Triathlete Laurent Vidal's recent heart attack has brought cardiac assessments to the fore. Photo / Getty Images
The heart attack suffered by triathlete Laurent Vidal, the '49 per cent Kiwi, 51 per cent French' fiance of Andrea Hewitt, has brought cardiac assessments to the fore for New Zealand's Commonwealth Games representatives.
The New Zealand Olympic Committee instructs athletes to undergo medical tests as part of the vetting procedure.
The heart-related part of the tests have taken on added importance as Vidal joined a host of past athletes, including New Zealand Olympic champions such as Sir Peter Snell, Rob Waddell, Nathan Cohen and Hamish Carter, who needed heart medication to perform physical activity.
Glasgow-bound athletes will undergo electrocardiograms (ECGs), which check the likelihood of heart attacks and other potential cardiac anomalies. The rhythm is recorded on to paper to establish if the muscle is damaged or short of oxygen.
Dr Bruce Hamilton, the medical lead for NZOC and High Performance Sport New Zealand, says heart issues are a priority for Glasgow. The topic is under discussion among the NZOC medical team at a meeting this weekend where doctors, physio and massage therapists are undergoing first aid refresher courses.
"There's no evidence to suggest such heart incidents are more frequent but they're very much in the public eye over the last 10 years. We want to understand the risk factor by melding athletes' family history with the examination findings.
"As part of our screening process we recommend an ECG which we perform on-site at our national training centre in Auckland or at the new sports hub in Cambridge."
Hamilton says cardiac risk factors vary between sports such as lawn bowls and middle-distance running where there is a gulf in physical exertion.
"It also depends how old you are as to what risk you face. If you're aged over 45, heart problems have probably moved from being a congenital issue [one you're born with] to the likes of coronary artery diseases.
As a further precaution, a defibrillator will be taken to Glasgow for emergency use in the New Zealand village.
"In the first instance the tests are trying to identify those at risk but the AED [automated external defibrillator] is a security blanket."
Dr Rob Doughty is a cardiologist at Auckland Hospital where he is leader of the heart failure service. He is also the Heart Foundation chair in heart health at the University of Auckland. He conducts athlete heart assessments with sports organisations across a range of disciplines, usually in conjunction with the doctor employed by each sport.
"The risks [of heart problems] are potentially greater in high intensity sports. In lower intensity sports, even if athletes have a congenital problem, they're probably at no higher risk than the general population.
Participating at high intensity turns it into a problem. Most recreational athletes wouldn't push themselves to the same degree.
"The death of premier athletes is tragic but fortunately rare," Doughty says. "But it does highlight the importance of the assessments. We conduct tests with the aim of detecting congenital heart abnormalities as well as those developed during a sporting career; nature versus nurture, if you like. We help sports bodies interpret the tests. It's about taking a responsible attitude by being aware."
The issue has resurfaced courtesy of Vidal, but even last May, fellow triathlete Carter spoke to the New Zealand Herald about how his heart was affected.
"It's overuse, probably bordering on abuse," Carter said of his past regime. "Since I was 13, to when I retired at 34, I have done way too much real intense exercise, day after day after day. I'm not sure it's the healthiest thing to do. I'm pleased to have got out of [elite] sport and still be able to run."
Carter's assessment is reinforced by studies suggesting endurance sport might be linked to heart arrhythmias.
"Running too fast, too far and for too many years may speed one's progress towards the finish line of life," proposed a December 2012 editorial in British journal, Heart. The journal queried whether pumping blood through the heart for hours on end can result in long-term damage and reverse the health and life expectancy advantages of moderate aerobic exercise.
The Herald suggested such evidence could result in the over-stretching of heart chambers, the thickening of the heart walls and changes to electrical signalling, which can trigger rhythm problems. Studies have found scarring in the right ventricle of 13 per cent of endurance athletes and estimated veteran athletes might be five times more at risk of atrial fibrillation.
Marc-Vivien Foe (Football)
Fell to the ground during the Cameroon-Colombia semifinal at the 2003 Confederations Cup. Was pronounced dead 45 minutes later. Unbeknown to the 28-year-old, he was born with hypertrophic cardiomyopathy, a condition which thickens the heart muscles. The collapse represented the first symptoms. His death resulted in an improvement in ground resources at future international tournaments with defibrillators and trained staff on hand to assist in emergency.
Rob Waddell (Rowing)
Slumped over his oars after losing the deciding 2008 Olympic single sculls trial race against Mahe Drysdale. The fact the Sydney Olympic gold medallist endured the full 2000m is remarkable given his atrial fibrillation. His 33-year-old heart stumbled out of rhythm after about 300m. At the time Waddell said "it's like rowing in mud". He first suffered symptoms in a coxless four at the 1995 world championships, a reason why he reverted to the single sculls.
Alexander Dale Oen (Rowing Swimming)
Died during an April 2012 pre-Olympic Norwegian altitude camp in Flagstaff, Arizona from a previously undetected genetic heart condition. The 26-year-old went for a shower and was found 20 minutes later by roommates, slumped unconscious over the bath. Norway's first swimming Olympic medallist and the incumbent 100m breaststroke world champion, was not known to drink or take drugs.
Hoani MacDonald (Rugby)
The Southland player was treated for cardiac arrest after collapsing during his ITM Cup semi-final against Counties-Manukau in October 2012. Paramedics used a defibrillator after CPR and a shot of adrenaline failed to revive the 34-year-old's pulse. He was fitted with a device which, if his heart beats erratically, sends successive shocks that get larger until the heart resets itself. He retired as a result.
Hayden Roulston (Cycling)
In 2006, his career looked over, courtesy of a heart scare. The name of the condition was frightening enough - arrhythmogenic right ventricular dysplasia - which caused genetic defects to the muscle. Roulston was left short of breath with a rapid pulse. He attributed his recovery to the Japanese hands-on healing process of reiki, based on the idea an unseen life force energy flows through people. He was back on his bike in months.
Fabrice Muamba (Football)
Suffered a cardiac arrest, where his heart stopped for 78 minutes during an FA Cup match between Bolton and Tottenham Hotspur in March 2012. The then 23-year-old hit the pitch unconscious, having suffered ventricular fibrillation, a rapid and disorganised rhythm of heart beats. He retired five months later after receiving expert advice on his career prospects. He is now studying sports journalism.
Nathan Cohen (Rowing)
During the quadruple sculls heats at the 2013 world championships, the then 27-year-old's heart went out of rhythm, triggering a condition known as supraventricular tachycardia or SVT. "It feels like your oxygen is running out, you lose power and become weaker, like you're dragging something behind the boat," Cohen said. Until that point he managed the situation by restricting triggers like caffeine, and ensuring he got plenty of sleep. He retired in December.
Laurent Vidal (Triathlon)
Emerged from an induced coma last week after suffering a heart attack during training. The fiance of Andrea Hewitt, who describes himself as "49 per cent Kiwi, 51 per cent French", collapsed during a pool session. The 30-year-old sought help after suffering chest pains but collapsed and had to be revived. A tweet reading: "Hello world" saw him re-establish contact with society.
Jakob Ingebrigtsen referred to his father as 'the accused' throughout the trial.