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20 year old collapsed during marathon
My 20 year old son collapsed three blocks from the finish of a marathon three weeks ago.
According to the EMT report, 911 recieved a call for "unconscious/down in street" at 8:55 am and were on scene at 9:02 am. "Pt. was runner in marathon. Found altered, pale, SOB, speaking in 1-2 word sentences. Pt. felt nausea enroute". Vitals: BP 85/35 pulse 125, O2 sat 96%, sinus tachycardia, GCS 14. 1000cc NS given--GCS up to 15, BP 85/45, pulse 125. After completion of saline--BP 101/65/ pulse 110. Pt .markedly improved on admission to ED.
He was admitted to CCU, telemetry for three days with troponin levels of 5.47, peaked at 7.29 and dropped to 2.08 the am after admission. His discharge Dx was:
1. Syncopal episode
2. MI, based on troponin levels and normal cardiac function based on follow up echocardiogram.
3. Marathon associated troponin leak of uncertain significance.
4. Acute renal failure, secondary to rhabdomyolysis, resolved
5. Hypophosphatemia and hypokalemia, resolved.
6. Acute dehydration.
Follow up cardiology studies were done at a well-known university teaching/research medical center. He had an MRA, a stress echo (max heart rate of 200), both normal, saw an electrophysiologist --his father refused the EP study for him. I wanted my son to have the test. His 21 day event monitor showed no arrhythmia even while running . The four cardiologists, plus a consensus from other EP experts, recommended an implantable loop recorder. There is scant data on this, because it is unusual. I felt the loop recorder was very important as the syncope is still unexplained in full--the doctors think it may be a rare combination of the stress of the marathon, with severe muscle breakdown and very high CPK, and severe dehydration, but wanted to see the loop information over a year's time to absolutely rule out any arrhythmias.
My 20 year old healthy-feeling son is balking at all the tests and doctors and wants to get back to college where he runs cross-country and track. He, of course, cannot do this until he has medical clearance. But he's a RUNNER and he runs like a gazelle.
Here is my problem--my son is scheduled to have the loop recorder implanted tomorrow morning. Again, his father does not want this done because it is invasive and he doesn't see it as valuable. I am the exact opposite--I think the more information we have, the more we can get through this extremely stressful time. Unfortunately, my son (just because one is over 18 doesn't mean they have the wisdom or ability to make such potentially life-threatening decisions) has been influenced by his father and has declined the monitor. He says that even if he were diagnosed with an arrhythmia, he would not use an internal cardiac defibrillator, which has been explained to him.
My question--how do I now deal with my anxiety. If anything were to happen, I could never forgive myself for not being more assertive with his stubborn father (as it is, we are not speaking to one another at a time when we should be supporting each another ) or much stronger in trying to have my son understand how serious this is. The doctors were very clear in their explanations. I am unable to convince my son and I am afraid I am not being the mother bear I should be. Please help me come to terms with this very difficult dilema. Many, many thanks for your kind consideration.
According to the EMT report, 911 recieved a call for "unconscious/down in street" at 8:55 am and were on scene at 9:02 am. "Pt. was runner in marathon. Found altered, pale, SOB, speaking in 1-2 word sentences. Pt. felt nausea enroute". Vitals: BP 85/35 pulse 125, O2 sat 96%, sinus tachycardia, GCS 14. 1000cc NS given--GCS up to 15, BP 85/45, pulse 125. After completion of saline--BP 101/65/ pulse 110. Pt .markedly improved on admission to ED.
He was admitted to CCU, telemetry for three days with troponin levels of 5.47, peaked at 7.29 and dropped to 2.08 the am after admission. His discharge Dx was:
1. Syncopal episode
2. MI, based on troponin levels and normal cardiac function based on follow up echocardiogram.
3. Marathon associated troponin leak of uncertain significance.
4. Acute renal failure, secondary to rhabdomyolysis, resolved
5. Hypophosphatemia and hypokalemia, resolved.
6. Acute dehydration.
Follow up cardiology studies were done at a well-known university teaching/research medical center. He had an MRA, a stress echo (max heart rate of 200), both normal, saw an electrophysiologist --his father refused the EP study for him. I wanted my son to have the test. His 21 day event monitor showed no arrhythmia even while running . The four cardiologists, plus a consensus from other EP experts, recommended an implantable loop recorder. There is scant data on this, because it is unusual. I felt the loop recorder was very important as the syncope is still unexplained in full--the doctors think it may be a rare combination of the stress of the marathon, with severe muscle breakdown and very high CPK, and severe dehydration, but wanted to see the loop information over a year's time to absolutely rule out any arrhythmias.
My 20 year old healthy-feeling son is balking at all the tests and doctors and wants to get back to college where he runs cross-country and track. He, of course, cannot do this until he has medical clearance. But he's a RUNNER and he runs like a gazelle.
Here is my problem--my son is scheduled to have the loop recorder implanted tomorrow morning. Again, his father does not want this done because it is invasive and he doesn't see it as valuable. I am the exact opposite--I think the more information we have, the more we can get through this extremely stressful time. Unfortunately, my son (just because one is over 18 doesn't mean they have the wisdom or ability to make such potentially life-threatening decisions) has been influenced by his father and has declined the monitor. He says that even if he were diagnosed with an arrhythmia, he would not use an internal cardiac defibrillator, which has been explained to him.
My question--how do I now deal with my anxiety. If anything were to happen, I could never forgive myself for not being more assertive with his stubborn father (as it is, we are not speaking to one another at a time when we should be supporting each another ) or much stronger in trying to have my son understand how serious this is. The doctors were very clear in their explanations. I am unable to convince my son and I am afraid I am not being the mother bear I should be. Please help me come to terms with this very difficult dilema. Many, many thanks for your kind consideration.
In so many words, let him do as he likes. Honestly, all that work is unnecessary. Having invasive work for one episode--not even a bad episode, as the collapse has several other causes and the syncope didn't last after recovery--can seriously screw up his life. Your doctors are either paranoid since he is a runner (in the off chance that something is wrong with his heart, running is pretty much the worst thing to be doing), or they're trying to make some money by offering a non-vital procedure--that does happen, unfortunately.
Long story short, though, people often get freaked out by arrhythmias. Most of the time they aren't anything besides uncomfortable. The only reason you should be worried is if he has long QT syndrome or an extra electrical pathway within the heart--both of which would have been discovered already, unless you've got some incompetent doctors. Arrhythmias that don't come from these conditions are, for the most part, caused by a disturbance of the heart (i.e. large amount of cardiac stimulant in the blood, in rare cases sharp inhalation during a very specific period within the cardiac cycle, heavy blow to the chest). Exhaustion is just one of the many things that can cause an irregular beat. I'd figure that he doesn't want the procedure because he hears the term 'invasive,' and regardless of what level of disturbance this would put in his life, just the psychological aspect would likely make it difficult. Really, though, if his heart is going to stop beating from an arrhythmia, considering the history you've told us, the implanted device would just be a waste.
I'll add, too, that the implantable defibrillators are bad for the under fifty and active crowd. It would put an end to his running (it triggers at a certain heart rate), there have been several cases of malfunctioning pieces causing heart attacks, and it requires surgery every couple of years. In the end, then, there's a decent chance that getting overly concerned about this one episode could wreck his life as he lives it. Your son will be fine, just let him be and remember that he's still if not less, likely to keel over dead than any other active twenty year old.
Long story short, though, people often get freaked out by arrhythmias. Most of the time they aren't anything besides uncomfortable. The only reason you should be worried is if he has long QT syndrome or an extra electrical pathway within the heart--both of which would have been discovered already, unless you've got some incompetent doctors. Arrhythmias that don't come from these conditions are, for the most part, caused by a disturbance of the heart (i.e. large amount of cardiac stimulant in the blood, in rare cases sharp inhalation during a very specific period within the cardiac cycle, heavy blow to the chest). Exhaustion is just one of the many things that can cause an irregular beat. I'd figure that he doesn't want the procedure because he hears the term 'invasive,' and regardless of what level of disturbance this would put in his life, just the psychological aspect would likely make it difficult. Really, though, if his heart is going to stop beating from an arrhythmia, considering the history you've told us, the implanted device would just be a waste.
I'll add, too, that the implantable defibrillators are bad for the under fifty and active crowd. It would put an end to his running (it triggers at a certain heart rate), there have been several cases of malfunctioning pieces causing heart attacks, and it requires surgery every couple of years. In the end, then, there's a decent chance that getting overly concerned about this one episode could wreck his life as he lives it. Your son will be fine, just let him be and remember that he's still if not less, likely to keel over dead than any other active twenty year old.
at some point i would hope that your son sees that in his case he is lucky that a potential fatal event did not happen while he was running and would do everything to make sure that it doesn't. at the age of 20 he has many years of running in his future, and i would think that he doesn't want to have this in the back of his mind every time he's at the starting line of a marathon. i am sure that every experienced runner would tell him to have this done, from what i understand they are very disciplined and take great care to take care of their bodies (and minds) having this test, while it may be an irritant for a short period, will give him peace of mind to be able to continue with his love of running for many years to come. as the parent of daughter near your son's age with a heart condition i feel for you. i spent two years waking up every day worrying about her heart, now she is doing better than she has in three years, and while it is still an issue we can plan for her future without having that fear hanging like a cloud. please let us know how everything goes and of course we wish your family good health and peace of mind
dawn
dawn
An internal loop monitor is barely invasive and won't affect his daily life. While it is possible that the strain of the marathon (remember that the first guy to run 26 miles died within an hour of completing his task) is the sole trigger for his episode, his continued interest in competitive running is a significant risk given his serious reaction. He can continue to run, date, drink (if he does), sleep, eat etc. as usual, but he'll have that nifty little bionic device recording his heart's reaction to it all so that the doctors can be sure that he doesn't have an underlying and possibly deadly arrhythmia.
What's the big deal? Big payoff if you find something, no loss if you don't.
Consider, however, that your husband and son may be reacting with such adamant distaste for the test because of FEAR of what it MAY reveal. Many people faced with possible bad news much prefer denial over action. Your husband may be very frightened of what the loop could uncover, and your son, both influenced by his father AND frightened of what he may find out has the perfect excuse to deny the test. "I'm afraid of what it might tell me, and my dad doesn't want me to get it done, so I'll not get it done and I won't have to face anything that might happen." What a perfect avoidance excuse!!!
Bless your heart in having to deal with this situation. I know the fear and concern must be overwhelming. At the same time, your son is of age, albeit a young age. If he denies the test, you cannot force him to have it done. Support him as best you can, and don't let YOUR fear interfere with loving and caring for your family. If you forget to enjoy them while you have them, then you don't really have them at all.
Take care, I hope it all works out for you.
What's the big deal? Big payoff if you find something, no loss if you don't.
Consider, however, that your husband and son may be reacting with such adamant distaste for the test because of FEAR of what it MAY reveal. Many people faced with possible bad news much prefer denial over action. Your husband may be very frightened of what the loop could uncover, and your son, both influenced by his father AND frightened of what he may find out has the perfect excuse to deny the test. "I'm afraid of what it might tell me, and my dad doesn't want me to get it done, so I'll not get it done and I won't have to face anything that might happen." What a perfect avoidance excuse!!!
Bless your heart in having to deal with this situation. I know the fear and concern must be overwhelming. At the same time, your son is of age, albeit a young age. If he denies the test, you cannot force him to have it done. Support him as best you can, and don't let YOUR fear interfere with loving and caring for your family. If you forget to enjoy them while you have them, then you don't really have them at all.
Take care, I hope it all works out for you.
Can you ask him if he could give it a try (for you)? Explain how anxious you are, about even the remotest possibility of losing him. I try to remind my adult kids that sometimes we do things for other people, even if it's something we don't necessarily want to do. Wouldn't it be wonderful if the tests came back normal, and he could get on with his life knowing that his heart is healthy? Sounds like a low risk for a great benefit!
Good luck...please keep us posted.
Good luck...please keep us posted.
wow, i would be like you scared for my son, and i guess thats what i would tell my son, do you want to be running and fall over dead from something that could of been prevented. tell him how inportant this is, does he want to be in the back of a ambulance again. its very hard when they are that age and can make up their own mind, but not understanding why dad would not want his son to be check good so that he would not have this problem, dad should be the one who cant live with self if something happens to son not you , your doing all you can, i know its breaking your heart , knowing your son needs this, pray it helps. God Bless you and your son, and i hope he does the loop
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