Wednesday, October 10, 2007

The 2007 Chicago marathon-a hot weather wipeout

The weather is not supposed to be hot for the Chicago marathon which is held in October. This year it was hot and so hot that things seemed to get out of hand. One news report described what took place as "havoc".

The race directors at some point canceled the race in mid course due to the excessive heat which should not have been a surprise as the preceding week had been unusually hot. Many runners continued ,however, ignoring barriers and the shut down of the watering stations. One runner died but the official report is that he did not die from heat related cause but from a pre-existing cardiac condition. Some runners blamed the race directors for poor planning and at least one person connected with the race blamed the runners for pouring water over their head instead of drinking the water. He was quoted as saying he had never seen runners pour water over their heads. He should watch runners in the summer and fall in Houston.Apparently some runners left the course to get drinks at local stores. Things did not go smoothly.

Many runners were treated by the medical teams set up for the race. This brings to mind the issue of medical management of the collapsed runner, an issue of personal and professional interest to me. Professional because internists are supposed to know all about electrolytes and the like and personal because I continue to participate in marathons and if I ever collapse I hope someone knows what to do.

I have posted before on this subject quoting the work of Dr. Noakes from South Africa who is a well known authority in this area who has emphasized the importance of hyponatremia and the critical necessity to know the serum sodium level in a collapsed runner and has urged race directors to arrange for access to point-of-care serum sodium determinations. The point has been made that determining the sodium level should precede the reflex starting of normal saline as that is not the appropriate treatment for severe hyponatremia.

This sodium issue has to be raised in regard to the death of the young runner concerning whom news reports indicate he died from mitral value prolapse (MVP).

I was puzzled as to how MVP would be the mechanism of death and my doubt was reinforced by a very recent posting by a cardiologist, Dr. Wes. He knows much more cardiology than I and he expressed his doubt about the putative cause of death.You have to wonder about electrolyte problems and arrhythmias.There are well documented deaths in marathoners due to severe hyponatremia . After the 2000 Houston marathon ,during which temperature was as high as 86 degrees, which was only slightly cooler than Chicago, there was a report of four young female runners were hospitalized with severe, life threatening hyponatremia , all of whom were successfully treated.

I bet there will be many calls from patients with the diagnosis of MVP- many of whom have in fact very little wrong with their hearts- to their primary care doctors or to cardiologists.

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