Deaths at Bramham

Re: Deaths at Bramham

Hannah Wynne Richards — Fri, 22 Jun 2012 12:41:39 GMT

Good luck

Wynne

Re: Deaths at Bramham

Simon Neuhoff — Fri, 22 Jun 2012 11:27:27 GMT

Thanks for that Julian! My post above was mostly tongue in cheek - I have done numerous similar rides in the past though this will be marginally tougher than any to date. Still not expecting to drop dead though! Currently as fit as I've ever been I think. Very much looking forward to it, will be staying on to watch the pros do it in rather better style than me!

Re: Deaths at Bramham

Julian Earl — Fri, 22 Jun 2012 10:53:43 GMT

[quote user="Simon Neuhoff"]

[quote user="Jane Adams"]

Stuff to frighten us...

[/quote]

Thanks Jane ;-) Just what I want to be reading 3 weeks ahead of the Etape du Tour - 201k in the Pyrenees with five categorised climbs!

[/quote]

Don't worry Simon, there's another study somewhere showing ex-pros live an average of eight years longer than the general population.

Have a good ride by the way, you have me green with envy.

Re: Deaths at Bramham

Simon Neuhoff — Fri, 22 Jun 2012 10:23:02 GMT

[quote user="Jane Adams"]

Sheppard M N (2012) Histopathology 60, 381–396 The fittest person in the morgue?

The cardiovascular benefits of regular physical activity are well established (J. Sci. Med. Sport,7, 2004, 6). James Fixx wrote the best-selling book on running entitled The Complete Book of Running (1977), which led to an increase in popularity. However, when Fixx collapsed and died suddenly while running in 1984, people began to consider the adverse effects of sport on cardiac conditions. Going back in time, in 490 bc Phidippides, a young Greek messenger, ran 26.2 miles from Marathon to Athens delivering the news of the Greek victory over the Persians, and immediately collapsed and died. This is probably the first recorded incident of sudden death of an athlete running a marathon. According to Noakes (Med. Sci. Sports Exerc.,19, 1987, 187), one of the earliest reports on the association between running and cardiac risk was published in 1909, which claimed that school cross-country races over one mile for boys below the age of 19 years were totally inappropriate, and that the associated stress will cause damage in the heart and other organs. Death in athletes is highly publicized and has a substantial emotional impact on the community at large, given that athletes are perceived as the healthiest segment of society.

Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes
Authors:: La Gerche, A
Burns, AT
Mooney, DJ
Inder, WJ
Taylor, AJ
Bogaert, J
MacIsaac, AI
Heidbuchel, H
Prior, DL
Source:: EUROPEAN HEART JOURNAL; APR, 2012, 33 8, p998-p1006, 9p.
Publisher Copyright:: OXFORD UNIV PRESS
ISSN:: 0195668X
Document Type:: Article
Author Keywords:: Athlete
Right ventricle
Exercise
Cardiac magnetic resonance
Myocardial injury
Fibrosis

Subject Category:: CARDIAC & CARDIOVASCULAR SYSTEMS
Abstract:: Aims Endurance training may be associated with arrhythmogenic cardiac remodelling of the right ventricle (RV). We examined whether myocardial dysfunction following intense endurance exercise affects the RV more than the left ventricle (LV) and whether cumulative exposure to endurance competition influences cardiac remodelling (including fibrosis) in well-trained athletes.
Methods and results Forty athletes were studied at baseline, immediately following an endurance race (311 h duration) and 1-week post-race. Evaluation included cardiac troponin (cTnI), B-type natriuretic peptide, and echocardiography [including three-dimensional volumes, ejection fraction (EF), and systolic strain rate]. Delayed gadolinium enhancement (DGE) on cardiac magnetic resonance imaging (CMR) was assessed as a marker of myocardial fibrosis. Relative to baseline, RV volumes increased and all functional measures decreased post-race, whereas LV volumes reduced and function was preserved. B-type natriuretic peptide (13.1 14.0 vs. 25.4 21.4 ng/L, P 0.003) and cTnI (0.01 .03 vs. 0.14 .17 g/L, P 0.0001) increased post-race and correlated with reductions in RVEF (r 0.52, P 0.001 and r 0.49, P 0.002, respectively), but not LVEF. Right ventricular ejection fraction decreased with increasing race duration (r 0.501, P 0.0001) and VO(2)max (r 0.359, P 0.011). Right ventricular function mostly recovered by 1 week. On CMR, DGE localized to the interventricular septum was identified in 5 of 39 athletes who had greater cumulative exercise exposure and lower RVEF (47.1 5.9 vs. 51.1 3.7, P 0.042) than those with normal CMR.
Conclusion Intense endurance exercise causes acute dysfunction of the RV, but not the LV. Although short-term recovery appears complete, chronic structural changes and reduced RV function are evident in some of the most practiced athletes, the long-term clinical significance of which warrants further study.
Language:: English
Accession Number:: 000303162300018
Copyright:: Copyright (c) 2012 Institute for Scientific Information
Database:: Science Citation Index

Authors:

Werner, C
Furster, T
Laufs, U

Source:

HERZ; FEB, 2012, 37 1, p68-p71, 4p.

Publisher Copyright:

URBAN & VOGEL

ISSN:

03409937

Document Type:

Article

Author Keywords:

Physical activity
Myocardial remodeling
Prevention

Subject Category:

CARDIAC & CARDIOVASCULAR SYSTEMS

Abstract:

Myocardial remodeling comprises changes in cardiac shape, mass, diameter, and function in response to changes in hemodynamic load, cardiac damage, or neurohumoral stimulation. Adaptive remodeling is a consequence of physiological stimuli such as physical activity. Maladaptive remodeling results from pathologic conditions such as myocardial ischemia and cardiac valve disease. Since regular vigorous endurance exercise can result in cardiac remodeling cardiologic screening is recommended for athletes to identify individuals with cardiomyopathies. Moderate physical activity is cornerstone of primary and secondary prevention of cardiovascular diseases. In secondary prevention, individual training recommendations need to be adapted to the underlying myocardial disease and individual risk factors. Experimental and clinical studies show that specific training interventions exert cardioprotective effects and reverse remodeling. However, clinical and basic science studies are needed to understand the mechanisms of adaptive and maladaptive remodeling and to better utilize this powerful therapeutic tool in the treatment of myocardial diseases.

And there's more.

[/quote]

Thanks Jane ;-) Just what I want to be reading 3 weeks ahead of the Etape du Tour - 201k in the Pyrenees with five categorised climbs!

Re: Deaths at Bramham

jd2008 — Fri, 22 Jun 2012 06:19:13 GMT

Sheppard M N (2012) Histopathology 60, 381–396 The fittest person in the morgue?

Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes
Authors:: La Gerche, A
Burns, AT
Mooney, DJ
Inder, WJ
Taylor, AJ
Bogaert, J
MacIsaac, AI
Heidbuchel, H
Prior, DL
Source:: EUROPEAN HEART JOURNAL; APR, 2012, 33 8, p998-p1006, 9p.
Publisher Copyright:: OXFORD UNIV PRESS
ISSN:: 0195668X
Document Type:: Article
Author Keywords:: Athlete
Right ventricle
Exercise
Cardiac magnetic resonance
Myocardial injury
Fibrosis

Subject Category:: CARDIAC & CARDIOVASCULAR SYSTEMS
Abstract:: Aims Endurance training may be associated with arrhythmogenic cardiac remodelling of the right ventricle (RV). We examined whether myocardial dysfunction following intense endurance exercise affects the RV more than the left ventricle (LV) and whether cumulative exposure to endurance competition influences cardiac remodelling (including fibrosis) in well-trained athletes.
Methods and results Forty athletes were studied at baseline, immediately following an endurance race (311 h duration) and 1-week post-race. Evaluation included cardiac troponin (cTnI), B-type natriuretic peptide, and echocardiography [including three-dimensional volumes, ejection fraction (EF), and systolic strain rate]. Delayed gadolinium enhancement (DGE) on cardiac magnetic resonance imaging (CMR) was assessed as a marker of myocardial fibrosis. Relative to baseline, RV volumes increased and all functional measures decreased post-race, whereas LV volumes reduced and function was preserved. B-type natriuretic peptide (13.1 14.0 vs. 25.4 21.4 ng/L, P 0.003) and cTnI (0.01 .03 vs. 0.14 .17 g/L, P 0.0001) increased post-race and correlated with reductions in RVEF (r 0.52, P 0.001 and r 0.49, P 0.002, respectively), but not LVEF. Right ventricular ejection fraction decreased with increasing race duration (r 0.501, P 0.0001) and VO(2)max (r 0.359, P 0.011). Right ventricular function mostly recovered by 1 week. On CMR, DGE localized to the interventricular septum was identified in 5 of 39 athletes who had greater cumulative exercise exposure and lower RVEF (47.1 5.9 vs. 51.1 3.7, P 0.042) than those with normal CMR.
Conclusion Intense endurance exercise causes acute dysfunction of the RV, but not the LV. Although short-term recovery appears complete, chronic structural changes and reduced RV function are evident in some of the most practiced athletes, the long-term clinical significance of which warrants further study.
Language:: English
Accession Number:: 000303162300018
Copyright:: Copyright (c) 2012 Institute for Scientific Information
Database:: Science Citation Index

Authors:

Werner, C
Furster, T
Laufs, U

Source:

HERZ; FEB, 2012, 37 1, p68-p71, 4p.

Publisher Copyright:

URBAN & VOGEL

ISSN:

03409937

Document Type:

Article

Author Keywords:

Physical activity
Myocardial remodeling
Prevention

Subject Category:

CARDIAC & CARDIOVASCULAR SYSTEMS

Abstract:

And there's more.

Re: Deaths at Bramham

Simon Neuhoff — Thu, 21 Jun 2012 17:41:01 GMT

[quote user="Martin Atkinson"]

Whether this argument turns into an anti horse sport thread or not, unlike the Grand National scenario, the issue here is not about injuries due to unsuitable conditions or unnecessarily hard courses, it is about horses which are not fit to exercise because they have heart disease that should perhaps have been detected/investigated previously. There will always be the case of a young animal dropping dead with occult heart disease same as footballers dropping dead on the field of play but I'll wager that my heart is as good if not better that most people half my tender 62 years because I do do vast amounts of hard exercise so that exercise is not going to kill me, and there is no reason to believe the same shouldn't apply to animals. I suspect my kids will be waiting for their inheritance for a while yet.

[/quote]

Read something the other day about endurance athletes (they were cyclists in this study) and heart damage as documented by echocard...... This was in a cycling mag not a peer reviewed journal mind!

Re: Deaths at Bramham

Wren — Sat, 16 Jun 2012 17:23:28 GMT

Yes endurance are quite strict on that sort of thing but heart rates during and after sections of the race dictate prizes and/or eliminations. It's actually part of the competition to have a low heart rate.

There are no checks at all at affiliated (BE) national events and at FEI three-day events the only point in the proceedings that I've had a horse listened to is in the holding area at the end of the XC course. You're not allowed to go back to the stabling until the horse's heart rate has dropped sufficiently.

Re: Deaths at Bramham

Tim Cheyne — Sat, 16 Jun 2012 16:23:02 GMT

[quote user="Wren"]I wonder how many apparently fit eventers (excluding the lottery-funded ones) ever get listened to nowadays after a decent bit of exercise?[/quote]

Hi, Wren. I cannot speak for 'eventers' but I have some rather 'hands-off' knowledge of the endurance events here and there are stringent checks, including heart auscultation, at the beginning, end, and intervening stages of of such events. Horses whose heart rhythms and rates do not return to normal wthin a specified time are not allowed to continue and, at the finish, cannot be a 'winner'. Flat race regulations are a little less stringent; runners are checked the morning of the race but at the finish only those that visually appear to need a check; that said, the course vets are good at spotting those that do need checking.

Tim.

Re: Deaths at Bramham

Colin Thomson — Sat, 16 Jun 2012 10:29:52 GMT

[quote user="Wren"]

[quote user="Colin Thomson"]

[People who were there (and know what they're talking about)

[/quote]

I hope you're not implying by that that I don't....

[/quote]

Sorry - Absolutely not! But I wouldn't know personally, and these were the opinions of folks who have either ridden in similar events (at a lower level) or officiated at them, not just a MOP as a spectator, for example.

Colin

Re: Deaths at Bramham

Wren — Sat, 16 Jun 2012 09:17:46 GMT

[quote user="Colin Thomson"]

[People who were there (and know what they're talking about)

[/quote]

I hope you're not implying by that that I don't....

I think there is little chance of the PM results entering the public domain. Further information I have received says that Jagganath ( the horse who died having completed the course) may have been suffering from ventricular tachycardia - apparently his heart rate did not fall as normally expected after he'd been cooled down and remained as high as when he'd finished the course. Apparently he did receive some treatment before dying.

Tim - perhaps unfortunately phrased on my part, but no, the vets I talked to did not in any way mean to imply that either horse, to their knowledge, had pre-existing problems.

Interestingly in the old long-format days all horses would have had their hearts auscultated in the 10 minute box after strenuous exercise (ie. phases a, b and c, which included a steeplchase) immediately before starting the XC. I certainly remember a couple of top horses being withdrawn at this point as previously undetected murmurs/arrhythmias had been detected. Maybe this was a wise precautionary step? I wonder how many apparently fit eventers (excluding the lottery-funded ones) ever get listened to nowadays after a decent bit of exercise?

Re: Deaths at Bramham

Tim Cheyne — Fri, 15 Jun 2012 05:38:45 GMT

[quote user="Colin Thomson"]As I understand it both horses went to Liverpool Vet School for pm. Whether we find out what the cause of deaths were will depend in part on whether the owners make that information public, I suppose. [/quote]

Thanks, Colin. Yes, that is fair enough, client confidentiality, but I do hope that they make the major findings public, if only in their own interest. The 'antis'are likely to misinterpret any hearsay if they want to ban competitions.

Tim.

Re: Deaths at Bramham

Colin Thomson — Thu, 14 Jun 2012 21:21:22 GMT

[quote user="Tim Cheyne"]Anyway, are we likely to learn the results of the autopsies?[/quote]

As I understand it both horses went to Liverpool Vet School for pm. Whether we find out what the cause of deaths were will depend in part on whether the owners make that information public, I suppose.

People who were there (and know what they're talking about) confirmed that the cross country conditions were excellent on both days. And there were no "problem" fences - people who fell off were falling off all over the place, not just at one or two fences.

Colin

Re: Deaths at Bramham

Tim Cheyne — Thu, 14 Jun 2012 18:51:09 GMT

[quote user="Wren"]The vets who dealt with them told me that both would have PMs but in their opinion both could have collapsed and died at home, on the gallops or at any other competions.[/quote]

Thanks, Wren; yes, it was a very helpful explanation but I find the quote from the vets rather strangely (unfortunately?) phrased. I am sure that they meant that they saw no factors in the competition likely to have triggered the heart attacks but it could be read that the horses had a known defect from which they could drop dead at any time in any circumstances. [If the red star man is about I expect that I shall be in trouble. ]

Anyway, are we likely to learn the results of the autopsies?

Tim.

Re: Deaths at Bramham

Hannah Wynne Richards — Thu, 14 Jun 2012 11:53:07 GMT

Yes a lot Thanks Coincidences do happen but I initially found it worrying Hope your events went well

Wynne

Re: Deaths at Bramham

Wren — Wed, 13 Jun 2012 19:31:33 GMT

Ok, I'll step in to fulfill my usual role of Vetsurgeon Horse Fatality Adviser

I wasn't at Bramham on the Saturday when the fatalities occured (was eventing elsewhere) but I was there on the Sunday and spoke to several of the vets present. Firstly the ground wasn't waterlogged or even heavy - it really was very good. You could barely see where the previous day's horses had been (and they were using most of the same fences) and by the end of Sunday it was hardly more cut up than it had been at the start. I think the dressage was wetter but this took place on the Thursday and Friday in the rain. From Friday afternoon until the close of the event on Sunday there was no further significant rain. If the ground had been atrocious to the point of being unsafe it would have been fair of the event to have cancelled (usually this is because ambulance cover to all areas of the course cannot be guaranteed rather than anything else); however if the ground had merely been heavy (which it wasn't) it would have been up to individual competitors to choose whether to compete. Some horses can't handle 'heavy' whilst others are mudlarks. Neither of the deceased horses were in line for Olympic selection so there will have been no external pressure on them to run whatever the circumstances.

Both horses died of suspected cardiac events. Lead The Way at a complicated fence about a third of the way round the course and Jagganath after completion of the course whilst waiting to be 'vetted out' of the collecting area. The vets who dealt with them told me that both would have PMs but in their opinion both could have collapsed and died at home, on the gallops or at any other competions.

Hope that helps!

Re: Deaths at Bramham

Tim Cheyne — Tue, 12 Jun 2012 19:04:59 GMT

[quote user="Martin Atkinson"]

Of course another question is who made the diagnosis of heart disease, is this supposition or did someone conduct a thorough post mortem examination?

[/quote]

I hope that it is more than supposition, or just a casual veterinary opinion, but I have not seen a report published so far. However, if autopsies were performed (and I hope that they were) the pathologist could be waiting a week or more for test results. Gross pathology does not always provide the answer.

Tim.

Re: Deaths at Bramham

Martin Atkinson — Tue, 12 Jun 2012 18:46:25 GMT

Of course another question is who made the diagnosis of heart disease, is this supposition or did someone conduct a thorough post mortem examination?

Re: Deaths at Bramham

Hannah Wynne Richards — Tue, 12 Jun 2012 17:45:02 GMT

I'm not trying toget eventing banned- competition horses live lives of luxury especially when I think of the many abandoned horses or those kept on tethers on Swansea council estates-it's just that 2 deaths from suspected heart attacks in 1 event-and that with most of the country waterlogged made me think ? cause and effect

Wynne

Re: Deaths at Bramham

Tim Cheyne — Tue, 12 Jun 2012 17:38:52 GMT

[quote user="Virginia Campbell"]

[quote user="Tim Cheyne"] many horses that drop dead suddenly, on or off the track, have been subjected to rigorous exercise up to that point without giving cause for concern.[/quote]

Best Mate being a prime example.

[/quote]

Yes, and that horse of the Queen Mother some years ago, the name of which I forget.

Tim.

Re: Deaths at Bramham

Virginia Campbell — Tue, 12 Jun 2012 17:34:48 GMT

[quote user="Tim Cheyne"] many horses that drop dead suddenly, on or off the track, have been subjected to rigorous exercise up to that point without giving cause for concern.[/quote]

Best Mate being a prime example.

Re: Deaths at Bramham

Tim Cheyne — Tue, 12 Jun 2012 17:33:12 GMT

[quote user="Martin Atkinson"]it is about horses which are not fit to exercise because they have heart disease that should perhaps have been detected/investigated previously. [/quote]

Martin, I am glad that you included 'perhaps'. Quite apart from the difficulties of detecting occult heart disease in the horse, there is a difference between diseases of the heart and factors that might cause sudden unexpected heart failure; I am thinking of embolism in this case. Also, although I hope that you are right about yourself (May you live long, young man), many horses that drop dead suddenly, on or off the track, have been subjected to rigorous exercise up to that point without giving cause for concern.

Tim.

Re: Deaths at Bramham

Mark Holmes — Tue, 12 Jun 2012 14:08:29 GMT

[quote user="Hannah Wynne Richards"]

Do you suggest grandad goes playing squosh in order to hurry up the inheritance?

Wynne

[/quote]

My grandparents aren't leaving sufficient inheritance to make it worth buying them a squash racket.

On the subject of horses however, unless they are used for a purpose they are large, expensive and rather destructive lawnmowers. These horses would be worked irrespective of Bramham, its possible the problem could equally have occurred in the following weeks and we would have heard nothing about it.

Re: Deaths at Bramham

bob lehner — Tue, 12 Jun 2012 14:01:03 GMT

[quote user="Martin Atkinson"]but I'll wager that my heart is as good if not better that most people half my tender 62 years because I do do vast amounts of hard exercise so that exercise is not going to kill me, and there is no reason to believe the same shouldn't apply to animals. I suspect my kids will be waiting for their inheritance for a while yet.[/quote]

Blimey - you're tempting fate.....!

Anyway - anyone with any sense knows that vigorous exercise is very bad for you and is to be avoided at all costs.

Re: Deaths at Bramham

Martin Atkinson — Tue, 12 Jun 2012 11:06:49 GMT

Re: Deaths at Bramham

Tim Cheyne — Mon, 11 Jun 2012 15:52:12 GMT

[quote user="Hannah Wynne Richards"]

Do you think that heavy going at Bramham contributed to the deaths of 2 horses from suspected heart attacks-and if so should the event have been cancelled?

[/quote]

No, I agree with Mark's post above. One horse was 10 yo the other 14 so it is quite possible that there was some underlying chronic pathology. Unfortunately horses younger than those drop dead unexpectedly at events, flat and jump races, and endurance trials. The riders were top-notch competitors who would have valued their relationship with their horses. I feel sure that they would not have pushed their mounts unreasonably if they had sensed a problem.

Tim.