The perils of a triathlon

MANILA, Philippines - The hardest part in a triathlon may be the running event, which comes last, after the athlete has almost depleted all his energies swimming and cycling — but the most dangerous part is the first event, the swim, if you look at triathlon deaths in the past three years with all of them occurring in open waters. 

Miguel Vasquez, who died during the first Cobra Ironman Philippines in CamSur, was a “strong swimmer” by friends and acquaintances’ accounts, working out regularly with a personal trainer at the Manila Polo Club, but he suffered a stroke in the waters of Lago del Ray at CWC last Sunday, Aug. 23. 

As part of Team Alamat, Vasquez was doing the swim leg; Johann Espiritu, the cycling and Patrick Garcia, the running. “Miguel was a great guy, he was a good friend and a good man,” says Johann. “I am deeply affected by his death, I’ve lost a very good friend.”

The death in CamSur and other recent fatalities in athletic events — such as 28-year-old elite runner Ryan Shay at the Olympic Trials in New York, and 32-year-old Esteban Neira in the swim event of the New York Triathlon, both in 2008 — raise nagging questions that have been hounding athletes and doctors around the world: Why, despite all the endurance training and preparation of otherwise healthy athletes, do sudden deaths occur on race day? In Shay’s case, an irregular heartbeat due to an enlarged heart was found to be the cause; in Neira’s the autopsy failed to determine the cause of death.  

While marathon deaths occur throughout the 42-kilometer racecourse, most triathlon deaths occur in the beginning — the swim event.

In one US state alone, Wisconsin, three triathletes died swimming at three separate triathlons from January to August this year (last year, 10 people died in US triathlons). Statistically, reports peg 1.5 deaths per 100,000 triathlon participants while the fatality rate for marathons is 2 for every 100,000 runners. 

What causes the sudden deaths of seemingly healthy individuals? Can adrenaline kill you? 

During the athletes’ briefing at the Convention Hall of CWC the day before the race, Ironman local race director Jon Eric Imperio reminded participants to watch their heart rates during the first event when athletes experience both heightened excitement and anxiety about finishing the race.

A New York Times report by Christie Aschwanden on triathlon deaths points to abnormal heart rhythms as the main cause of death for most of the fatalities.

“‘Evidence suggests that swimming may trigger a certain type of cardiac arrhythmia caused by a genetic condition called long QT syndrome,’ said Dr. Michael Ackerman, a cardiologist and the director of the Windland Smith Rice Sudden Death Genomics Laboratory at the Mayo Clinic in Rochester, Minn.

 “Dr. Ackerman’s research team has identified several genetic forms of long QT syndrome, and one of those seems especially bothered by swimming, he said. He’s still not sure why, but sees one clue in a Japanese study several years ago that found that irregular heartbeats occur more commonly during swimming than during the same level of aerobic activity on land.

“‘It’s not that swimming is horrendously dangerous and running is not,” Dr. Ackerman said. “It’s really a perfect storm that needs to happen. It requires a second hit, something to irritate it, and we know that swimming is one of those triggers, but it’s not going to be the absolute trigger.”

Dr. Ackerman adds, “Any medical problem in the water is more likely to turn fatal than one that arises during a bike ride or a run…If you faint while running a race and your heart snaps back into sync 10 or 30 seconds later, you wake up. If it happens in the water, even if your heart regains rhythm 30 seconds later, now you’re underwater.”

The swim event in a triathlon, as triathlete Russ Evenhuis, points out in the same article, “can be like jumping into a washing machine. You will get swum over, kicked, hit and banged into.”

Should athletes then hang up their goggles, their running shoes, and park their bikes? Throw away their training logs and say goodbye to endurance training? It’s the same question that faces us every time we hear about a plane crash: Should we drive or take a boat instead?

The answer, of course, is no. For thousands of people who are participating in these sports, the health benefits outweigh the risks — even harder to quantify is the psychological profit they reap from their hours of hard training.