An Ounce of Cardiac Prevention?

[Guest guest]

The Editorial of the Aug 2002 " Personal Fitness Professional " warrants some

comment. It said:

<An Ounce of Prevention.

Conrad Swanson

The death of ST Louis Cardinals pitcher Darryl Kile

in June brought nationwide attention to an alarmingly prevalent disease:

atherosclerosis, or heart disease..... If atherosclerosis can claim the life

of a 33-year old professional athlete in peak condition, it can happen to

anyone.

The tragedy is that Kile's death could have been prevented if he had been

aware of his condition and sought the proper treatment. As fitness

professionals, it's our responsibility to educate our clients about this

disease and help them reduce risk factors by eating right, exercising

regularly, maintaining a healthy weight, controlling hypertension and not

smoking. But, if you look deeper, our responsibility starts before a client

does one rep of an exercise or runs one minute on the treadmill. It is

important that we screen and assess every single potential client for

possible risk factors. Research shows that knowing your cleints' family

histories may be the most important thing you can do to help them reduce

their risks of heart disease. Insist that all your clients undergo thorough

fitness testing before you develop an exercise program for them, just as

doctors subject their patients to a thorough evaluation before surgery....>

***While the author is to be complimented on trying to create a greater

awareness of the risk of cardiac disease among the general population, he

also needs to have been a little more cautious in what he wrote.

I do not know the full medical case history of Kile, but I would never state

that " his death could have been prevented if he had been aware of his

condition and sought the proper treatment " because a large percentage of the

population which experiences heart attacks or other cardiac events show no

clinical or preclinical signs of any heart condition.

Many people suffer from " silent ischaemia " and other asymptomatic forms of

heart disease - and all the existing medical tests cannot provide an " early

warning " of impending doom. These folk (and I am one of them) receive

excellent bills of health after extensive medical tests and may suffer

massive coronaries soon afterwards. There are some who show no cardiac risk

factors, including any family history of cardiocirculatory disease, who have

fatal or near-fatal heart attacks (also like me). There are some who

exercise aerobically and anaerobically and live the healthiest of lives (even

to the extent of eating no 'harnmful foods " ), yet have die or experience

massive heart attacks (like me). Survival in those cases depends to a far

greater extent on receiving excellent medical intervention within minutes of

the heart attack (which I had).

Such instances apparently occur among 30 percent or more of those who have

massive heart attacks and there is no foolproof or even vaguely competent way

of predicting one's risk if you happen to be one of those unfortunate freaks

like me who show absolutely no signs or medical histories that would raise

the smallest of flags. In my case, it was only an invasive angiogram which

reveal the huge extent to which four of my coronary arteries (including the

extremely important left anterior descending artery - or " widow-maker "

artery) were occluded.

Only a few days before the big cardiac event my training was going so well

and my lifts were increasing so well that I was thinking of returning very

seriously to top level national competition. I wanted to be the oldest man

in South Africa to compete and take a place in the open national

championships and not simply in the " Masters " or " old boys " event.

Man proposes, God disposes! Two days later I was lying collapsed on the

floor of the lecture theatre in front of 100 of my engineering students

without exepriencing any prior warnings like chest, arm or neck pains,

breathlessness etc. There was just some profound dizziness and nausea which

I didn't initially worry about because I have suffered from BPPV (benign

paroxysmal positional vertigo) for many years and this sort of sensation was

not too unusual. While I reeled around dizzily on the podium, I just warned

my students that Siff wasn't carrying out one of his usual " Dead Poets'

Society " type of teaching demonstrations (which most of my students had

expected during my plus 30 years on the university staff); nor was he drunk

and disorderly, but that he was just suffering from this weird medical

disorder which may have resulted from his skindiving days.

Next thing I was flat on my back in excruciating agony, feeling like every

tiny cell in my body was being crushed out of existence and being painfully

reconstructed elsewhere in the universe. I then experienced an altered

mental state in which I learned that I was dying of a heart attack, so I was

able to call out to students to rush to the campus medical center for

emergency help. The rest of the story is quite a fascinating one right from

this point, through the quadruple bypass surgery and right up to my early

days of rehab. But I shall end at this point because my ability to write to

all of you now is adequate proof of my continued existence.

Up to that point in my life my cardiac disease knowledge, like that of many

physiology postgrads, general medical graduates, most nursing staff and

almost all fitness professionals was largely one of theory and book learning,

but after my personal experience many of my concepts about cardiac disease

and rehab changed radically. There is nothing like any personal disease or

tragedy for making someone a highly-informed commentator in those fields and

I was no exception. That is why I simply had to comment on this

well-meaning editorial.

The bottom line is this: all the testing and screening for cardiac disease,

whether carried out by basic fitness tests and questionnaires or the most

advanced technological means, does not offer any reliable way of preventing

someone from experiencing a serious or fatal heart attack. I am certainly

not alone in this regard - several medical articles have been written which

seriously question the validity and cost-effectiveness of cardiac screening.

[Others might like to share some references in this regard - I don't have the

time at present to hunt for my collection.]

The best thing that anyone can do in the gym setting is make sure that

emergency intervention of the highest calibre can be carried out as soon as

possible and that 911 (or its overseas equivalent) is called immediately.

That is why it is very pleasing to note that many gyms now possess their own

defibrillators and are training staff in their use. As a basic anti-clotting

agent, everyone should carry around a few aspirins and chew 1 or 2 quickly at

the slightest sign of heart attack (yes, I am aware that some people respond

poorly to aspirin - good reason to find out if you are one of those

unfortunates).

The editor stated that it was advisable for fitness professionals to carry

out " tests " and interviews for cardiac screening - this is not the wisest

course of action, because very few fitness pros are qualified medics - it

would be far preferable to have experienced medical experts carry out such

tests. Fitness professionals should never overestimate their abilities and

education when someone's life is at risk. We have specialists in every walk

of life and it does not lower one's image or reputation by calling upon those

who offer expertise that any of us may lack.

Dr Mel C Siff

Denver, USA

http://groups.yahoo.com/group/Supertraining/