Love of squash may break your heart

Press, 15 January 1986, Page 26

Love of squash may break your heart

DOCTOR’S ADVICE

(From the Royal N.Z. College of General Practitioners)

Squash causes a severe and prolonged work load on the heart muscle throughout play, and may be the cause of abnormal heart rhythms and lead to death.

So say investigators from the Royal Infirmary, in Glasgow. They took electrocardiograms in 21 healthy men aged 21 to 43 while they played squash. The men were regular players, participating at least twice a week. None had any previous heart disease.

They wanned up for 10 minutes, and played for 40 minutes. Maximum heart rates rose on average to 90 per cent of the predicted maximum — in one man, as high as 197 a minute. The authors suggest that since men over the age of 40 are at higher risk of coronary heart disease than younger men, they should consider changing to a less dangerous sport. The point that the Glasgow researchers wanted to make is that sometimes heart disease is unknown until it has caused sudden death. That was the first sentence of a recent paper in the “Medical Journal of Australia,” written by Lawrence K. Altman, after the death of James Fixx. Fixx was the man who wrote “The Complete Book of Running,” the best-seller many think was responsible for the running and jogging craze that swept the Western world. He had been an overweight, 40-cigarettes-a--day slob, but he became a thin, non-smoking runner. The cruel irony is that he died jogging at a youthful 52.

It was a heart attack that killed him, and there had been no warning. He had run up to 16km a day, and had played a tough game of tennis the day before he died. Ominous news was that his father had died at the age of 43, of a heart attack, having had his first at the age of 35. People said he should have gone regularly to his doctor for a check-up.

Coronary artery disease (the hardening of the arteries that leads to heart attacks) may be very far advanced before it is detectable by medical tests. In the person who does not complain of chest pain, no physical sign that can be found at routine examination of the chest and heart can lead the doctor to suspect coronary heart disease. The heart appears to be perfectly normal. That is not to say that the 40-year-old would-be runner should not have a check first — he or she should. There are several diseases of the heart and other organs that can quite easily be detected, and for which treatment (or modification of the exercise programme) may be desirable. This is not the case with symptomless coronary heart disease. The electro-cardi-ogram is usually normal. The chest X-ray shows no enlargement of the heart Two tests may help. The first is the treadmill, or exercise stress test.

The patient works on the treadmill for a specific amount of work.

Electro - cardiograph leads, attached to points on the chest and limbs during the exercise, show the increase in heart rate, but more important, show changes in the shape of the graph if the heart is strained by lack of oxygen, lack of blood in the coronary arteries, hardening of the arteries.

If that seems simple enough, why doesn’t everyone have a stress test?

It is not that simple. Cardiologists are far from agreement on the value of the test.

Many people who prove to have normal coronary arteries show changes on the stress test that suggest otherwise. Conversely some with abnormalities have normal tests.

It takes time and specialised equipment to ascertain the conditions.

The coronary angiogram is more accurate. Here dye is injected into the coronary arteries and X-rays are taken to show blockages and narrowing of the vessels. Doctors are not keen on these sorts of “invasive” tests, where needles are placed into the very vital organs, with the risks of mishap that that entails. This is all very well for the person who has severe chest pain on exertion, but hardly practicable for syptomless middle-aged men.

Tests with radiocactive elements such as thallium are even more expensive. There is much to be learnt about coronary heart disease; and we have a lot to learn about the value or danger of running. Some will say James Fixx died early because of running. Others will say that he lived longer than he should have because of it.