Deaths in triathletes: immersion pulmonary oedema as a possible cause

Richard E Moon; Stefanie D Martina; Dionne F Peacher; William E Kraus

doi:10.1136/bmjsem-2016-000146

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Deaths in triathletes: immersion pulmonary oedema as a possible cause

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Deaths in triathletes: immersion pulmonary oedema as a possible cause

Richard E Moon, Stefanie D Martina, Dionne F Peacher and William E Kraus

BMJ Open Sport & Exercise Medicine, Vol.2(1), pp.e000146-e000146

08/2016

DOI: 10.1136/bmjsem-2016-000146

PMCID: PMC5117085

PMID: 27900191

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Abstract

Background/aimTo address the question as to whether immersion pulmonary oedema (IPO) may be a common cause of death in triathlons, markers of swimming-induced pulmonary oedema (SIPO) susceptibility were sought in triathletes' postmortem examinations.MethodsDeaths while training for or during triathlon events in the USA and Canada from October 2008 to November 2015 were identified, and postmortem reports requested. We assessed obvious causes of death; the prevalence of left ventricular hypertrophy (LVH); comparison with healthy triathletes.ResultsWe identified 58 deaths during the time period of the review, 42 (72.4%) of which occurred during a swim. Of these, 23 postmortem reports were obtained. Five individuals had significant (≥70%) coronary artery narrowing; one each had coronary stents; retroperitoneal haemorrhage; or aortic dissection. 9 of 20 (45%) with reported heart mass exceeded 95th centile values. LV free wall and septal thickness were reported in 14 and 9 cases, respectively; of these, 6 (42.9%) and 4 (44.4%) cases exceeded normal values. 6 of 15 individuals (40%) without an obvious cause of death had excessive heart mass. The proportion of individuals with LVH exceeded the prevalence in the general triathlete population.ConclusionsLVH—a marker of SIPO susceptibility—was present in a greater than the expected proportion of triathletes who died during the swim portion. We propose that IPO may be a significant aetiology of death during the swimming phase in triathletes. The importance of testing for LVH in triathletes as a predictor of adverse outcomes should be explored further.

Details

Title: Subtitle: Deaths in triathletes: immersion pulmonary oedema as a possible cause
Creators: Richard E Moon - Departments of Anesthesiology and Medicine, Duke University Medical Center, Durham, North Carolina, USA
Stefanie D Martina - Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
Dionne F Peacher - Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA
William E Kraus - Department of Medicine, Division of Cardiology, Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA
Resource Type: Journal article
Publication Details: BMJ Open Sport & Exercise Medicine, Vol.2(1), pp.e000146-e000146
DOI: 10.1136/bmjsem-2016-000146
PMID: 27900191
PMCID: PMC5117085
NLM abbreviation: BMJ Open Sport Exerc Med
ISSN: 2055-7647
eISSN: 2055-7647
Language: English
Date published: 08/2016
Academic Unit: Anesthesia
Record Identifier: 9984006487902771

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