Swimming Deaths and the Triathlon

author : AMSSM
comments : 9

Twenty of the total 25 deaths associated with triathlons as recorded by USA Triathlon occurred during the swim portion of the events. So, what’s the deal with swimming?

By Grant Morrison, MD

Member AMSSM

 

A recent New York Times article reported on a number of recent deaths associated with triathlons, all associated with swimming. These include:

  • A 60 year old male at the Spudman Triathlon in Burley, Idaho

  • A 52 year old male at the New Jersey State Triathlon

  • A 32 year old male at the New York City Triathlon

Overall, eight deaths have occurred in triathlons during this year, and all occurred during the swim portion of the event. Twenty of the total 25 deaths associated with triathlons as recorded by USA Triathlon occurred during the swim portion of the events.


So, what’s the deal with swimming?


The swim portion of the triathlon is associated with the highest potential rate of injuries; however, data from the Ironman Triathlon World Championship tells us that only 3% of all medical visits at the Hawaii event are associated with swimming injuries. Given that 25-30% of all starters there end up seeking medical attention, the total number of swimming injuries seems small.


Fatalities are not common with triathlon or other endurance events, but they do occur. In marathons, deaths related to heart problems have been reported to occur at the rate one death per 50,000 runners. These are spread out throughout the course, with most occurring near the finish.


Sudden deaths related to exercise have typically been considered to fall into two major divisions: those over the age of 35 are almost always attributed to coronary artery disease or “clogged arteries,” and those under the age of 35 have typically been associated with a variety of heart defects, both anatomic and physiologic.


So, back to swimming: Are these deaths all related to coronary artery disease? And why do they all occur during swimming and not other portions of the race? Several theories have been suggested. A lot of suspicion is placed on a peculiar heart rhythm disorder known as “Long Q-T syndrome.” This is a peculiar problem that occurs as heart pauses between beats, and the cells of the heart tissue are getting ready to squeeze again when signaled to do so by the heart’s own electrical circuit. In Long Q-T syndrome, something goes wrong, and during that pause the heart cannot continue beating. For unknown reasons, this phenomenon seems to occur more often during swimming.


What else about swimming could be the problem? Quite frankly, it is hard to help people as quickly and easily if their heart stops beating during a swim than during a run or bike. Automated external defibrillators can be found nearly everywhere in public these days, and are readily available during most sporting events, but putting them to use in the middle of a lake is impossible. CPR cannot be delivered in the water. Even getting to a victim can be a challenge; during a run or bike someone who collapses is usually seen immediately and response is rapid. During a swim the competitor may be hard to see under several feet of water and flailing swimmers overhead, and the collapse might be very difficult to spot.


So as a triathlete, what can you do to protect yourself? Should every triathlete get an EKG? Most studies have shown that getting an EKG on every athlete would bankrupt the health care system, and might not be sufficient anyway. Your responsibility lies in knowing what your risk factors are and being aware of symptoms that must be checked out. Know your blood pressure, cholesterol levels, and family history of heart disease, and take measures to keep these under control. Be aware of lightheadedness, dizziness, nausea, fainting episodes, sudden fatigue, and, of course, chest pain during any exertion, especially swimming. Get into your physician to get these symptoms and risk factors evaluated.


Grant Morrison, MD
Orthopedics/Sports Medicine/Family Medicine
Assistant Professor
Department of Family Medicine
University of Minnesota Physicians

Rating

Click on star to vote
40260 Total Views  |  105 Views last 30 days  |  24 Views last 7 days
date: October 20, 2008

AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

avatarAMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

View all 360 articles