Tips For Management Of Sudden Collapse During Exercise
Dr. Tapan Ghose
Director and Head
Department of Cardiology
Fortis Flt. Lf Rajan Dhall Hospital
New Delhi
In the recent past several celebrities have collapsed during or immediately following exercise. They were active individuals representing our society. The cause of sudden collapse may be due to relatively benign condition called
1. Exercise Associated Collapse (EAC) or Exercise Associated Postural Hypotension (EAPH) and devastating illness called Sudden Cardiac Arrest (SCA).
2. Sudden cardiac arrest (SCA) : The causes and outcomes of these two conditions are different. EAC / EAPH has good outcome whereas SCA has disastrous outcomes.
The causes of EAC/EAPH are :
- Dehydration
- Hyperthermia (Exercise induced high body temperature)
- Interplay of atheletic low heart rate, lower extremity blood pooling and impaired cardiac baroreflexes
The cause of SCA are :
- Coronary heart disease (Blood vessels disease)
- Cardiomyopathy (Heart muscle disease)
- Aortic valve stenosis (Valve disease)
- Pulmonary valve stenosis (Valve disease)
- Severe pulmonary artery hypertension (High lung BP)
- Long QT syndrome (ECG abnormalities)
- Systemic hypertension (High BP)
Immediate Management
Symptoms of light headedness, fatigue, weakness and fainting or sudden fall from an erect posture are the presentation of both EAC or SCA. Any of these symptoms during mass athelete event or exercise session should be viewed with caution.
First, make the person lie down in a safe place on farm surface. Tap or shake the shoulder, ask are you ok?. If conscious call for help, dial 121. If unconscious, begin CPR (cardiopulmonary resuscitation) and call for help
CPR has the acronym of C-A-B
- C-Compression
Kneel down, place your lower palm at the centre of the chest of the victim between nipples, place the other hand over your first hand, push down 2 inches (5cm) at 100-120 compression every minute. The chest springs back after every compression. Use your entire body weight for effective compression.
- A-Airway
Clean the mouth and airway after 30 chest compressions, do head lift, chin lift if you have been trained in CPR
- B-Breathing
2 cycles of breath either by mouth to mouth or mouth to nose or bag mask device should be delivered after every 30 chest.
If automated external defibrillator (AED) is available, that should connect while one person continued CPR. AED should be connected and shock should be delivered. CPR should be continued until taken over by medical team. Otherwise the person should be transported with ongoing CPR to the nearest healthcare facility.
Further Management
EAC – Symptoms usually improves within 5 minutes. The indications of hospitalization in EAC are:-
- Persistent changes in mental state
- Body temperature > 102°F
- Blood pressure < 110mmHg
- Heart rate > 100
SCA – SCA victims may become alert if the, rhythm reverts to normal or blood supply to brain in adequate. CPR should be discontinued once spontaneous circulation (pulse), breathing and sensorium are normal. They should be transferred to hospital immediately.
Prevention
- Hydration before exercise (drink enough water)
- Adequate sleep prior night (At least 7 hours sleep)
- Appropriate clothing (Not too tight)
- Avoid unaccustomed exercise if you have fever, loose motion, or have taken medications which may alter blood pressure or pulse rate.
- Before embarking on weight loss program or exercise regimen for the first time its wise to consult your doctorefore embarking on weight loss program or exercise regimen for the first time its wise to consult your doctor.
- Family history of premature CAD (CAD in a first degree male relative ≤ 55 years age of female relative ≤ 65 years of age), sudden death, congenital heart condition, ECG abnormalities dictates further assessment by experts before you begin your exercise program. Prevention is better than cure.
At the regulatory level, public access defibrillation should be more widely available, benefit of chain of survival and basic CPR should be tought to everyone.
