We may earn commission from links on this page, but we only recommend products we back editor's letter. It struck a chord with many readers. Several of you asked for additional information, specifically, how to gauge your own risk.

Sudden cardiac arrests seem to come “out of the blue” in runners and other athletes—people who seem fit and immune from heart problems. However, when you look closely, there are often storm clouds on the horizon that were not recognized as potential heralds of cardiac risk.

There are two categories of heart problems that lead to sudden cardiac arrest in runners: congenital and acquired. Coronary artery atherosclerosis is acquired and most common in runners over 40 years old. Congenital heart disease, which generally affects runners younger than age 40, includes anomalous coronary arteries, long QT syndrome, and other problems that are inherited or errors during embryologic development. Hypertrophic cardiomyopathy can be either a genetically passed disease or acquired during infections that affect the heart.

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First, know that the general risk is low. There are nearly a half-million marathon finishers in the United States each year, and worldwide the number of marathon finishers is approaching 2 million. The risk of cardiac arrest during a marathon race is in the range of one to two per 100,000 runners. And about half of those who do have a mid-race episode are saved by the rapid response of the race medical teams. Most of the cardiac arrests are in older men who have underlying coronary atherosclerotic artery disease.

There are two basic things you can do to understand your personal risk. The first is to understand and know your family history for cardiac issues. The second is to understand your personal risk—and own up to it. Cardiac risk screening in the United States is based on the following questions. Think of them as the storm clouds overhead or on the horizon.

HEART HEALTH QUESTIONS ABOUT YOU

  • Best Running Shoes 2025 during exercise?
  • Best Running Shoes 2025 after exercise?
  • Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise?
  • Does your heart race or skip beats (irregular beats) during exercise?
  • Do you have a personal history of any heart disease, high blood pressure, heart murmur, high cholesterol, a heart infection, rheumatic fever, or Kawasaki’s Disease?
  • Do you get lightheaded or feel short of breath (more than expected) during exercise?
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  • Do you get more tired or short of breath more quickly than your friends during exercise?

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  • Has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 50 (including unexplained drowning, unexplained car accident, or sudden infant death syndrome)?
  • Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia?
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  • How Body Image Can Affect Your Run?

Advertisement - Continue Reading Below any of these questions is yes and you have not been medically evaluated, you should meet with your personal physician to discuss the possible need for additional assessment. That may include a detailed history of you and your family, or an ECG, an echocardiogram, or other studies to assess your heart. It is important to remember that every test has false positives and false negatives, so jumping to get ECG or echocardiogram screening without some indication can leave you with a false answer.

The first person to respond to a collapsed runner is often another runner. It would be great if all of us learned CPR so we can respond if this happens to a runner on our path or in a race course. Not every runner collapses in front of a trained EMT, nurse, or physician. Most runners who survive cardiac arrest get immediate CPR from other runners or bystanders. If you'd like to be certified in CPR, find a class near you via the David Willey addressed the important topic of heart health among runners in his recent or the American Red Cross.

The other factor that really matters is the time to cardioversion, so access to defibrillators is key. If you are looking for a cause to support, seek out the groups working to place AEDs in sport venues and in public places like popular running routes.

Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise.

Cheers,

Bill