Wednesday, November 26, 2014

Caution! Five Warning Signs You Shouldn’t Ignore

(Editor's note: This article originally appeared in June 2010).

by Larry Creswell, M.D.

My triathlete friends seem to be pretty “in touch” with their bodies. They are hyper-vigilant about the first signs of “swimmer’s elbow” or plantar fasciitis or leg muscle strain. They’re also apt to be proactive about dealing with these problems. Maybe that’s just because it’s sometimes easy to self-diagnose a musculoskeletal problem and easy to self-prescribe rest, ice or analgesics. Or maybe, over time, they’ve learned the lesson that early intervention can head off bigger problems later on. That’s an important lesson.
 
I’ve noticed, though, that my triathlete friends often give short shrift to some of the warning signs of potentially more worrisome problems -- problems that stem from the heart or vascular system. This is particularly true for my male athlete friends! Like I mentioned in my last article, young “healthy” men just don’t like to go to the doctor. I think that athletes like to believe they’re invincible, ignoring serious warning signs until they just simply can’t be ignored any longer. But just like plantar fasciitis, for example, it’s always best to recognize and deal with any serious heart-related problem earlier rather than later.
 
So here’s my short list of five important warning signs that you shouldn’t ignore. These are symptoms that you should discuss with your physician. Get reassurance if there’s really no serious problem and get evaluated promptly if your doctor believes there may truly be something wrong.
 

  1. Chest pain: Once every few weeks I meet with a small group of third-year medical students to talk about patient scenarios that involve chest surgery and one of the scenarios that we discuss deals with a young patient with chest pain. I ask the medical students to come up with a list of the potential causes and I’m always amazed at how many answers are offered up. Sometimes they’re able to list 30 or more. That’s the way it is with chest pain -- many, many potential causes. The causes include things like injuries to the chest, reflux disease of the stomach, inflammation of the joints between the ribs and breast bone, anxiety, and diseases of the esophagus, among others. 

    The students are quick to remember the potentially life-threatening causes such as heart attack (that we call acute myocardial infarction), collapse of one of the lungs (tension pneumothorax), tears (dissection) of the aorta (the large blood vessel that carries blood away from the heart), and pulmonary embolism (blood clots that travel to, and lodge in the lungs). I suppose that any of these causes may be in play for an athlete with chest pain. But the particular scenario that’s important for athletes is chest pain that comes with exertion and is relieved at rest. This can be an indication of coronary artery disease (CAD) -- plaque build-up in the coronary arteries that supply blood to the heart muscle itself. In its early stages, the pain can be very subtle. In its later stages, the pain can be crippling. The good news is that, working with your physician, you can be evaluated to see if chest pain is due to CAD and a variety of treatments may be available, depending upon your situation. Don’t ignore chest pain!
     

  2. Shortness of breath: As athletes, we’re all short of breath at some point -- some of us earlier than others, depending on our fitness level. And as athletes, we’ll each become accustomed to the level of shortness of breath that is associated with a given workout or level of effort. What’s worrisome is when there is some change to that pattern -- when shortness of breath is unexpectedly out of proportion to what you’d ordinarily expect. That’s when the alarm bells should go off inside your head. Just like chest pain, there are a myriad of causes of shortness of breath, ranging from pulmonary or bronchial infections, to asthma (potentially made worse with exercise), to blood clots in the lung. For athletes, the most worrisome sign is shortness of breath that persists after exercise stops or shortness of breath that occurs at rest. Both are signs that a heart condition may be responsible. These are warning signs that you should report to your physician right away.
     
  3. Loss of consciousness: Much of medical school involves learning a big vocabulary of new “medical” words. Our word for sudden, unexpected loss of consciousness is syncope. Patients will use a variety of terms like “blacking out,” “passing out,” “falling out,” or even just “light-headedness” or “dizziness.” Again, there are many causes, such as dehydration, side effects of various medications, etc. For athletes, one common scenario is syncope at the end of a workout, when the exercise is stopped abruptly without a period of cooling down. Thankfully, that situation can be avoided just by remembering to have an appropriate cool-down after each workout. The worrisome type of syncope occurs during exercise. This almost always indicates a serious underlying medical problem -- and often related to the heart. All cases of syncope should be discussed with your physician, but it’s particularly important (bordering on emergency) to be evaluated if you have syncope during exercise.
     
  4. Fatigue: Like shortness of breath, all athletes are familiar with fatigue. Almost regardless of the sport, fatigue just comes with the territory. It’s important to remember that, besides exercise, there are a variety of causes of fatigue, including depression, the side effects of various medications, and anemia, among others. It’s also true that fatigue can be a symptom of underlying heart disease. Athletes become accustomed to the degree of fatigue that is associated with any particular workout or load and they should be acutely aware when there is a change to this pattern. Whenever there is a sudden change in an athlete’s pattern of fatigue or when fatigue persists for an excessively long time, it’s important to get evaluated. Find out what’s going on.
     
  5. Palpitations: Of the five warning signs I’m discussing, palpitations -- the feeling of an abnormally high or irregular heartbeat -- is undoubtedly the most common among athletes. It’s an unusual problem in school-aged athletes, but is very common among middle-aged endurance athletes. In some reports, as many as 70% of adult athletes report this problem. The palpitations may occur during exercise or at rest. We could make a list of 50+ specific arrhythmias (abnormal heartbeats) that account for palpitations in athletes. The most common problems are due to abnormal heartbeats or rhythms (like atrial fibrillation) that start in the upper chambers of the heart (atria). Most of these arrhythmias are benign, and require no treatment. But if you’re bothered by frequent palpitations, best to find out exactly what’s causing them, because they’re sometimes a sign of underlying heart problems that require treatment. Resist the urge to ignore this problem.

 
I realize this is a short list. But by paying attention to just these five warning signs, athletes can uncover most of the potentially serious underlying heart-related medical conditions that could place them at risk. Do this for yourself and remind your athlete friends, too.

Larry Creswell, M.D., is a cardiac surgeon and Associate Professor of Surgery at the University of Mississippi Medical Center in Jackson, Mississippi. You can contact him at lcreswell@surgery.umsmed.edu. You can also learn about Larry in his recent Endurance Corner athlete profile.

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