Health: The heart of the matter

Cardiac conditions and looking after your heart

Cardiac conditions don’t just affect the elderly and unfit – even young, fit and healthy cyclists can be affected. Could it be worth taking a little test?

This March, 26-year-old former world solo 24-hour mountain bike champ and journalist James Williamson was riding in the Cape Epic stage race in South Africa when he died of a previously undiagnosed genetic cardiac condition.

The Australian’s death isn’t as isolated an incident as you might think. British cyclist and coach John Ibbotson died of a genetic heart condition in 2005, Adrian Hawkins had just been selected for the GB Cycling Squad for the Barcelona Olympics in 1992 when he died of cardiac failure, and in 2007 Danny Bennett, member of the French cycling team Charvieu Chavagneu, died of a heart attack caused by a heart condition called myocarditis. These are just a handful of the athletes who have lost their lives to cardiac failure, all of them young and fit.

“In the UK, it’s estimated that about one in 300 people have a potentially life-threatening heart condition,” says Dr Steven Cox, deputy chief executive for Cardiac Risk in the Young (CRY), “and about one in 100 will have a condition that may not be immediately life-threatening, but could cause them issues later in life.

“In large part these conditions are genetic,” says Cox, “especially when they occur in young, healthy people who have not fallen prey to lifestyle choices that may impact upon cardiac health, such as smoking, inactivity and poor diet.”

Fatal rhythm

When fatal, these conditions are classified as sudden cardiac death syndrome (SCDS), and a 2006 study reported an incidence of around one in 1000 per year. Rare, yes, but worth knowing about.

Around a third of SCDS cases in adults under 35 years old are caused by hypertrophic cardiomyopathy (HCM) and it’s the most common cause of sudden death in young athletes. It can affect people of any age, but occurs more frequently in men. Most worryingly perhaps is that many of those with HCM display no symptoms at all.

“In general, the main abnormality of the heart in HCM is that the heart muscle has become excessively thick,” says senior cardiac nurse for the British Heart Foundation, Fotini Rozakeas. “How thick and how much of the muscle is affected can vary from one person to another.”

This abnormality causes the fibres of the heart to lose their usual arrangement, leaving it vulnerable to dangerous and potentially fatal heart rhythms. Adding strain through intense exercise can, in some cases, trigger heart failure.

Get tested

Screening for heart conditions takes the form of an electrocardiogram (ECG), which looks at the electrical conduction pathways around the heart using electrodes placed on the subject’s chest. It takes just a few minutes to carry out and can be arranged through CRY.

“The International Union of Cyclists stipulates that cardiac screening must be carried out on riders on an annual basis,” says Cox. “This means that at the high levels you’ll have a smaller representation of deaths. However, most deaths occur in lower levels of athletes, people who play football on a Saturday, or run marathons or are members of their local cycling clubs. These people are equally as at risk, but are unlikely to be tested.”

Although some people would rather live in ignorance than give up the sport they love, Cox thinks that everyone should have the option to be tested. “People have the right to have an ECG test if they’re concerned. This can be organised through CRY, for a maximum cost of £35.”

Screening isn’t faultless, as athletes’ hearts can be enlarged through exercise which, while not dangerous, may mask other conditions. But according to Cox, screening identifies HCM in 95 to 97 per cent of cases. “As this is the most common cause of SCDS in athletes, this figure provides some reassurance,” he says.

In Italy it’s mandatory to have an ECG before taking part in competitive sports at any level, including sportives. According to a study on the impact of this law, published in the Journal of the American Medical Association in 2006, the incidence of SCDS has decreased by 89 per cent from 1979-1980 to 2003-2004.

A word of reassurance

It’s important to point out that these conditions can be exacerbated, not caused, by cycling and other forms of exercise. In general your heart needs exercise to stay healthy because it helps control weight, reduces blood pressure and cholesterol, eases stress, prevents type two diabetes – which often has cardiovascular implications – and generally makes you feel better about yourself. Only in rare instances will exercise be discouraged, and even then that’s only if you work out to intense levels.

Hands on hearts

Although heart conditions don’t always display symptoms, there are some warning signs that you shouldn’t ignore. According to the British Heart Foundation, symptoms to look out for include:

Shortness of breath: This generally occurs when exercising or being active. Most people are only mildly restricted by their shortness of breath. However, some may feel more restricted in the level of exercise they’re able to take, and very occasionally some people may be short of breath while they’re resting.

Chest pain: This is a common symptom, along with tightness on exertion (angina), which occurs because the heart isn’t receiving a sufficient blood supply. HCM causes the microscopic coronary arteries within the heart to become narrowed, meaning that even though the main coronary arteries are in most cases normal, the blood supply is reduced and can cause pain.

Palpitations: This is the sensation of an extra or skipped heartbeat. In some cases, palpitations may start suddenly and feel very fast, and they can be accompanied by sweating or light-headedness.

Light-headedness and blackouts: This may occur when the person is exercising, or after palpitations, or sometimes for no apparent reason.

Hearty foods

Looking after your heart includes eating a healthy diet. In general, this is easy – don’t eat too much saturated or trans fat, but do eat protein, fruit and vegetables. However, below is a list of a number of specific ingredients to add to your diet, and why they’re good for your heart.

Tomatoes: These are a source of vitamins C and E, flavonoids and potassium, which may all help to regulate blood pressure, and research has linked high tomato consumption to a reduced risk of heart disease.

Oily fish: Fish is a great source of omega-3 fatty acids that can help protect your heart by reducing inflammation of muscle tissue and the risk of blood clots. These fats also work to keep your cholesterol at a healthy level.

Oats: These contain beta glucan – a soluble fibre that helps reduce cholesterol – and minimal fat to avoid artery clogging.

Aubergines: Containing the protective nutrient vitamin E, aubergines are a useful source of potassium, which helps to regulate blood pressure.

Onions: Red onions are rich in quercetin, an antioxidant which may help to improve blood circulation.

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