've
Speaker 2: taken the test one time. Is that enough to cover
Speaker 2: them for a couple of years or should you check
Speaker 2: before every major race?
Speaker 1: Yeah, I think that the baseline ecg uh if it's
Speaker 1: completely normal, that will be uh essentially reassuring. Um that
Speaker 1: there's no uh there's no obvious problem at that stage.
Speaker 1: Um But, and the echocardiogram as well, if that's normal,
Speaker 1: completely normal with no heart muscle problem, then that's also
Speaker 1: very reassuring. Uh So I don't think one necessarily needs
Speaker 1: to repeat
Speaker 1: those tests before every race unless one developed new symptoms
Speaker 1: or say someone is, has been unwell one or two
Speaker 1: weeks before the race with a recent infection or cough
Speaker 1: or fever. Then it might be worth having a check
Speaker 1: up before going through a strenuous or long race.
Speaker 2: Doctor Li, you also mentioned earlier on, for example, it's
Speaker 2: even happened in other sports. The football, we're not just
Speaker 2: isolating it to the marathon, um, team sports, field sports,
Speaker 2: it does come up as well. It has occurred.
Speaker 1: Yes. Yes, that's right. And uh and athletes and you know,
Speaker 1: on the field, uh uh people playing football, basketball that
Speaker 1: they can collapse suddenly as well. So I think that
Speaker 1: the same applies. One can consider screening for these uh
Speaker 1: heart problems even though rare, but they can be picked
Speaker 1: up from screening tests. So what to do
Speaker 2: from
Speaker 1: there.
Speaker 2: So it's very hard for us to tell whether are
Speaker 2: we talking about exertion due to long exertion or is
Speaker 2: it about short sharp bursts of exertion or is it
Speaker 2: all the same?
Speaker 1: So it depends on the underlying heart problem. Um So certainly,
Speaker 1: um short sharp bursts are potentially dangerous for those who
Speaker 1: have heart muscle thickening because when you, when you suddenly
Speaker 1: exert yourself and push yourself really hard, the the thickened
Speaker 1: heart muscle can, can actually restrict blood leaving the heart
Speaker 1: going into the brain and, and people collapse on that.
Speaker 1: Uh But long distance running, if you have an inherited
Speaker 1: heart rhythm problem or abnormal anatomy of the blood vessels
Speaker 1: of the heart
Speaker 1: can also increase risk of arrhythmias. So, so not all
Speaker 1: the same and the different problems depending on the underlying
Speaker 1: heart problem.
Speaker 2: Ok. Gonna end off with this question from one of
Speaker 2: our listeners. Thank you for accepting across you say apologies
Speaker 2: if this was covered earlier. But what is the difference
Speaker 2: between this and a heart attack? Ok. They're quite different. So, yes,
Speaker 2: Doctor Liu.
Speaker 1: Yeah. So good, good question actually, because both sudden death
Speaker 1: in with the conditions we've mentioned and a heart attack
Speaker 1: can lead to sudden cardiac death or the person can
Speaker 1: collapse suddenly with an abnormal dangerous rhythm. The main difference
Speaker 1: is a heart attack is due to a sudden blockage
Speaker 1: of the blood vessel outside the heart leading to a
Speaker 1: acute myocardial infarction. And then that sudden blockage then leads
Speaker 1: to the dangerous arrhythmia. Heart attacks tend to occur in
Speaker 1: older people, particularly above the age of 40.
Speaker 1: And if they have other risk factors like high cholesterol diabetes,
Speaker 1: high blood pressure. So certainly we, you know, as cardiologists
Speaker 1: and general doctors, we often look for risk factors for
Speaker 1: heart attack or coronary artery disease. Uh whereas younger people
Speaker 1: tend to have these other rarer conditions like this, these
Speaker 1: abnormal heart blood vessels from birth or heart muscle thickening,
Speaker 1: but the final result both can lead to sudden death.
Speaker 2: Doctor Liu, thank you for helping our listeners understand this,
Speaker 2: this tragic situation. I wish we didn't have to talk
Speaker 2: about it. Of course, this coming on the heels of
Speaker 2: a death being announced for one of the participants at
Speaker 2: the recent Singapore Marathon. And this being the third death
Speaker 2: in the 23 year history of the Singapore marathon. Dr
Speaker 2: Reginald Liu was here on health matters, helping us understand
Speaker 2: the concept of sudden cardiac death. He's a senior consultant,
Speaker 2: cardiologist at the Harley Street Heart and Vascular Center, Glen Eagles.
Speaker 2: And I thank you for your whatsapps and questions that
Speaker 2: came through
Speaker 2: before making any decisions. Based on the information in our program,
Speaker 2: please consult a medical professional.