Sharing this from a local forum. A condition to be aware of.
"Swimming induced pulmonary edema (SIPE), a form of high output heart failure. The physiology involves a pooling of the body’s blood into the core, and when there is an overload of blood circulation in the core, the weakest link is usually the lung’s capillaries so the blood leaks into there. the risk then is of a deprivation of oxygen supply that causes cardiac arrest.
Im sharing this because i think it’s really important for triathletes to understand this “high output heart failure” which has an unusual incidence in triathletes and results from this perfect storm of some or all of the following variables that are independent of your fitness/training.
use of wetsuit - adds additional extrinsic compression to the extremities that shunts blood up to the core. here, i blame the NY ironman’s poor logistics as this was further exacerbated by the fact that we had to wear the wetsuit for 2 hours leading up to the swim. temperature of water - causes blood to pool into core and out of extremities to keep body warm (cold is anything below body temperature, so don’t think this only applies in freezing water) pressure of water - water exerts a much larger force on bodily tissues than air does, and the increased pressure forces blood from the skin, muscle, fat etc into the vessels/circulatory systempre-race adrenalin - increases cardiac output AND constricts blood vessels moving blood toward core hydration - increases the volume of blood cells
"
Basically it doesn’t matter if you are in great shape, new, veteran, or not. We are all possibly at risk of this cardiac problem because of environmental factors it seems.
I am not a doctor or expert - just opening grounds for a discussion.
Wasn’t me - I am reposting from a local tri teams forum. No way I could sit in my wetsuit that long on dry ground, it’s way to tight until you get into the water.
At my last oly race the swim start was delayed “by 15 minutes” due to thick morning fog. We couldn’t even see the shore buoy. Then the DR postponed the start another 15 minutes. Then another. Then basically said "we start as soon as we can see the second turn buoy. We stood on the beach for 2 hours. I put on the wetsuit about 20 minutes before swim was supposed to start. That left me standing on the beach, in a wetsuit, for 2:20.
“That left me standing on the beach, in a wetsuit, for 2:20”
this is, in my opinion, a problem. it’s not a problem if the air temp is cold enough. but it is a problem if the air temp is warm. but the solution is easy. you take the wetsuit off down to your waist. that solves the problem, unless the air is really warm. the problem is that the RD needs to know to say this to his competitors.
“That left me standing on the beach, in a wetsuit, for 2:20”
this is, in my opinion, a problem. it’s not a problem if the air temp is cold enough. but it is a problem if the air temp is warm. but the solution is easy. you take the wetsuit off down to your waist. that solves the problem, unless the air is really warm. the problem is that the RD needs to know to say this to his competitors.
Yep. We couldn’t take the wetsuits off because the RD intended to start “as soon as the fog lifted” and that’s what eventually happened. Thefogisliftingthreetwoonebooooooop! And we were swimming, with scant couple of minutes of notice. Me and the fellow I was chatting with recognized the issue. I was going to talk to the RD but I was so hot and exhausted afterwards that I forgot. Besides, with the swim imminent we couldn’t make the 300y walk on over to the port-a-potties. That was an even bigger issue.
use of wetsuit - adds additional extrinsic compression to the extremities that shunts blood up to the core. here, i blame the NY ironman’s poor logistics as this was further exacerbated by the fact that we had to wear the wetsuit for 2 hours leading up to the swim.
Blaming NY IM logistics is a reach. I rode the ferry in IM NY. Just before the ferry docked I got into my wetsuit. I was in my wetsuit no more than 10 minutes before entering the water.
This is actually what is statistically more prevalent in swim deaths than cardiac events according to what researchers are now finding out via autopsies. It is very good information to be aware of.
Can you share that evidence? Or point us where to find it?
I’m not aware of any account of a triathlon swim fatality that’s in keeping with SIPE as a cause…and I’m not aware of any autopsy findings in the victims that suggest that diagnosis.
Moreover, I’m not aware of reporting on any athletes rescued from a triathlon swim (alive) where SIPE was established with certainty as a diagnosis.
In fact, all of the swim deaths from 2003-2011 had cardiac arrest as an immediate cause.
Can you share that evidence? Or point us where to find it?
I’m not aware of any account of a triathlon swim fatality that’s in keeping with SIPE as a cause…and I’m not aware of any autopsy findings in the victims that suggest that diagnosis.
Moreover, I’m not aware of reporting on any athletes rescued from a triathlon swim (alive) where SIPE was established with certainty as a diagnosis.
In fact, all of the swim deaths from 2003-2011 had cardiac arrest as an immediate cause.
These others are not as clear and do point out that the connection is not definitive. One could ask, if someone goes into Acute Pulmonary Edema, how healthy was their heart to begin with? Did they actually go into a torsades de pointes rhythm from a prolonged QT syndrome? A Vtach or Vfib?
The problem is that you cannot really capture the data to be able to accurately measure it, so arrhythmia gets the blame without the data to support that in all cases. Bottom line, SIPE does occur and it is quite serious. Even if you are unaware of a death that occurred from it, that doesn’t mean you discount it. As one who has had panic attacks in the water and has EIA, it is interesting to read the studies and find out just how little is known about this stuff.
I think it’s important to be very clear. Above, you asserted that SIPE was statistically more prevalent than heart problems in autopsies of triathlon swim death victims.
That’s simply not true.
I don’t doubt that SIPE exists. That condition has been well-established and the accounts from our fellow triathletes that you mention are simply fascinating.
The piece from Dr. Dressendorfer is also interesting. But it’s important to remember that this is an opinion piece. This isn’t a study. This isn’t presenting autopsy information from victims. The author’s background is such that the article deserves our attention, though. It’s most useful for the discussion about SIPE physiology.
Lastly, you questioned the data about arrhythmias. It is a fact that all but 2 of the swim fatality victims from 2003-2011 DID have a fatal arrhythmia when they were rescued from the water and the remaining 2 victims were found in asystole some time after the swim portion had ended.
I’ve learned in medicine, and with triathlon!, that anything is possible. And in that sense, SIPE may play a role in these deaths. But I’m very skeptical.
I think it’s important to be very clear. Above, you asserted that SIPE was statistically more prevalent than heart problems in autopsies of triathlon swim death victims.
That’s simply not true.
I don’t doubt that SIPE exists. That condition has been well-established and the accounts from our fellow triathletes that you mention are simply fascinating.
The piece from Dr. Dressendorfer is also interesting. But it’s important to remember that this is an opinion piece. This isn’t a study. This isn’t presenting autopsy information from victims. The author’s background is such that the article deserves our attention, though. It’s most useful for the discussion about SIPE physiology.
Lastly, you questioned the data about arrhythmias. It is a fact that all but 2 of the swim fatality victims from 2003-2011 DID have a fatal arrhythmia when they were rescued from the water and the remaining 2 victims were found in asystole some time after the swim portion had ended.
I’ve learned in medicine, and with triathlon!, that anything is possible. And in that sense, SIPE may play a role in these deaths. But I’m very skeptical.
If you read my post above, you will see that I corrected myself and said that while I don’t doubt arrhythmia is the leading cause, I question WHY they occur in the first place.
A V/Q mismatch will cause physiological problems including arrhythmias, pulmonary edema. The bigger question I have is WHY do these people have these to begin with?
Are people developing SIPE in the water and due to the hypoxia going into an arrhythmia? You can’t really study that because it isn’t a place where you can just go and collect evidence to support the theory for the most part I would think.
The bottom line is that no one really knows. There is a complete lack of information as to why this occurs. At least on dry land (marathons) we have first responders that can work quicker and it is typically a more definitive answer.
Rather than trying to be right here, I am simply asking the questions. It’s not like you can recreate the conditions in a lab and there is only so much information you can gain from an autopsy according to my training partner who is a pathologist. I think it is far too simple to just say “They died as a result of a refractory V-Fib”…no kidding…most people do. WHY did they die as a result of the V-Fib is the real concern.
I dont blame the ny ironman. i only think that this further exacerbated the situation. it didn’t help, that’s all. it wasn’t the only cause, for sure. but, wearing a wetsuit increases constriction of blood vessels in your legs and pools the body’s blood to the core. wearing it for longer makes this process of blood pooling happen for longer.
Hey, I should have started by saying that I am sympathetic to your situation and wish you the very best.
You mean you couldn’t even carry a disposable bag with your wetsuit and lube and wear a disposable sweat/warm-up outfit? Perhaps logistics wouldn’t allow that…if not, perhaps it is good rethinking having/or the logistics of this race!
thanks david. no doubt, i could have figured a way to do just that. but, it didnt occur to me. the race was really logistically complex - we had to take a ferry to transition the day before with most of the stuff we’d need on raceday. it’s an intense period of coordination and packing just the right stuff so i didn’t really get to think about a wide spectrum of things beyond the necessities. i wouldnt have known that was a necessity, or a preferred thing to do, at the time, so it wouldnt have occurred to me anyhow, particularly given that that just adds another layer of things to do pre-race.
but, you’re totally right.
so maybe that should be a lesson here to everyone - try to wait as long as possible to put on the wetsuit. i definitely wish i had!