"Something was not good today"says Thomas K. (name changed by the editor) from Munich to his wife when he returns from his training round at the end of July 2020. There was suddenly this pain in his chest and arm. Shortness of breath. And dizziness. So much so that he had to sit on a stone for 15 minutes before he could continue. His wife persuaded him to make an appointment with a cardiologist. However, as Thomas feels generally fit, he goes for another run a few days before his doctor's appointment. After all, he has to train because he wants to ride a Transalp with two friends in a fortnight' time. Thomas doesn't return home from this run. After the autopsy, the doctor says "Her husband did not suffer. He lost consciousness so suddenly that he may not even have felt the impact on the ground."
These topics can be found in the article on heart health:
Statistics of the German Heart Foundation
According to statistics from the German Heart Foundation, sudden cardiac death in Germany affects 0.7 to 3 out of every 100,000 people doing sport each year. 96 per cent of these are men. The main causes in men under the age of 35 are usually inherited diseases of the heart valves, aorta, coronary arteries or ventricles. These diseases are usually only discovered when cardiac arrhythmia occurs during heavy exertion in sport.
In men over the age of 35, however, it is mainly coronary heart disease (calcification of the coronary vessels) and myocarditis that can lead to cardiac arrest during exercise. In both cases, acute arrhythmia occurs, the heart fibrillates and stops pumping blood into the body, the brain is no longer supplied with oxygen and the affected person loses consciousness. Without first aid measures in the form of chest compressions and the use of a defibrillator by the emergency doctor, death will occur within a very short time. But the good news is that sudden cardiac death can be prevented.
Heart check-up: this is how the examination works
Martin Bosch had such a shocking experience himself. One of his training partners was out on a Sunday tour with friends and was suddenly left behind. This did not seem unusual to the group. Probably a flat tyre. So they waited. But the friend didn't come and didn't answer his mobile phone - he couldn't do it anymore. Alarmed, Bosch called his old school friend, Dr Martin Schick, senior physician at Freiburg University Hospital, a few days later. During the conversation, the question quickly arose: What is your own heart health actually like? Together they arranged a check-up appointment at the Institute for Exercise Medicine. And for old times' sake, they also invite the other mates from their old, close-knit biker group. When they were at school and university, they were all young, fit and spent every spare minute on their bikes - today: in their mid-forties, fathers with families, stressful jobs and little time for sport. In principle, the best conditions for the development of coronary heart disease.
When the four men meet in the waiting room at Freiburg Hospital in March 2022, they are delighted to see each other again, but they are also nervous. What if I find out that I'm no longer allowed to do sport in future? Martin Schick had a Covid infection a few weeks ago and then had breathing problems for a long time - has the virus taken hold in the form of myocarditis? Markus works a lot, has two small children, and since he has been working from home due to coronavirus, he has been missing out on training kilometres to the office. The result within two years: twelve kilos more on the scales. The 20 cigarettes a day may also be reflected in some figure today.
But the doctor is already standing in the doorway and it's time to start. One by one, everyone is called to the various test stations.
Station 1: Blood and urine collection
The samples taken go straight to the laboratory. An important finding from this is the blood lipid level. Elevated cholesterol levels (especially LDL cholesterol, triglycerides) are partly responsible for dangerous deposits in the blood vessels. Elevated blood sugar levels are indicators of diabetes mellitus, which eats into the blood vessel walls in the long term. Especially untreated diabetes, because it may not yet have been recognised. In addition, liver and kidney values as well as changes in red and white blood cells provide information about possible inflammation in the body. Interesting in the urine: Are there inflammatory cells present that indicate a disease of the kidneys and urinary tract?
Station 2: Medical history
The doctor asks about current complaints and previous heart-related illnesses, including within the family (genetic predisposition). In addition, allergies, alcohol and nicotine consumption, medication and frequency of sporting activity. In addition, listening to the lung function, palpation of the lymph nodes and internal organs, check of the physical condition in general.
Station 3: measuring the body
Height, weight, measurement of the general body fat and muscle percentage using scales and by measuring the fat folds on the upper arm and, very importantly, the waist circumference. According to the WHO, a circumference of more than 102 centimetres in men and 88 centimetres in women also indicates an increased proportion of fat in and around important organs, which significantly increases the risk of cardiovascular disease. Two people of the same weight can therefore be at different risk simply due to the different distribution of their body fat.
Station 4: Resting ECG and ABI value
Electrodes are attached to the upper body while the patient is lying down. They measure the heart rate and rhythm during recovery and show the position of the heart. At the same time, blood pressure is measured on the arms and ankles. The resulting ABI value (ankle-brachial index) indicates the state of blood flow in the leg arteries. A value below 1 indicates a dangerous occlusion of these vessels. A generally high blood pressure (from values of 140/90) is one of the top risks for a heart attack in the long term, as the heart has to constantly pump against this pressure in the circulation and the vessels calcify more quickly.
Station 5: Echocardiography - ultrasound of the heart
Lying down, you watch your own heart beat. The doctor sees even more on the screen: he measures the overall size and pumping function (efficiency) of the heart and ventricles. He looks for damage to the heart valves, possible inflammation of the pericardium and possible constrictions in the aorta. This provides information about the oxygen supply to the heart. Deposits in the coronary arteries themselves cannot be recognised here.
Station 6: Exercise ECG
On the bicycle ergometer, electrodes on the upper body are used to measure the heart rate and simultaneously the blood pressure as the load increases (gradually increasing by 50 watts every three minutes until the maximum load is reached). This allows the individual's performance to be determined, as well as cardiac arrhythmia and signs of coronary heart disease. If the doctor detects movement disorders of the heart muscle in stations 5 and 6, a further ultrasound examination on the ergometer (stress echocardiography) may be considered.
Station 7: Debriefing with the doctor
Here, the blood and urine values from the laboratory, any abnormal values from the other stations and the resulting risks of heart disease are discussed individually. The exact values of all tests are then sent by post.
The result of the heart examinations
All four test candidates come out of the last doctor's room relieved: none of them suffer from acute myocarditis or coronary heart disease, which could lead to sudden cardiac death during sport. But everyone gets food for thought for optimising their lifestyle. However, this can no longer dampen the party mood of the four today. Now it's time to celebrate: with a short bike ride on the Freiburg trails (which didn't exist back then in their biking days), an after-ride beer and a barbecue afterwards, which will go on until the early hours of the morning and - just like back then - to their physical limits.
Interview with Dr Stephan Prettin about the cardio check
BIKE: None of the four test subjects were diagnosed with coronary heart disease or myocarditis - does this mean they are now immune to sudden cardiac death?
STEPHAN PRETTINThe risk of sudden cardiac death in sport can be significantly reduced with such preventive examinations. Congenital heart defects and narrowing of the coronary arteries would have been detected very reliably. But of course we cannot rule out the possibility of myocarditis in the future, e.g. as a result of a viral infection.
In the statistics of fatalities, footballers are hit most often. However, cyclists are only just behind. How can this be, when fitness sports are supposed to be good for the heart, especially at an older age?
Sudden cardiac death in sport is most frequently triggered by an arrhythmia (ventricular fibrillation). This disorder can be triggered by intense physical exertion in a previously damaged heart. In any sport. The fact that footballers are most frequently affected is most certainly a statistical distortion that has to do with the general number of athletes. Regular physical training such as cycling reduces the overall risk of heart disease, which can sometimes be fatal. That is a fact.
What symptoms do you recommend a cardiac examination for?
For example, if you experience chest pain on exertion, unexplained breathlessness on exertion or a significant drop in performance for no apparent reason. Cardiac arrhythmia during exercise should also be investigated.
Which test results/values would lead you to advise an athlete against training?
Acute myocarditis can trigger life-threatening arrhythmias through physical exertion. I would recommend taking a break. There are constellations in which high-intensity, performance-orientated competitive sport must be discouraged in the long term. Congenital diseases of the conduction system, for example. However, the continuation of regular exercise in the case of existing heart disease is usually expressly desirable after treatment and under regular monitoring, as it demonstrably improves the prognosis in the long term.
Are there now any findings on how much damage Covid disease does to the heart?
In some cases, this viral infection also leads to inflammation of the heart muscle. However, this is a rare complication. Incidentally, the risk of myocarditis due to infection with the SARS-CoV-2 virus is 100 to 200 times higher than the risk of myocarditis due to the Covid vaccination. There are also indications that the risk of other heart diseases such as atrial fibrillation and heart attacks increases in the months following a Covid infection.
Four men - four different heart stories
How much do stress at work, in everyday life and with my family, as well as some vices, weigh on my heart? And can I compensate for this by cycling? These four men wanted their receipt.
Martin Bosch (45), Managing Director of several clinics in and around Wiesbaden, two children
The sudden cardiac death within our tour group was a shock. Especially as it also affected a relative of mine. Due to corona and all the organisational stress we have in the hospitals as a result, I've been sitting in the office for plus/minus 60 hours a week for some time now. Nevertheless, I still make time for sport: I go cycling alone or with a training group for 4-6 hours a week and try to go running twice in the morning before work.
Result of the investigation: My ECG on the ergometer was unclear, but only at maximum heart rate. The doctor therefore advised me to have another stress echo examination. I did this a few days later and thankfully the all-clear was given. I was able to tackle the planned Transalp in the summer with relief.
Martin Schick (45), senior physician at Freiburg University Hospital, two children
Night shifts and working at full capacity sometimes take their toll. But this rhythm is part of my life and I enjoy it. As long as I feel good about it, this kind of stress shouldn't be a problem. However, I had a Covid infection a few weeks before the check-up and quickly got out of breath while exercising for a long time afterwards. I was a bit worried about that.
Result of the investigation: Huge relief - Covid hasn't left any damage. Now I know that my head can set the pace in future if I get out of breath early again. I was amazed at my blood pressure reading of 200/70 mmHg under stress. Everything is still within normal limits, but I will check my values regularly in future. High blood pressure doesn't hurt, but it kills you a little more every day. I was pleased that I pedalled 5 watts/kg and was amazed at how well my Strava/iWatch values matched the test.
Markus Veil (46), risk controller (bank) from Munich, two children
With 5000 kilometres on my bike, I was one of the fittest in our touring group before Covid. But with my sometimes quite stressful job, I soon only managed to cycle to the office (about 10 kilometres one way). When the coronavirus and working from home meant I couldn't do that either, I soon had twelve kilos more on my ribs. Climbing stairs, going for walks and romping around with the children - I'm out of breath frighteningly quickly. But I'm sure this is also due to my consumption of a packet of cigarettes and the odd beer after work. I had the jitters before the check-up, but I wanted to have my physical decline in black and white now.
Result of the investigation: Now it's official, I have too many kilos on my ribs. A few other values are also significantly worse than I would have expected. However, I now know exactly where my deficits lie and what I can do about them. It's also great to realise that my fitness from pre-corona times hasn't completely evaporated. So even short journeys to work are good for me in the long term! My goals: I've bought a new bike and built a fitness routine into my everyday life. 400 km/month, healthy eating plan - the pounds are already melting off!
Matthias Kimmer (46), landscape architect from Weil am Rhein, three children
My workload varies depending on the season, but on average I work about 8.5 hours a day. I cycle to work every day (10 kilometres), I also run 1-2 times and I go to football training once a week. In principle, I eat a healthy diet, but if there's one thing I can't keep my hands off, it's crisps.
Result of the investigation: I would never have thought it, but my blood pressure was slightly elevated at rest (level 1). This could be due to the fact that I had been under a lot of stress at work the week before and hadn't slept much at night, as one of my children had febrile convulsions. However, all other values were normal. My conclusion from the test: I will make a little more time for my sports programme.
The Golden Seven: Tips for a fit heart
A healthy heart can cope with a lot. But if various vices come together, it can lose its rhythm. Here are seven tips on how to keep your engine in rhythm.
1 Diet: plenty of fresh fruit and vegetables
Use wholemeal products, little salt and unsaturated fats and eat as varied a diet as possible. Avoid ready-made products with harmful trans fats (crisps, chips, anything deep-fried) as much as possible.
2 Exercise regularly
Just 15 minutes a day helps to lower cholesterol levels and blood pressure. On the other hand, not exercising for weeks and then going full throttle one day puts a lot of strain on the heart and circulation. Therefore, always start at a relaxed basic pace, which also strengthens the immune system!
3 Control weight & belly fat
Being overweight harbours the risk of high blood pressure and diabetes. The heart also has to work harder to supply the increased body mass with blood and oxygen. Visceral fat on the abdomen in particular can also fatten important organs.
4 Avoid stress
Mental health has a major influence on blood pressure. Stressed people also often suffer from binge eating and insomnia and have higher cholesterol levels.
5 Sufficient sleep
It is not only responsible for physical recovery. Metabolic waste products are also removed during sleep.
Cure 6 infections completely
"Sweating out" colds or Covid infections is not a good idea. If you do sport with an infection, you run the risk of myocarditis. This means that the doctor may prescribe a sports ban of 3-6 months.
7 No tobacco, little alcohol, avoid too much salt and sugar
Smoking causes tobacco substances, among other things, to accumulate in the blood vessels, which can lead to arteriosclerosis. Alcohol can disrupt the heart's sinus rhythm, salt increases blood pressure and too much sugar damages the heart's nervous system.
First aid: chest compressions
In the event of a sudden cardiac arrest, every second counts. The brain must continue to be supplied with oxygen. These are the three most important points to bear in mind during resuscitation.
1 Determine unconsciousness
Speak to the person and shake them gently by the shoulders. If the person does not wake up: call the emergency services immediately on 112.
2 Check breathing
Does the chest rise and fall, can breathing noises be heard? If not, start chest compressions immediately to ensure a minimum supply of oxygen to the brain.
3 Cardiac massage
The patient lies flat on their back. Expose the chest and place the ball of one hand on the lower half of the sternum (vertical bone in the front of the chest to which the ribs are attached). Place your other hand over it. Straighten your arms and bring your shoulders over the sternum. Now press forcefully into the chest about five to six centimetres deep, 100 to 120 times per minute (macabre mnemonic: to the beat of "Highway to Hell"). Until the emergency services take over with a defibrillator. According to the German Heart Foundation, mouth-to-mouth breathing by laypeople is not necessary because the patient's blood still contains oxygen. What is important now is that it reaches the brain.
TIP: There are mobile phone apps from the Red Cross and "Defikataster". They show the locations of over 40,000 defibrillatorswhich are used for first aid measures, especially at sports facilities, and should also be easy to use for non-professionals.
Gitta Beimfohr
Editor
