Two runners had heart attacks in a race. How often does it happen?

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Steven Lome, a cardiologist and long-distance runner, had never witnessed a cardiac arrest while running. He also didn’t expect to use his professional skills outside of work.

But while running the Monterey Bay, Calif., Half Marathon on Nov. 13, Lome saw not one, but two runners collapse on the course, and he performed CPR on both of them. The two runners, men in their 50s and 60s, survived and are expected to make a full recovery, Lome said in a twitter thread🇧🇷

“I just thought it was such a crazy, crazy, random event that there were two cardiac arrests, and they both happened right in front of me,” he said in a telephone interview.

The incidents, which received national attention, offer lessons and reminders for runners of all abilities. While sudden cardiac arrest is uncommon among road racing participants – according to a 2012 study published in the New England Journal of Medicine, the incidence rate is 0.54 per 100,000 participants, with a significantly higher rate during marathons compared to half marathons. Most of these cases of cardiac arrest (71%) were fatal. There were about 5,000 finishers in the Monterey Bay Half Marathon.

Cardiologists also emphasize the importance of listening to your body and understanding risk factors and possible warning signs. Both runners have a family history of heart disease. The fact that both survived can be attributed in part to the quick action of bystanders who performed CPR and the availability of automated external defibrillators (AEDs).

“Actually, it was an amazing response,” Lome said. “It was a great team effort.”

Get certified in CPR and AED

When Lome saw the first runner, Greg Gonzales, 67, of Vancouver, Wash., collapse about 30 feet ahead of him around the third mile of the race, he reckoned that “it wasn’t just a simple fainting or tripping.”

Lomé started chest compressions “within a minute” after Gonzales collapsed and said someone called 911. He added that within minutes, paramedics arrived with a defibrillator. The American Heart Association recommends Hands-Only CPR, which instructs the person giving chest compressions to push hard and fast into the center of the patient’s chest. Push it to the beat of the Bee Gees’ “Stayin’ Alive,” Lome said. “It’s because that’s the right beat.”

Gonzales woke up two or three minutes after receiving the AED shock, Lome said.

Gonzales said in a telephone interview that the last thing he remembered about running was speeding up an incline around the third mile. When he regained consciousness, he was in the back of an ambulance.

“I felt fine, other than terrible chest pain, and they indicated that the chest pain was caused by broken ribs from the chest compressions,” Gonzales said.

Lome continued his run after helping Gonzales and finished the half marathon in 2 hours 30 minutes 32 seconds. Then he saw the second runner, Michael Heilemann, 56, of San Anselmo, Calif., collapse just beyond the finish line. Lomé started chest compressions. A volunteer from the race brought an AED “within one to two minutes,” he said.

Heilemann woke up after a shock, Lomé said.

“The finish line is a relatively common area for cardiac events,” said John Ellison, medical director of the Monterey Bay Half Marathon and Big Sur International Marathon.

Ellison credited those around him with saving the runners’ lives. “The ultimate treatment for cardiac arrest is not CPR, it’s defibrillation, it’s putting electricity in the chest to restart the heart,” he said. “And CPR is important for preserving brain function and keeping the blood flowing in the meantime.”

Both Gonzales and Heilemann are runners with a family history of heart attacks or heart disease.

Gonzales’ father died of a heart attack at age 58, and his brother had a heart attack at age 59. “That’s why I ran and tried to keep my weight down and tried to eat the right foods,” Gonzales said.

Heilemann said his father, who died three years ago of heart disease, went into cardiac arrest when he was 56. His uncle and cousin also died of heart disease.

Both men said they felt healthy going into the race. But a healthy lifestyle “doesn’t make you immune to your risk factors,” said sports cardiologist Jonathan Kim.

“Generally, if you exercise a lot, eat healthy, you’ll control your cholesterol, you’ll control your blood pressure. But there’s nothing you can do to control your genes,” Kim said. “And make sure you have a strong family history to let your doctor know about this, so that when you start to get past your 40s, 50s, you have the proper cardiac evaluations and the evaluation by the preventive cardiologist is very important.”

About a year and a half ago, Gonzales felt a “small twinge of pain” in the left and right sides of his chest. The pain came and went. “Five seconds here, 20 seconds here, 30 seconds here, maybe a minute every now and then,” he said. “No more than probably five to 10 times.” Then, about eight months ago, Gonzales had a “little inch” of pain in his left bicep.

He ignored the pain and attributed it to other things, like indigestion or pain from lifting weights. Gonzales said that, looking back, he should have gone to the doctor.

These signs should not be ignored. “Even if you’re running like me, trying to work out like me, if there’s a problem like this, contact your internist or doctor right away,” Gonzales said.

Studies have shown that exercise can reduce your risk of heart disease, but it’s important that you talk to your doctor before participating in an endurance event, especially if you have risk factors.

“A lot of people run marathons and do well,” Kim said. “But if you’ve never done this before, you want to think about what your risk factors might be and make sure all of those have been addressed and controlled.”

Do not train when you have a respiratory illness

While Lome’s tweet about the two runners going into cardiac arrest sparked speculation on social media that the incidents could be COVID-related, experts said there was no evidence to support this.

Kim, who is the director of sports cardiology at Emory University, says that the fact that two runners experienced cardiac arrest during the same race is “probably more of a coincidence” than an indication that there has been an increase in heart rate. events due to the pandemic.

“We have not personally observed an increase in cases of myocarditis, or cases of sudden cardiac arrest in athletes as a result of covid,” he said.

He advised against training when you have a respiratory viral infection.

“Respect the virus, whether it’s covid or just a bad cold or flu, you shouldn’t train with a viral syndrome,” Kim said. “This is something we preached in my field pre-covid, and we certainly continue to preach post-covid.”

Heilemann said he had not tested positive for the coronavirus, and Gonzales said he tested positive in January and had symptoms of fatigue until July but has been able to train normally since then.

“I believe this half marathon was the hardest I’ve ever trained for a half marathon,” said Gonzales. “I felt great.”

Both runners said they plan to run and finish the Monterey Bay Half Marathon next year.

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Two runners had heart attacks in a race. How often does it happen?

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