Marathoners, Get an EKG

Disclaimer: I am not a medical professional and do not have the credentials to provide medical treatment or advice.  This post is only my personal opinion based on my own experiences with medical tests and running.  It is not meant to be used as a guide for your own health decisions.  If you think you need an EKG or a similar procedure, please consult your personal care provider.

Getting into marathon shape is not easy, regardless of your weight, height or athletic history. Even once you make it to the finish line, you feel like your muscles are full of battery acid, ready to eat through your skin. You limp for days and wonder how you’ll ever manage to take another airborne step again. But one thing is certain: you’re likely to be in pretty good shape.

The buildup of mileage, the rush of oxygen and tearing up of muscle over the last four to six months have made you stronger. Your legs can carry you forward for hours, your resting heart beat has dropped a few beats per minute, and your body has become more energy efficient. There’s always one sign at every marathon emblazoned with some variation of the oft-quoted (but statistically unreliable) factoid that only 0.1% of the population has finished a marathon. We take that to heart, pun intended, because despite the noise and talk, we really are a minority.

The problem is that after many years of this, long-distance runners can fall into the trap of thinking they’re invincible. While the country (and increasingly the world) experiences public health and obesity crises, we stand somewhat apart, logging weekly miles and trying to eat right. Our reasons are diverse. We might have started training to lose weight, to challenge ourselves, or to carve out daily time to clear our minds. Whatever the cause, running between five and ten miles in one sitting is rarely a big deal to us.

But every so often the specter of doom rears its ugly head. I’m not talking about injuries – those happen to all of us and often enough that we know how to deal with most of them. I’m referring to the sobering fact that every so often, we are flooded with emails from friends and relatives all reminding us that someone died mid-race.

Long distance running is a unique sport. Few other sports allow thousands of amateur athletes to compete alongside the cream of the crop. Few other sports allow spectators to witness such incredible variance in performance over such a long period of time. We watch professional athletes on TV perform amazing feats, as they drop to the ground, heaving and sweating, but we never think they’re in any real danger. They are, after all, professionals. But that moment of security last a few minutes in a marathon as the elites and top 1% zip by. After that, it’s the throng of every-people, who run for fun or a sense of accomplishment.

The farther down the course you traverse, the more ragged everyone looks. The enthusiastic smiles of the first 10k become contorted in rictus grimaces, ebullient cheers are now hissed through gnashed teeth. As you watch people struggle to stay strong over such an unforgiving distance, it’s only natural to wonder whether the sport is good for them. And every so often, it seems like that question is given a dark answer.

First, the good news is that the numbers are on our side. If marathon running were truly bad for us, then we’d be seeing a lot more deaths. A recent Forbes article pins the likelihood of death from a marathon at 0.5 to 2 deaths for every 100,000 participants. While that is absolutely no comfort to the friends and family of the rare death, it does put the activity in perspective. For example, you are more likely to die while swimming, biking, playing football or even playing tennis and far more likely if you drive a car. Even with the boom that the sport is experiencing, deaths are very rare. A study published in the American Journal of Sports Medicine showed that despite the increase in participants from 2000 to 2009, the low incidence remains the same.

But the fact that they still happen sends a shiver down our spines, regardless of our PR ambitions. This year alone there have been deaths at the New York City Half Marathon, the London Marathon, the Shamrock Marathon in Virginia Beach and the Rock ‘n Roll Raleigh Half Marathon.  The fact that three of those examples were half marathons shows that the phenomenon is not limited to runners journeying 26.2 miles.

So why is it that some runners never cross the finish line? Dr. Peter McCullough from Dallas’ Baylor University Medical Center says that whenever a young, relatively fit person collapses mid-race, it’s most likely due to hypertrophic obstructive cardiomyopathy (HCM). This is a condition where the heart muscle or myocardium is thickened and thus restricts blood flow. The biggest issue with this condition is that it is asymptomatic, or difficult to detect until you’re having a cardiac episode.

But there is a way to detect if you have any abnormalities in the heart, including HCM, and that’s by getting screened. This is done via electrocardiogram (ECG or EKG), a device that measures the electrical activity of the heart. I went through the procedure in early May and it was completely painless. In addition to the EKG, I also underwent an ultrasound and a stress test, where I walked on an inclined treadmill with several electrodes attached to my chest. Every two minutes or so, the speed and incline increased until I was sweating bullets. During the ultrasound, I could see my heart expanding and contracting and each individual valve flapping effortlessly.

Most of the screening was, to be completely honest, a fun ego stroke. The majority of the patients that walk into the doctor’s practice were there because they had a problem and not for some peace of mind. Since HCM is a largely unfelt heart condition, I wanted to make sure I wasn’t that one unfortunate runner among the masses. After all, the most common fatalities occur in men in their 30s, albeit those with pre-existing, undiagnosed heart abnormalities.

It would seem somewhat reasonable to suggest then, that you too should get screened. If you are a serial marathoner, an ultrarunner or someone who routinely logs over 30 miles a week in the sport, it wouldn’t be unwise to take a look at your heart, especially if you experience any sort of chest pain or pressure during a run or if you have a family history of HCM.  Some might even say that routine checkups should be compulsory.  However, the American Heart Association has oddly not recommended mass screening. Their reasons have to do with resource allocation and logistics – there are simply many more health issues to tackle that take more lives and there are far too many active, athletic people in the United States to warrant that many EKGs (it’s also suggested that it would cut into cardiologists’ profit margins if widespread EKGs achieved economies of scale).

“The cardiac community is divided on this,” says Dr. McCullough. “But I fall in the camp where I think that everyone involved in serious athletics should have a echocardiogram, just like every woman who gets pregnant has two or three ultrasounds.”  Source

I agree completely. If you have the incentive (you are a serial marathoner or an ultrarunner) and the opportunity (you have decent health insurance), then by all means, get screened and run calm.

About Dan
Running a marathon in all 50 states because there's no better way to explore the world around you than on your own two feet, for as long as you can, until you hate yourself and everything around you. Then you stop, get a medal, and start over.

6 Responses to Marathoners, Get an EKG

  1. I totally agree although I have not had an EKG to diagnose (or rather un-diagnose) this condition, only to rule out a different irregularity. The one I had was normal though.
    I’ve read and listened to news stories with great interest about this, as my soon-to-be 12-year-old has expressed interest in running a half marathon next year. One news report stated that it could show an irregularity that could sideline a student athlete for no reason, such as an irregularity that wouldn’t cause arrest during stress. So basically, they said EKG’s weren’t necessary. I took offense to that as a reasonable parent. If an EKG would save ONE SINGLE person, child or adult (especially MINE), from arrest during any event at any time, isn’t it worth it? I guess it does to me.
    So my plan is to have a preventative EKG done for my son this fall when he has his normal checkup. If I have to pay for it, fine, I don’t care, because I would at least have the peace of mind that I did my due diligence.
    Thanks for writing about this 🙂

  2. Amanda Nyx says:

    Seriously – get it done if you can. Even if you’re only doing “short” distances, something like this can rear its ugly head to ANYone. It’s so important to know what is happening inside your body BEFORE you test its limits! Getting screened is a decision you will NEVER regret.

  3. My doctor always looks at me like “why are you in my office?” The fact that I run seems to exclude the possibility of so many issues. I’m not sure I could talk him into sending me for an EKG.

  4. Mike says:

    Two sobering words: Ryan Shay.

    My first question whenever it’s recommended I get tested for something is “What is the rate of false positives?” I can’t remember the exact percentage, but I do recall this number being low for EKGs. And as you mentioned, follow-up work including an ultrasound can be done to confirm or refute EKG results. Luckily an EKG is one of the less expensive tests a doctor can order. Plus they’re wonderfully non-invasive, as opposed to other tests (I’m lookin’ at you, colonoscopy) that nobody wants to get for a darn good reason.

    Bottom line, there’s very little downside to getting an EKG, and its relative affordability makes it one of the few tests that’s worth asking about during your next physical. I’ve yet to meet a doctor who will stand his ground and say “no” to an earnest and well-informed patient.

    Even if a runner chooses not to get an EKG and stress test, I would say it’s important that they listen to and know their own body like (and including) the back of their hand, and understand whether they have any family history of heart disease and/or abnormalities.

    Coincidental timing, Dan… I just listened to a recent and complementary Runner’s Academy podcast on “How safe is marathon running for your heart?” You can check it out here:

    Onwards to the cardiologist!

  5. dwill says:

    I never realized such tests (basic EKG’s at least) were affordable. Makes me think of maybe doing it especially since I’m not a professional athlete by any means.

  6. Joy says:

    I am actually getting one done today, but not for the reasons you listed. It seems my heart murmur is making noise again, and I have never had it checked as an adult. Heart health and endurance sports is crucial. This is sound advice for any of us. Thank you!

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