Fitness: Keep heart health in mind when exercising

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One minute, Ken Covo of Pointe-Claire was chatting and joking with his teammates in the dressing room after his weekly game of old-timers’ hockey, and the next minute he was waking up with a teammate leaning over him doing CPR.

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“It started out as a pretty regular fast-paced game,” said Covo, 65. “Toward the end of the first period, I got a feeling of intense heartburn. More intense than I have ever had. But I wasn’t short of breath and there was no pain radiating down my arm. I was still able to do hard shifts and even got off my once-a-year slapshot, so I ignored (the pain).”

About 10 minutes after getting to the dressing room, Covo felt light-headed. It’s the last thing he remembered before his heart stopped. Thanks to the quick thinking of his teammates, not only did he live to tell the tale, he’s back on the ice five months later.

It seems ironic that exercise, long touted as one of the most powerful interventions to improve cardiovascular health, can trigger sudden cardiac arrest. In fact, that’s the leading medical cause of death among athletes. But not every exerciser carries the same degree of risk. Those most affected by a sudden cardiac event during or shortly after vigorous exercise have pre-existing conditions that can’t be totally cancelled out by an active lifestyle. In the case of older athletes, the culprit is likely coronary artery disease, characterized by a narrowing of the arteries supplying blood to the heart.

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Tests performed after his cardiac event suggested that high blood pressure and cholesterol levels and a moderate narrowing of the arteries likely combined to stress Covo’s heart. Add a fast-paced game of hockey, and it was eventually enough to trigger a cardiac arrest.

Acknowledging the increasing number of masters athletes engaging in high-intensity exercise, a recent article in the Physician and Sportsmedicine journal stressed the importance of automated external defibrillators (AED) in athletic facilities and during masters events, as well as an established emergency action plan (EAP) specific to each athletic facility, league or event.

“Automated external defibrillators and EAP unequivocally reduce sudden cardiac deaths,” said the article’s authors, who hail from the universities of British Columbia and Trinity Western. “Access and use of an AED within sports settings can markedly improve sudden cardiac arrest survival.”

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Jean-Louis Bachand, a retired firefighter and first responder, was in a nearby team room when he got a call that Covo needed assistance. It was the second time he witnessed a teammate go into cardiac arrest at the rink.

“The first time, I administered CPR for 17 minutes before the first responders showed up,” said Bachand, who added the AEDs on site weren’t functioning. He’d like to see better maintenance of existing units, and suggests they be located closer to the ice surface.

“It’s not easy running to get an AED in a pair of skates,” he said.

To find out just how knowledgeable masters athletes are when it comes to their own heart health and what to do in the event of a cardiac arrest, the research team from British Columbia polled masters athletes (runners, triathletes, cyclists and hockey players) about the availability and location of AEDs in their exercise facilities, whether they have or know about an existing emergency action plan and their level of concern about having a cardiac event while exercising. A total of 501 masters athletes completed the survey.

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“More than half of the athletes (62 per cent) were not aware of an AED in proximity to where they exercise,” said the study’s authors. “For those who were aware of an AED near where they exercise, 78 per cent reported the device to be about 100 m away.”

A whopping 90 per cent of the athletes said they didn’t have an emergency protocol, despite 21 per cent stating they experienced someone fainting or having a cardiac arrest while exercising.

Simple strategies can save lives, such as sharing emergency contact information with teammates; having a cellphone by the field, pool or ice surface; training team or league members or workout partners to perform CPR; and making sure everyone knows the location of the closest AED.

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The best chances of survival occur when an AED is used within the first five minutes of cardiac arrest, which offers guidance as to the appropriate location of the nearest unit. For administrators of adult leagues or teams, it’s worth considering the purchase of AEDs. And it’s up to every athlete to know where the nearest AED is located, wherever they exercise.

As for Covo, the cardiac arrest taught him that being active isn’t a reason to ignore signs of a heart in distress.

“I look at it as a tough but really helpful learning experience,” he said. “I found out that fitness and heart health are not necessarily the same thing. And while my fitness level really helped in my recovery, I am eating more carefully and paying attention to all the risk factors.”

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Risk factors for sudden cardiac arrest

Signs of sudden cardiac arrest

• Chest discomfort
• Shortness of breath
• Weakness
• Fast-beating, fluttering or pounding heart (palpitations)
• Fainting or near fainting
• Light-headedness or dizziness
• Women may also experience nausea and vomiting, and shortness of breath may be more prevalent than chest pain.