Why Fit People Suffer Heart Attacks During Workouts
Heart attacks and sudden cardiac arrest (SCA) during exercise are rare but devastating events that often leave people shocked, especially when they strike seemingly healthy, fit individuals. High-profile cases, like athletes collapsing mid-game or runners suffering cardiac events during marathons, have raised questions about why even sporty people are not immune. Cardiologists are shedding light on the real reasons behind these incidents, dispelling myths and emphasizing the importance of understanding hidden risks. This blog explores the science, contributing factors, and preventive measures behind heart attacks and SCA in active individuals.
Understanding Heart Attacks and Sudden Cardiac Arrest
A heart attack (myocardial infarction) occurs when blood flow to a part of the heart is blocked, often due to a clot in a coronary artery, leading to heart muscle damage. Sudden cardiac arrest, on the other hand, is an electrical malfunction where the heart stops beating effectively, causing a person to collapse and, without immediate intervention, often leading to death. While the two are distinct, they can be related, as a heart attack may trigger SCA.
What surprises many is that fitness doesn’t always protect against these events. According to cardiologist Dr. Sanjay Gupta, a leading expert in cardiovascular health, “Being fit reduces your risk of heart disease, but it doesn’t make you invincible.” Even athletes with no obvious symptoms can harbor underlying conditions that surface during intense physical activity.
Hidden Culprits: Why Fit People Are at Risk
1. Undiagnosed Heart Conditions
Many fit individuals are unaware of congenital or inherited heart conditions that can predispose them to cardiac events. Conditions like hypertrophic cardiomyopathy (HCM), where the heart muscle thickens abnormally, are a leading cause of SCA in young athletes. Other issues, such as arrhythmogenic right ventricular cardiomyopathy (ARVC) or coronary artery anomalies, can remain silent until triggered by intense exercise. Dr. Gupta notes, “These conditions often show no symptoms until a catastrophic event occurs, especially under the stress of vigorous activity.”
2. Overexertion and Extreme Exercise
While regular exercise is heart-healthy, pushing the body to extremes—such as ultramarathons or high-intensity interval training (HIIT) without proper conditioning—can strain the heart. Intense workouts increase heart rate and blood pressure, raising oxygen demand. In rare cases, this can trigger a heart attack in someone with undiagnosed coronary artery disease (CAD), where arteries are narrowed by plaque. Dr. Aashish Contractor, a sports cardiologist, explains, “Extreme exercise can act like a stress test, revealing vulnerabilities in the heart that go unnoticed during rest.”
3. Plaque Rupture in Older Athletes
For older fit individuals, particularly those over 40, the risk of heart attack during exercise often stems from atherosclerosis—the buildup of plaque in arteries. Even those who appear healthy can have unstable plaques that rupture under the stress of exercise, leading to a clot and subsequent heart attack. “Fitness doesn’t erase plaque buildup from years of poor diet, stress, or genetics,” says Dr. Gupta. “A sudden spike in activity can dislodge these plaques, causing a blockage.”
4. Electrolyte Imbalances and Dehydration
Intense workouts, especially in hot or humid conditions, can lead to dehydration and electrolyte imbalances, particularly low levels of potassium or magnesium. These imbalances can disrupt the heart’s electrical system, increasing the risk of arrhythmias that may lead to SCA. Marathon runners and endurance athletes are particularly vulnerable if they don’t properly hydrate or replenish electrolytes.
5. Misuse of Supplements and Performance Enhancers
Some athletes turn to supplements or, in rare cases, performance-enhancing drugs to boost their workouts. Substances like high-dose caffeine, ephedrine, or anabolic steroids can stress the cardiovascular system, raising blood pressure or causing irregular heart rhythms. Dr. Contractor warns, “Many over-the-counter supplements are not regulated, and their impact on the heart can be unpredictable.”
6. Ignoring Warning Signs
Fit individuals often push through discomfort, mistaking warning signs like chest pain, shortness of breath, or dizziness for normal exercise fatigue. “Athletes are conditioned to ignore pain, but this can be dangerous,” says Dr. Gupta. Subtle symptoms, such as unusual fatigue or palpitations, may indicate an underlying issue that requires medical attention.
Who’s at Risk?
While anyone can experience a cardiac event, certain groups face higher risks:
- Young athletes (under 35): Often affected by congenital conditions like HCM or electrical disorders like Long QT syndrome.
- Older athletes (over 40): More likely to have coronary artery disease or plaque buildup.
- Those with a family history: A history of sudden death or heart disease in close relatives increases risk.
- New or returning athletes: People starting intense exercise after a sedentary period or returning after a break are at higher risk due to unconditioned hearts.
Real-Life Cases
High-profile incidents highlight the unpredictability of cardiac events. In 2023, NFL player Damar Hamlin suffered SCA during a game, later attributed to a rare condition triggered by blunt chest trauma. Similarly, marathon runners like Jim Fixx, a pioneer of the running movement, died of a heart attack in 1984 due to undiagnosed coronary artery disease. These cases underscore that fitness, while beneficial, doesn’t eliminate all risks.
Prevention: What Can Be Done?
Cardiologists emphasize proactive measures to reduce the risk of heart attacks and SCA during exercise:
Get Screened: Regular heart screenings, especially for young athletes or those with a family history, can detect conditions like HCM or CAD. Tests like ECGs, echocardiograms, or stress tests are critical for high-risk individuals.
Know Your Limits: Gradually build exercise intensity and avoid sudden, extreme efforts. “Train smart, not just hard,” advises Dr. Contractor.
Monitor Symptoms: Pay attention to chest pain, dizziness, or irregular heartbeats, and seek medical advice immediately.
Stay Hydrated: Maintain proper hydration and electrolyte balance, especially during long or intense workouts.
Healthy Lifestyle: A balanced diet, stress management, and avoiding smoking or excessive alcohol can reduce plaque buildup and other risks.
Learn CPR and AED Use: Sudden cardiac arrest is survivable with prompt intervention. Access to automated external defibrillators (AEDs) at gyms and sports facilities can be lifesaving.
Busting Myths
Myth: Fit people can’t have heart attacks.
Fact: Fitness lowers risk but doesn’t eliminate it, especially if underlying conditions or lifestyle factors are present.Myth: Only older people need heart screenings.
Fact: Young athletes can have congenital conditions that require early detection.Myth: Exercise always protects your heart.
Fact: Extreme or poorly managed exercise can sometimes trigger cardiac events.
Conclusion
The notion that fit, sporty individuals are immune to heart attacks or sudden cardiac arrest is a dangerous misconception. As cardiologists like Dr. Gupta and Dr. Contractor explain, hidden conditions, overexertion, and lifestyle factors can put even the healthiest-looking people at risk. By understanding these risks, getting regular screenings, and listening to their bodies, active individuals can continue to enjoy the benefits of exercise while minimizing dangers. The key is balance—pushing your limits responsibly while staying vigilant about your heart health.
Sources: Interviews with Dr. Sanjay Gupta and Dr. Aashish Contractor, American Heart Association, Mayo Clinic, and recent studies on exercise-related cardiac events.
