Tomar, Sprinting and Sudden Cardiac Death

Background

The death of Police Constable Subash Tomar in New Delhi in the #DelhiGangRape demonstrations is now almost certainly being attributed to a Cardiac Arrest. Various news media are carrying reports of the cause of death being Cardiac in nature and not external injuries, as originally reported.

NDTV’s segment where a Journalism student #Yogendra narrates the eyewitness account is here

http://www.ndtv.com/video/player/news/fromndtv/259579

Another segment, uploaded on YouTube by one of the demonstrators shows the other Policemen attending to him rendering some elementary form of CPR on his chest..definitely not something that someone with external injuries will be administered.

DNA Newspaper carries this article

http://www.dnaindia.com/india/report_no-major-external-injury-on-cop-subhash-tomar-s-body-hospital_1781861

From the above reports the following emerge:

– Tomar was aged 47 and pictures show that he had high BMI

– It is not clear if he had an active lifestyle, but as most policemen go…overwork and long hours leave them little time for physical fitness. An occupational hazard.

– It is also not clear what sort of medical check-ups he underwent. Going again by facilities extended to Policemen, probably none. Especially since his family has stated that he never suffered from any previous cardiac incident.

http://www.hindustantimes.com/India-news/NewDelhi/Constable-had-no-heart-problem-family/Article1-981007.aspx

– It is reported that he collapsed when he was running behind the protestors. It is quite likely that he sprang to a sudden sprint in giving the chase.

Lessons for Runners

So what lessons do we as Runners have to draw from this episode? This gains more importance as we head into the Marathon season of the Winter of 2012/2013. And generally more so for 40+ aged  individuals who get motivated into sudden bouts of restoring their youth

1. Considerable research points out to the fact that the risk of Cardiac arrest is very high when sudden physical activity is undertaken by individuals who are otherwise risky and who are not in good physical fitness.

– A Study of sudden cardiac arrests in elderly men who stepped out to shovel snow in the US revealed that sudden physical exertion in cold weather resulted in a steep rise of risk factors.

http://abcnews.go.com/Health/HeartFailureNews/heart-attack-risk-shoveling-snow/story?id=9812385#.UNsV9m-86So

– One study of 10 sedentary men with no history of cardiac disease found that their heart rates while shoveling rose above the recommended upper limit for aerobic exercise.

http://www.slate.com/articles/news_and_politics/explainer/2010/02/death_by_driveway.html

In the present case the conditions were similar. Delhi reported a sharp dip in temperatures of around 12C to 16C on that day. A sudden sprint behind the protesters was definitely not good for your heart.

2. Numerous studies point out to the fact that Sudden Cardiac Death ( SCD ) is a reported occurrence even among professional athletes with good levels of fitness. Dr Aashish Contractor, Cardiologist and Medical Director, Standard Chartered Mumbai Marathon mentioned that “Sudden Cardiac Death occurs in older Males 35+ mostly while running or jogging at a higher probability for casual joggers than for regular marathon runners. The major risk factor in most cases is undetected Coronary Artery Disease.”

http://www.procamrunning.in/forum/Ask-The-Doctor

This report by Cleveland Clinic deals with the issue of Sudden Cardiac Death in complete detail

http://my.clevelandclinic.org/heart/disorders/electric/scd.aspx

3. Inadequate warm up, even in healthy individuals is known to send heart rates racing far above recommended Maximum Heart Rates. Experts in Exercise Physiology always recommend that every endurance exercise should be preceded by a session of adequate warm up to bring the Heart rates into the target zone. Daniel Vaz, ACE Certified Chief Trainer at Nike Run Club and a veteran Marathoner himself responded, ” At our training centers we emphasise the need to adequately warm up before stressing the heart further with strenuous exercise. In cold winter mornings, the blood vessels are constricted and narrow, a condition known as vasoconstriction, a normal body reaction for preserving warmth. Adequate  warm up ensures that vasodilation occurs and thus more blood flows to the various parts of the bodies enabling strenuous exercise under safer conditions. ”

To know more about Daniel Vaz visit his discussion group at at http://runnersforlife.com/group/mumabimarathonrunners

4. Every runner knows that at the start of a running event, the excitement is very high and his body is pumping out adrenaline. Every regular runner knows that this level of excitement itself leads to higher heart rates and that most runners over pace themselves at the start. In a stressful situation the body also releases large amounts of cortisol. Well documented studies have established that these soup of stress hormones can result in Sudden Cardiac Arrest.

http://www.forensicmed.co.uk/pathology/sudden-cardiac-death/emotion-and-sudden-cardiac-death/

and

http://www.slate.com/articles/news_and_politics/explainer/2006/07/did_stress_kill_ken_lay.html

5. Lack of knowledge of CPR. It is apparent that the constables who were trying to revive Police Constable Subash Tomar lacked adequate knowledge of correct CPR. The video shows them making some attempts to pump the stomach / chest, while his neck is held crooked up. Possibly no mouth to mouth resuscitation was even attempted. His belt was not loosened, he was not laid flat on the ground and the pumping of his chest was not done in correct rhythm. It is unfortunate that many a death in our country can be prevented if a large section of the population knows the correct method of delivering CPR.

What is CPR – http://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation

Learning CPR – http://depts.washington.edu/learncpr/

All runners must make a sincere attempt to learn CPR and prevent Sudden Cardiac Deaths to others in their vicinity

In conclusion it can be started that several risk factors were at play that may have lead to the death of Constable Subhash Tomar due to Sudden Cardiac Death. Runners have a lot to learn from this and due caution must be exercised when attempting strenuous exercises under similar risk conditions.

P. Venkatraman