Download PDF
Int J Sports Med 2000; 21(8): 613-615
DOI: 10.1055/s-2000-8481
Orthopedics and Clinical Science
Georg Thieme Verlag Stuttgart · New York

Prior Myocardial Infarction is the Major Risk Factor Associated with Sudden Cardiac Death During Downhill Skiing

M. Burtscher1 , O. Pachinger2 , M. A. Mittleman3 , H. Ulmer4
  • 1 Department of Sport Science, Medical Section, University of Innsbruck, Austria
  • 2 School of Medicine, Department of Cardiology, University of Innsbruck, Austria
  • 3 Institute for Prevention of Cardiovascular Disease, Beth Israel Deaconess Medical Centre, Boston, MA, USA
  • 4 Institute for Biostatistics, University of Innsbruck, Austria
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Also available at
    Permissions and Reprints

More than 90 % of all sudden cardiac deaths (SCDs) during downhill skiing, the most popular winter sport world-wide, are attributed to men over the age of 34. However, no data exist on additional risk factors and triggers for SCD related to downhill skiing. Therefore risk factor profiles of 68 males who died from SCD during downhill skiing were compared to those of 204 matched controls. Skiers who suffered SCD had much more frequently prior myocardial infarction (MI) (41 % vs. 1.5 %; p < 0.001), hypertension (50 % vs. 17 %; p < 0.001), known coronary heart disease (CHD) without prior MI (9 % vs. 3 %; p = 0.05) and were less engaged in strenuous exercise (4 % vs. 15 %; p < 0.05) when compared to controls. Multivariate analyses even enhanced the importance of these risk factors.

Downhill skiing is considered to be a serious trigger for SCD especially in skiers with prior MI but also for those with hypertension, known CHD without prior MI, or insufficient adaptation to strenuous exercise. Skiing-related increased sympathetic activity might well disturb the autonomic balance with subsequent arrhythmias and/or may increase cardiac work and platelet aggregability with possible plaque rupture and coronary thrombosis. Therefore adaptation to high intensity exercise and therapeutic interventions or abstinence from skiing in certain cases should be considered for downhill skiers at high risk.

Key words:

Sudden cardiac death, downhill skiing, risk factors, prior myocardial infarction, hypertension, physical activity.

References

  • 01 Barnard R J, MacAlpin R, Kattus A A, Buckberg G D. Ischemic response to sudden strenuous exercise in healthy men.  Circulation. 1973;  48 936-942
    Google Scholar
  • 02 Burtscher M, Philadelphy M, Mittleman M, Nachbauer W, Likar R. Risk of sudden cardiac death during downhill skiing and mountain hiking. In: Johnson RJ, Mote CD, Ekeland A, (eds) Skiing trauma and safety, 11th Volume, ASTM STP 1289. Baltimore; American Society for Testing and Materials 1997: 30-36
    Google Scholar
  • 03 Burtscher M, Nachbauer W, Jenny E. Death risk in downhill skiing and preventive measures. In: Jenny E, Flora G, Berghold F Jahrbuch 97. Österreichische Gesellschaft für Alpin- und Höhenmedizin 1997: 155-172
    Google Scholar
  • 04 Burtscher M, Philadelpy M, Likar R. Sudden cardiac death during mountain hiking and downhill skiing.  NEJM. 1993;  329 1738-1739
    Google Scholar
  • 05 Cupples L A, Gagnon D R, Kannel W B. Long- and short-term risk of sudden coronary death.  Circulation. 1992;  85 (Suppl 1) I. 11-I. 18
    Google Scholar
  • 06 Feng D, McKenna C, Murillo J, Mittleman M A, Gebara O C, Lipinska I, Muller J E, Tofler G H. Effect of aspirin dosage and enteric coating on platelet reactivity.  Am J Cardiol. 1997;  80 189-193
    Google Scholar
  • 07 Fletcher G F, Balady G, Froelicher V F, Hartley L H, Haskell W L, Pollock M L. Exercise standards.  Circulation. 1995;  91 580-615
    Google Scholar
  • 08 Goldstein S. Beta blockers in hypertensive and coronary heart disease.  Arch Intern Med. 1996;  156 1267-1276
    Google Scholar
  • 09 Hurwitz J L, Josephson M E. Sudden cardiac death in patients with chronic coronary heart disease.  Circulation. 1992;  85 (Suppl 1) I. 43-I. 49
    Google Scholar
  • 10 Morris J N, Chave S PW, Adam C, Sirey C, Epstein L, Sheehan D J. Vigorous exercise in leisure-time and the incidence of coronary heart-disease.  The Lancet. 1973;  1 333-339
    PubMedGoogle Scholar
  • 11 Pickering T G. Exercise and hypertension.  Cardiol Clin. 1987;  5 311-318
    PubMedGoogle Scholar
  • 12 Sarter B H, Finkle J K, Gerszten R E, Buxton A E. What is the risk of sudden cardiac death in patients with hemodynamically stable sustained ventricular tachycardia after myocardial infarction?.  J Am Coll Cardiol. 1996;  28 122-129
    CrossrefPubMedGoogle Scholar
  • 13 Schwartz P J, La-Rovere M T, Vanoli E. Autonomic nervous system and sudden cardiac death.  Circulation. 1992;  85 (Suppl 1) I. 77-I. 91
    PubMedGoogle Scholar
  • 14 Siscovick D S, Weiss N S, Fletcher R H, Lasky T. The incidence of primary cardiac arrest during vigorous exercise.  NEJM. 1984;  311 874-877
    CrossrefPubMedGoogle Scholar
  • 15 Sleight P. Importance of cardiovascular reflexes in disease.  Am J Med. 1988;  84 92-96
    PubMedGoogle Scholar

Prof. Dr. Martin Burtscher

Department of Sport Science University of Innsbruck

Fürstenweg 185 6020 Innsbruck Austria

Phone: Phone:+ 43 (512) 5074478

Fax: Fax:+ 43 (512) 5072838

Email: E-mail:Martin.Burtscher@uibk.ac.at

      >