Dear Sports Doc,
I am a 24-year-old marathoner and a few weeks ago I had a weird episode when I started experiencing chest pains at mile 8 of a half marathon. My dad has hypertrophic cardiomyopathy with a family history of the same condition and I have never been checked. He takes medicine to regulate it and he was also a marathoner. Two of my friends, both prominent runners have been recently diagnosed with heart disease. I am worried about my heart health as a runner.
I was wondering what I (and other runners) should ask my doctor in terms of heart health. There are so many articles that have these really startling headlines about runner’s hearts, but don’t address the issue of evaluation or what to do if you have concerns.
Hypertrophic cardiomyopathy can be acquired from infections, drugs, and alcohol or inherited like your dad and maybe you. The reported incidence of HCM is 1 in 500, but the penetrance or expression of the gene is low as there does not seem to be a corresponding death rate. While the incidence of sudden cardiac arrest death is really low across all ages, it is even lower in runners under 40. With a family history of HCM, you should be checked by your physician even without the chest pain you recently experienced. You will likely get an ECG and echocardiogram, and possibly some additional imaging. Your family should be screened and you and your family may be candidates for genetic testing, as some HCM genes have been isolated.
For other runners, here are the questions we ask when screening for heart risk. Many runners begin running as young adults without a history of high school or college sports and never having a preparticipation physical evaluation. Look at these questions and if you answer yes to any of them, see your personal physician to discuss your circumstances:
HEART HEALTH QUESTIONS ABOUT YOU
- Have you ever passed out or nearly passed out DURING exercise?
- Have you ever passed out or nearly passed out AFTER exercise?
- Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise?
- Does your heart race or skip beats (irregular beats) during exercise?
- Has a doctor ever told you that you have?:
- High blood pressure
- A heart murmur
- High cholesterol
- A heart infection
- Rheumatic fever
- Kawasaki’s Disease
- Has a doctor ever ordered a test for your heart? (for example, ECG/EKG, echocardiogram, stress test)
- Do you get lightheaded or feel more short of breath than expected during exercise?
- Have you ever had an unexplained seizure?
- Do you get more tired or short of breath more quickly than your friends during exercise?
HEART HEALTH QUESTIONS ABOUT YOUR FAMILY
- Has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 50 (including unexplained drowning, unexplained car accident, or sudden infant death syndrome)?
- Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia?
- Does anyone in your family have a heart problem, pacemaker, or implanted defibrillator?
- Has anyone in your family had unexplained fainting, unexplained seizures, or near drowning?
As always, chest pain or pressure, passing out, skipping or racing heart, or lightheadedness/dizziness during running should alert you to stop and get evaluated as any of the above causes, plus coronary artery disease, could be the cause.
This is a long answer for you and other runners.
I hope this helps.