Huge local interest as people take part in triAthlone for many reasons

Kieran Galvin

WHILE the cream of Europe's triathletes battled for glory in Athlone last weekend, many of the local participants had different aims in mind. Some were happy to complete a triathlon for the first time; others were attempting to improve on their performance from last year; some took part for charity and others did it simply for fun.

Ian McLoughlin from lona Park, Athlone, more known for his basketball prowess, was among those who completed his first triathlon last weekend. Ian opted for the shorter swim (200 m) followed by 20k on the bike and the 5k run.

"I found the swim the hardest but I made up the time on the bike and on the run. I'm happy to get the first one out of the way, I might do another one or two, that's the plan anyway, it keeps me fit during the summer," said lan. Hazel Daly is a member of the Mount Temple TriAthlone Team, who took part in the tri- Athlone to raise funds for CRY (Cardiac Risk in the Young) and Cancer Care West.

"This is my third time to do it. We've done it for CRY for the past two years and this year we're doing it for Cancer Care West and CRY," said Hazel.

"It's a great buzz. I'm in a relay, I do the swim, Liz Mc- Cormack does the cycle and Patricia Cassells does the run, we've had the same team for the last three years."

This year, the Mount Temple group had 40 members doing the triAthlone to raise funds for the two aforementioned charities



Clonmel Dad to take on Pilgrimage walk in Spain

Clonmel Dad to take on pilgrimage walk in Spain in memory of his son.

Brendan O'Mahony a Clonmel man will embark on an emotional pilgrimage in Spain next month to mark the fourth anniversary of his son's sudden death and raise funds for charity.
Conor O'Mahony from Cherrymount was just 32 when he died from Sudden Cardiac Death (SCD) at his apartment in Dublin on July 25th 2006. Now his father Brendan is undertaking the 130 kilometres sponsored pilgrimage walk – El Camino Ingles - from Ferrol in Galicia to Santiago de Compostela in north western Spain in Conor's memory.
The walk will begin on July 17th and arrive in Santiago on July 25th, exactly four years to the day since Conor died.
"It's a way of remembering Conor and I'm doing the walk in his memory", says Brendan.
As well as a training schedule that has him pounding the roads around Clonmel early in the morning and late in the evening, Brendan is also collecting sponsorship for CRY (Cardiac Risk in the Young), a charity founded eight years ago by parents who experienced sudden and unexplained death within their families.
CRY is a self-supporting registered charity that doesn't receive government
funding of any kind. The organisation raises awareness of cardiac risk in the young and sponsorship from Brendan's walk will support CRYs Screening and Evaluation Centre at TaUaght Hospital, where families and individuals at risk can be evaluated, while counselling and support is also provided to families affected.
The Galicia area holds a special resonance for the O'Mahony family. Brendan O'Mahony Is to undertake a walk in Spain to raise money for charity in memory of his son who died suddenly Conor, who spoke Spanish and Portuguese fluently, travelled all over the world and his trip to the area in 2005 was his last holiday before he died.
A visit to Galicia was recommended by Conor to his family and Brendan feels that the time is right to undertake the pilgrimage. He will be joined for the last 10 kilometres of the walk by his wife Margaret and Kevin, one of the couple's three surviving sons, which, falling as it will on Conor's anniversary, will add to the poignancy of the occasion.
The walk will finish with midday Mass at the cathedral in Santiago de Compostela on July 25th, the feast' of St. James (Santiago in Spanish), where the congregation of several thousand overflows into the square. Whenever St. James' Day falls on a Sunday the cathedral declares a Holy or Jubilee Year. A time honoured tradition has it that pilgrims reaching Santiago during a Holy Year, and fulfilling certain conditions, are granted a plenary indulgence at a special ceremony.
Brendan, a well-known travel agent, has been preparing for the walk for several months and his training schedule has seen him lose three and-a-since St. Stephen's Day. He will walk between 20 and 25 kilometres (around 15 miles) each day during the pilgrimage.
The route will take him through a remote, rural and sparsely populated area, with a few steep climbs thrown in for good measure. He will have to carry his belongings in a back-pack - the recommended weight is 10 kilos, or 22 lbs - which will further test his endurance during a trek that will take him over 80 miles in nine days. Brendan, who already speaks Spanish, has also learned the local Gallego dialect to help smooth his journey through the region on Camino de Santiago, the Way of St. James, a walk that traces the footsteps of early Christian pilgrims and honours an early martyr (beheaded by King Herod) who's believed to be buried in Santiago de Compostela.
Brendan will pay his own expenses for the trip and all funds raised will be donated to CRY.
He has been greatly encouraged by the response so far. Anyone who wishes to contribute sponsorship may do so by contacting him at his home at 91, Cherrymount or at Clonmel Travel in Mitchel Street.


Sudden cardiac death in sport - the role of the GP

Related News Archive 

A big challenge for GPs is to identify those who may be at risk of sudden death while exercising, writes Dr Fionnuala Quigley.

General practitioners are often the first person to be called when a young person dies suddenly while exercising. The vast majority of these are considered sudden cardiac deaths. GPs have a key role in dealing with the family when this tragedy occurs. In addition, they have a responsibility in ensuring that family members are carefully screened so that further tragedy may be averted.

Unfortunately, the vast majority of athletes who die suddenly do not have any symptoms. However, young people can rarely present to their family doctor with symptoms related to underlying cardiovascular abnormality. This small group may be at risk of sudden cardiac death if these symptoms are not recognised and appropriately investigated. Identification and treatment of high-risk people may substantially reduce their likelihood of dying suddenly. Therefore, it is essential that GPs should have awareness and relevant knowledge in this area. The following points highlight some important issues.

Incidence of sudden cardiac death in sport

There is a shortage of robust data currently available. A survey of the causes of sudden death in sport in the Republic of Ireland (age range from 15 to 75 years and included all levels of sports activity) from January 1, 1996 to December 31, 1997 suggests that the incidence is low, one in 600,000 of the population (this was calculated on the basis that there were 51 cases over 10 years with a population of approximately three million).

This incidence level is significantly lower than that found in studies in the United States, where the incidence of sudden death in young competitive athletes is believed to be two per 100,100 per year. The incidence in Italian competitive athletes (age 14-35 years) appears to lie between that of the Irish and American studies, reported at 3.6/100,000. The difference in incidence levels between countries is difficult to explain, but may merely reflect the small number of studies to date.

Despite the variability in the reported incidence of sudden death in sport, it does seem that the risk is 2.5 times higher in athletes than in age matched non-athletes.

It has been suggested that the risk of sudden cardiac death increases with increasing intensity of exercise and increasing level of competition. The relative risk of death during sport participation appears to be greatest in the case of cardiomyopathies and congenital coronary artery anomalies. Possible causes of sudden cardiac death in sport.

Most studies agree on the association between sudden cardiac death in sport and the following abnormalities:

  • The commonest cause in those over 35 years appears to be atherosclerotic coronary artery disease
  • The commonest causes in those less than 35 years are:
    • Hypertrophic cardiomyopathy is the most commonly reported cause (prevalence is one in 500 in the general population)
    • Congenital coronary artery anomalies
    • Arrythmogenic right ventricular cardiomyopathy
    • Dilated cardiomyopathy
    • Myocarditis
    • Aortic dissection (usually in the context of Marfans syndrome);
    • Electrical disorders: Channelopathies such as congenital long or short QT syndromes, Brugada syndrome, cathecholaminergic polymorphic ventricular tachycardia, Wolff Parkinson White syndrome;
    • Commotio cordis, which can be caused by projectiles such as hockey pucks, or bodily contact such as karate blows;
    • Ventricular fibrillation can be induced without structural injury to the ribs, sternum or heart
    • Unknown. A normal heart at post mortem has been found in one to sevenper cent of cases. Channelopathies may well account for a number of these previously considered unexplained deaths as in these cases the heart would be morphologically normal

Relevant symptoms

  • Syncope or near syncope, particularly if exercise related
  • Exertional chest pain 
  • Shortness of breath or fatigue out of proportion to the degree or physical activity;
  • Palpitations or irregular heart beat

Family history

When presented with a young person with symptoms that could be attributable to a cardiac abnormality, it is critical to take a full and detailed family history.

The following questions should be included:

  • Has anyone in your family under the age of 50 years: Died suddenly and unexpectedly? 
  • Been treated for recurrent fainting? 
  • Had unexplained seizure problems?
  • Had an unexplained drowning while swimming?
  • Had an unexplained car accident?
  • Had heart transplantation?
  • Had a pacemaker or defibrillator implanted?
  • Been treated for irregular heartbeat Had heart surgery?
  • Experienced sudden infant death (cot death)?
  • Does anyone in the family have Marfans syndrome?

If the answer is yes to any of the above, an underlying cardiovascular condition needs to be considered

Clinical examination

A thorough clinical examination should be performed in all cases, paying particular attention to the following:

  • Blood pressure
  • Murmurs (in hypertrophic cardiomyopathy 20 per cent will have a systolic murmur which is exaggerated on performing the Valsalva manoeuvre or from changing from the supine to the standing position)
  • Radial and femoral pulses
  • Stigmata of Marfans syndrome

Referral to a specialist

The following should be considered for referral to a specialist (ideally a cardiologist with a particular interest in the area):

  • Family members of a young individual who has died unexpectedly
  • Those with suggestive symptoms, particularly exercise related syncope, near syncope, chest pain, palpitations, and shortness of breath or fatigue out of proportion to the degree of physical exertion
  • Positive finding on examination
  • Abnormal ECG

The role of GPs in pre-participation cardiovascular screening of young athletes

Ideally GPs should be involved, but such a role would potentially have major financial and manpower implications. The ‘Lausanne Recommendations’ (International Olympic Committee Medical Commission) have advised the following for all participants at the beginning of competitive activities until aged 35 years
Personal history
Family history
Physical examination
12'leadECG
The rationale for including an ECG is that it is abnormal in 95 per cent of cases of hypertrophic cardiomyopathy and in 80 per cent of individuals with arrhythmogenic right ventricular cardiomyopathy. The Italian Pre-Participation Screening Model, which includes an ECG, has shown 90 per cent reduction in mortality.

 However, the current pre-participation cardiovascular screening of athletes in the United States does not include an ECG. The false positives associated with the ECG as well as the financial implications and logistics of ECG interpretation remain a concern in the US.

Cardiac arrest during sport

Although a relatively rare event, GPs, particularly those actively involved as team sport physicians, need to be aware that cardiac arrest can occur in young people while participating in sport.

The following points need to be considered:

Prompt recognition and diagnosis (brief seizure-like activity or involuntary myoclonic jerks have been reported in approximately 50 per cent of young athletes with sudden cardiac arrest);
Presence of a trained rescuer (that is, trained in basic life support)
Early defibrillation improves survival for young athletes with sudden cardiac arrest. The single greatest factor affecting survival from sudden cardiac arrest is the time interval from cardiac arrest to defibrillation.

Conclusion

One of the greatest challenges for GPs is to identify' those who may be at risk of sudden death while exercising Careful history taking, clinical evaluation and appropriate referral for specialist opinion, may go some way towards averting these tragic deaths In the future it is anticipated that all young athletes in Ireland will require pre-participation evaluation and this will involve major commitment by general practitioners.

References available on request.

Dr Fionnuala Quigley is a GP in West Cork, a senior lecturer on the Masters Degree Programme in Medical Science, Sport and Exercise Medicine at University College Cork, and a trustee of the charity CRY (Cardiac Risk in the Young)


MINI MARATHON MEMORIES FOR ST.MARKS

 



 

Subcategories