Long-distance racers have a history of dying. Pheidippides, the first marathoner of us all, croaked at the finish line. Recently, two runners, both under the age of 40, collapsed near the finish line of a half marathon in Raleigh, North Carolina. Though the race’s organizers said that the men’s deaths appeared to be from natural causes, the frequency of racing-death headlines is not so natural.
Studies published in the Journal of the American College of Cardiology say that about one in 200,000 runners will experience sudden cardiac arrest, and one in 50,000 will experience a heart attack from coronary artery disease during a marathon. According to the Heart Foundation, 250,000 Americans suffer sudden cardiac death annually. Many of these incidents can be linked to preexisting conditions. It has been calculated that one in 500 U.S. high school athletes has a usually trivial and identifiable cardiac “abnormality,” such as hypertrophic cardiomyopathy, or HCM, a thickening of the muscle wall around the heart.
The American Heart Association has linked HCM to a third of the 1,866 recorded athlete deaths over the past three decades. Of that number, many are runners like Micah True, star of the national bestseller Born to Run, as well as athletes such as University of Southern Indiana basketball player Jeron Lewis and Chicago Bears defensive end Gaines Adams. But these are rare and high-profile cases. Still, if the probability of experiencing cardiac arrest during physical activity is seemingly so low, and if knowledge about the problem is at an all-time high, then why are athletes dying so frequently?
Maybe because you don’t know you are dying. “The symptoms of a heart attack are the same as the side effects of exercise,” says Bonnie Taub-Dix, a registered dietitian who appears regularly on Good Morning America. “Your heart is racing, you are sweating, your chest hurts, and it’s hard to breathe.”
In a report on Fox News, Gordon Tomaselli, a cardiologist at the Johns Hopkins Outpatient Center, explained an athlete’s ability to run right through all the warning signs. “In order to have symptoms, it’s a supply-demand situation. You only get chest pains when the demand on the heart outstrips its ability to supply blood and nutrients to other organs,” he says. “So you can be totally asymptomatic, and your first symptom is sudden death.”
While the symptoms may be hard to pick up on, underlying conditions are not—as long as you look for them. ECG tests are the best method for pinpointing any preexisting heart problems, and while the idea of making tests mandatory for race participants has been tossed around, event directors and runners alike know that wouldn’t be practical. Beyond testing, knowing what your body is saying, and when to stop during the miles logged, is even more important. “Moderation is the key to everything,” says Taub-Dix. “Running and exercise are great for your health, but there is such a thing as too much of anything.”