Intense Weight Lifting Linked To Heart Condition
May Be Caused By Tear In Heart's Major Artery
High-intensity strength training may lead to a potentially deadly
condition called aortic dissection, in which the heart's major artery
tears, according to a report in the Journal of the
American Medical Association.
"Dissection happens in a split second," says Dr. John
Elefteriades, chief of cardiothoracic surgery at Yale University and
Yale-New Haven Hospital, and the lead author of the report.
In those who lift
weights and already have an enlarged aorta, the elevated blood pressure
that occurs during weight training may lead to the dissection, Dr. Elefteriades
says.
Aortic dissection strikes about two of every 10,000
people, according to the National Institutes of Health (NIH).
While it can affect anyone, it's most often seen in men ages 40 to 70,
the NIH states.
The condition of aortic dissection is "uncommon but
not rare," says Dr. Elefteriades, adding that it is what caused the
death of actor John Ritter earlier this year and has been declared the
cause of death of many athletes who died suddenly.
Researchers
Review Underlying Causes
Using a Yale database, Dr. Elefteriades and his colleagues
identified five people who suffered acute dissection of the aorta during
high-intensity weight training or other strenuous exercise.
At the moment the dissection occurred, two of the people
were weight training, one was trying to move a heavy granite structure,
and two were doing pushups, the researchers say.
All were found to have an enlarged aorta, but not at
a level expected to present a high risk of dissection, Dr. Elefteriades
says.
Three patients who had surgical repair survived; the
other two died before surgery could be attempted.
"We're not saying stop weight training," says Dr. Elefteriades,
a long-time weight trainer himself. "It's a wonderful activity and a
very important activity." It can help maintain muscle mass as you age,
for instance, and help maintain strength for everyday chores such as
carrying groceries.
Expert
Advises Caution in Select Group
But Dr. Elefteriades does recommend caution in certain
people, including those with known aortic aneurysms - a widening or
ballooning of the vessel caused by disease or a weakening of the vessel
wall.
Also, those with a family history of aneurysm or dissection,
underlying high blood pressure, and those at or beyond middle age should
be cautious, he says, because the aorta stiffens with age.
Those with connective tissue disease, such as rheumatoid
arthritis, are also at higher risk, Dr. Elefteriades.
"I think there has to be this underlying enlargement
[of the aorta] before the dissection happens," Dr. Elefteriades says.
"But we wanted to sound this warning bell that strength
training and weight lifting can cause these dissections in people who
already have a mild enlargement of the aorta," he adds.
The problem, Dr. Elefteriades says, is that many people
with an enlargement do not know they have it. An echocardiogram - an
ultrasound evaluation of the heart - can determine whether the aorta
is enlarged, he says.
When dissection of the aorta occurs, "the aorta splits
into two layers," Dr. Elefteriades says. "It splits in such a way that
it becomes a double-barreled tube instead of a single-barreled one."
You can quickly lose blood internally and die.
Until more research is done, what should weight lifters
who may be at risk do? Avoid weight training so strenuous that your
blood pressure rises excessively, Dr. Elefteriades says.
"We do know that levels of blood pressure that are high
are dangerous," he says. Serious weight trainers, who often bench press
300 or 400 pounds, may get blood pressures that are dangerously elevated,
even up to 370 millimeters of mercury systolic, he says. Normal systolic
pressure, measured as the heart beats, is below 120; normal diastolic
pressure, measured as the heart rests between beats, is below 80, Dr.
Elefteriades says.
While it is difficult to pinpoint how much weight
is too much, Dr. Elefteriades suggests that for upper body weight training,
"above half your body weight you are starting to get into the high pressure
zone. For the lower body, the legs are stronger, so you could probably
lift more than half your body weight [safely]."
Serious weight trainers should consider having an echocardiogram,
he says.
The other take-home advice from the report is very obvious
for weight lifters or would-be weight lifters, says Dr. Craig Miller,
a surgeon at Stanford University Medical School.
"If they have dilation or aneurysm of the thoracic aorta
or a connective tissue disorder or a family history of premature aortic
catastrophic complications, do not weight lift," Dr. Miller says.
Always consult your physician for more information.
Online
Resources
American
College of Sports Medicine
American
Heart Association
Healthfinder,
US Department of Health and Human Services (HHS)
National
Academy of Sports Medicine
National
Institute on Aging Exercise Guide
National
Institutes of Health (NIH)
|
January
2004
In
This Issue:
Intense
Weight Lifting Linked To Heart Condition
Researchers
Review Underlying Causes
Expert
Advises Caution in Select Group
What
Is Aortic Dissection?
Online
Resources
Other
Resources:
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What
Is Aortic Dissection?
According to the
National Institutes of Health (NIH), aortic dissection
involves bleeding into and along the wall of the aorta (the major artery
from the heart), most often because of a tear or damage to the inner
wall of the artery.
This usually occurs
in the thoracic (chest) portion of the aorta, but may also occur in
the abdominal portion.
The exact cause
is unknown, states the NIH, but risks include atherosclerosis
(hardening of the arteries) and hypertension (high blood pressure).
Traumatic injury
is a major cause of aortic dissection, especially blunt trauma to the
chest as can be caused by hitting the steering wheel of a car during
an accident.
Aortic dissection
may also be associated with other injury, infection, congenital (present
from birth) weakness of the aorta, and collagen disorders (such as Marfan's
syndrome, pseudoxanthoma elasticum, Ehlers-Danlos syndrome, relapsing
polychondritis, or abdominal aortic aneurysm).
The NIH
lists the following as symptoms of aortic dissection include the following:
-
chest pain
-
sudden, severe,
sharp, or stabbing pain located below the sternum, then radiates
under the shoulder blades or to the back; may radiate to shoulder,
neck, arm, jaw, abdomen, or hips; location may change - pain typically
moves distally (to arms and legs) as the aortic dissection progresses
in the same direction
-
changes in
thought ability, concentration (confusion, disorientation)
-
decreased
movement, any location
-
decreased
sensation, any location
-
intense anxiety,
anguish
-
pallor
-
rapid pulse
(heart rate)
-
profuse sweating
-
dry skin/mouth,
thirst
nausea, vomiting
dizziness, fainting
-
shortness
of breath (dyspnea); difficulty breathing when lying flat (orthopnea)
Always consult your
physician for more information. |
