Cardiac Anomalies - is something going on or is this normal?

[fmk_RoI]

Over the last few years elite professional cycling has seen a number of riders sidelined either temporarily or permanently with cardiac conditions.

Caveat emptor: The impact of Covid since 2020 needs to be borne in mind when considering this list, as does the fact that it relies on publicly disclosed information and is therefore incomplete both in the number of cases and in their descriptions.

2023: Heinrich Haussler (39, undisclosed anomaly); Jan Polanc (31, undisclosed anomaly); Sep Vanmarcke (34, undisclosed anomaly); Wesley Kreder (32, myocarditis, with cardiac arrest); Nathan Van Hooydonck (27, arrhythmia, with cardiac arrest); Niklas Eg (28, arrhythmia)

2022: Tim Declercq (32, pericarditis); Sonny Colbrelli (33, arrhythmia, with cardiac arrest); Alexis Renard (23, arrhythmia)

2021: Elia Viviani (31, undisclosed anomaly); Zdeněk Štybar (35, undisclosed anomaly)

2020: Jannik Steimle (23, undisclosed anomaly); Patrick Bevin (28, arrhythmia); Serge Pauwels (36, myocarditis); Diego Ulissi (31, myocarditis)

2019: Vasil Kiryienka (37, undisclosed anomaly); Roger Kluge (33, PFO)

2018: none reported

2017: Ramūnas Navardauskas (29, arrhythmia); Lars Boom (31, arrhythmia)

2016: Gianni Meersman (31, arrhythmia); Johan Vansummeren (35, arrhythmia); Michael Rogers (36, arrhythmia)

2015: none reported

2014: Robert Gesink (27, arrhythmia); Olivier Kaisen (30, arrhythmia); Klaas Lodewyck (26, arrhythmia); Nick Nuyens (34, arrhythmia )

2013: none reported

2012: Haimar Zubeldia (35, arrhythmia)

2011: Mario Aerts (36, arrhythmia)

2010: Kim Kirchen (31, cardiac arrest)

2009: Nicolas Portal (29, arrhythmia)

* * * * *​

In addition to these, there's a few cases from the women's peloton, pro-conti, conti, 'cross, MTB, and track where only the newsworthy stories get reported:

2024: Peter Sagan (34, tachycardia); Anna Shackley (22, arrhythmia)

2023: Jarno Mobach (25, arrhythmia)

2022: Azizulhasni Awang (34, AAOCA); Lizzy Banks (31, pericarditis); Audrey Cardon-Ragot (32, stroke caused by undisclosed anomaly); Chloé Dygert (25, tachycardia)

2021: Romain Sicard (33, undisclosed anomaly); Chloe Hosking (30, pericarditis); Sarah Gigante (21, myopericarditis)

2020: Jimmy Turgis (28, undisclosed anomaly); Fernando Barceló (25, tachycardia)

2019: none reported

2018: Grégory Habeaux (35, arrhythmia); Paweł Cieślik (31, ASD / PFO); Tangay Turgis (20, undisclosed anomaly)

2017: Carmen Small (36, arrhythmia)

2016: none reported

2015: Romain Zingle (28, myocarditis)

2014: Will Walker (28, arrhythmia); Niels Albert (28, arrhythmia)

2013: none reported

2012: none reported

2011: none reported

2010: Nicolas Vogondy (32, arrhythmia)

* * * * *​

And then there's the deaths. In 2023 Mark Groeneveld (20), a Dutch rider with the Canadian-registered Conti squad XSpeed United died of a suspected heart attack.

In 2019 Robert de Greef (27), a rider with Conti outfit Alecto CyclingTeam (formerly with Pro-Conti Roompot - Nederlandse Loterij), suffered a cardiac arrest 15 kms into the Omloop van de Braakman, on the first cobbled sector. After being treated at the roadside he was hospitalised but died four weeks later.

In 2018 Michael Goolaerts (23), a rider with the Pro-Conti outfit Veranda's Willems Crelan, died as a result of a cardiac arrest suffered during Paris-Roubaix. In October Jimmy Duquennoy (23), a rider with the Pro-Conti outfit WB Aqua Protect Veranclassic died in his sleep of a cardiac arrest.

In 2016 Gijs Verdick (21), a rider with the Conti squad Jo Piels, suffered a heart attack during a U23 race in Poland and died a week later. Earlier in the year the Conti squad Roubaix-Lille Métropole's Daan Myngheer (22) suffered a heart attack during the Critérium International and died in hospital two days later.

In 2012 Rob Goris (30) of Pro-Conti squad Accent Jobs-Willems Veranda suffered a heart attack during a visit to the Tour de France.

In 2009 Pro-Conti rider Frederiek Nolf (21) died of a presumed heart attack in his sleep while competing in the Tour of Qatar.

* * * * *​

As well as the deaths in the professional ranks, there have been a number of widely reported deaths in the amateur ranks. In 2022 Scottish MTB XC Champion Rab Wardell (37) died in his sleep from a suspected cardiac arrest. Earlier that year Belgian amateur Cédric Baekeland (28), of the Dovy Keukens amateur team, died in his hotel room in Mallorca.

In 2020 Niels De Vriendt (20), of the VDM-Van Durm-Michiels-Trawobo amateur squad, died during a training race.

In 2018 Jeroen Goeleven (25), who rode for one season at Conti level before dropping down to an amateur squad, was found dead in his room by his father and is presumed to have suffered a heart attack.

In 2017 Eslam Nasser (22), an amateur riding for the Egyptian national team, collapsed and died during a track meet. The same year a Belgian amateur, Bjarne Vanacker (20), died in his sleep of a presumed cardiac arrest.

There have also been notable deaths in the ranks of retired riders. In 2020 there was Nicolas Portal (40) ex of AG2R,, Caisse d'Epargne and Sky. In 2009 Steve Larsen (29), a retired pro formerly with Motorola, died of a heart attack while running. (Autopsy disagreed.)

* * * * *​

The number of cardiac cases listed above doesn't necessarily suggest that there is a problem that cycling is failing to confront. Cyclists have always had heart problems: look at Stive Vermaut, Nico Mattan, Bobby Julich; look at Franco Bitossi; look at Eddy Merckx. Look at riders who died, like Marc Demeyer or Vicente López Carril or Tim Pauwels. Cyclists, often times they suffer the same problems as everyone else (even though anti-doping rules deny them the same treatments as everyone else, but that's a story for another day). And the numbers above aren't particularly high when you consider the size of the professional peloton (which includes about 700 riders at WT level, more 500 riders in Pro-Conti squads and more than 2,700 riders in Conti outfits). But, given the myth of the EPO deaths, you tend to notice these things, they tend to stick in the mind, and you want some sort of explanation, preferably one that doesn't just say nothing to see here, move along, one that actually explains to you what is actually at play here.

So, what the hell is going on, something or nothing?

nb: I'll edit the above list if/when additional relevant names are suggested.

 

[Benotti69]

Give them Meldonium


No surprise riders are suffering health effects from taking so much PEDs. CIRC reported some riders taking 30 tablets a day during GTs.

Whatever is causing the heart arrhythmia's will no doubt come out. Probably the same stuff that killed footballers recently.

 

[Merckx index]

Re: Cardiac Anomalies - is something going on or is this nor

I have an arrhythmia, though I’m far older than those cyclists, and the cause appears to be at least partly genetic, as my brother has a similar condition. Still, there are a couple of factors that could be relevant to cyclists:

1) though my symptoms are to a large extent random and unpredictable, the condition tends to get worse in hot weather, presumably because it affects the body’s salt balance. I wouldn’t be at all surprised if pros riding long distances almost every day in sometimes very hot weather would aggravate any tendency they had to begin with, though of course that wouldn’t explain any recent increase in the condition, assuming there is such;
2) I did some searching for possible environmental effects, and found one study claiming that phthalates, components in many plastic water bottles, increased risk. These substances will be familiar to clinic posters, as one of them, DEHP, was once considered as a possible marker for blood transfusions. Phthalates like these contaminate all of us now, from not only water bottles, but plastic wrap used for food, the seat covers in cars, some cosmetics, and other sources as well, and presumably they’re present in higher concentrations in today’s cyclists than those of the past.

Of course, certain PEDs might be factors as well, as Benotti notes. Anything that affects cardiovascular function, like meldonium, might conceivably increase the risk of arrhythmia.

 

[staubsauger]

I had a test course of ADHD drugs (Strattera) this spring and it caused me high blood pressure and fast pulse. Sleeping pills like promethazine lead to prolonged qt intervals of the heart. Beta blockers caused my neighbor serious cardiac arrhythmia.

I ain't surprised at all given the mix of drugs cyclists take regularly. There doesn't even need to be a new doping drug around. If the rumors are true, a mix of prozac, kenalog or lipotropine, benzodiazepines or promethazine, tramadol, beta blockers and coffee + alcohol might cause serious cardiovascular diseases without correct dosage.

Especially the antidepressants+sleeping pills+painkillers combo ain't no good at all! Add the wide variety of doping products cyclists take to that and boom.

 

[DFA123]

Another factor surely has to be better awareness of these conditions, and more thorough screening. I don't have any data to back this up, but it seems logical that riders are being diagnosed with conditions now that would have slipped through the net even 10 years ago, let alone 40 years ago.

As implied in the OP, this number of cases doesn't seem to be massively out of line with what you'd expect from the general population - just that there is a high chance of issues being picked up in cyclists and it has a much bigger (more newsworthy) potential impact on their lives than your average office worker.

 

[Red Rick]

Probably a combination of

Genetics
Doping
Chance
Extreme exercise

 

[fmk_RoI]

Interesting. Five responses and four automatically include doping, either as the primary cause or as a likely cause, and only one considers the perception/detection angle.

 

[ciranda]

Re: Cardiac Anomalies - is something going on or is this nor

Most of the cyclists that have retired due to heart conditions are belgian so it follows that Belgium has more rigid controls. If similar values were applied everywhere I guess more would choose and would have chosen to stop. Otoh it does not seem like other countries have had many still active cyclists die bc of heart problems, thankfully. Two more names: Steve Vermaut and Denis Zanette (not sure if he retired early because of a heart condition).

 

[RedheadDane]

I don't really care what causes it. I just hope that if a rider is advised to stop by his doctor, then he'll do so.

 

[CyclingEnthusiast]

I'm 21, never doped and I have a history of high intensity exercise with rowing and cycling. I have a cardiac arrthymia that was diagnosed as being relatively benign by a doctor after a scan. The arrythymia is a lot more noticeable at a very low heart rate (40ish) which was probably a contributing factor in its diagnosis.

A lot of the time it might go unnoticed in individuals who aren't as highly trained as the arrythmia is harder to detect at the higher resting heart rates, just my little take on it.

 

[fmk_RoI]

Re: Cardiac Anomalies - is something going on or is this nor

Two more names: Steve Vermaut and Denis Zanette (not sure if he retired early because of a heart condition).

You know, this is why I came up with a list, because whenever you try to talk about this, names get chucked in like dollar bills in a strip joint and - like in the strip joint - you get distracted and impressed by the figure. Put years to the names though and you get a very different picture. Neither of those names is within the last ten years.

 

[Benotti69]

Re:

Interesting. Five responses and four automatically include doping, either as the primary cause or as a likely cause, and only one considers the perception/detection angle.

Clue is it is the clinic.

 

[papisimo98]

Kim Kirchen

 

[Huapango]

Re:

Please include Charlie Craig to this list.

 

[fmk_RoI]

Re: Re:

Please include Charlie Craig to this list.

Absolutely not. Now you're just being silly.

 

[King Boonen]

I think in the UK it's about 3% of the population who are known to have arrhythmia. I know this isn't an extensive list but it doesn't seem like it's falling massively out of line with what is thought common. It's also much more likely to be picked up in professional athletes who are much more highly monitored than the general population.


Of course it's possible any or all of those cases could be caused by doping, but you'd need much, much more information to even get close to that being a sensible hypothesis.

 

[fmk_RoI]

Re:

I think in the UK it's about 3% of the population who are known to have arrhythmia. I know this isn't an extensive list but it doesn't seem like it's falling massively out of line with what is thought common.

I ran a version of the list in a book review about cardiac anomalies in mid-life weekend warriors. I had reviewed the book solely because this is an interesting topic. Unfortunately, the book wasn't very enlightening on what the real-world incidence of cardiac anomalies is.

On the numbers front, an earlier book I'd read - one of those out-of-copyright stocking-filler reprints - had this from a nineteenth century physician, George Herschell, which I thought was all kinds of brilliant:

"For whilst the novice, by sheer carelessness may strain his heart - but if under middle age can escape if he will only take the most ordinary precautions - the skilled and trained professional cyclist, on the contrary, who can travel for hours without turning a hair, is almost certain to produce degenerative changes in his heart and arteries."

Herschell went on to use math to prove that the craze of the hour was a crazed mass murderer:

"Of a thousand people over middle age, we may expect to find a hundred whose circulatory apparatus is beginning to show signs of wear. If only fifty out of this thousand take up cycling - and as things go I am sure this is below the average - out of this fifty, five will certainly have affected hearts. And there is no getting away from this fact. It therefore follows that at least five out of every fifty persons over middle age who take up cycling will be almost certain to do themselves grave injury unless they exercise the greatest prudence."

So back in the c19th, let's say you were talking about a problem believed to impact 10% of the population. I think your 3% is probably closer to where it is today.

There are all sorts of questions to ask, I know: does age have an impact (ie of the 3%, are more of them 50-plus than 30-minus?), does lifestyle impact (active versus sedentary). Maybe having figures from other sports would help here, I don't know if anyone's ever actually done that though. With the figures we have for cycling, we do have to ask if this is all of them or are there riders taking time-outs or retiring without sharing the real reason? (And I think we have to acknowledge that the further back we go, the less reliable is the data, more is shared today than was ten or twenty years ago.)

That the numbers don't actually fall out of line with what you might expect was actually the biggest thing that struck me, given that before doing the list I thought the problem was much, much bigger.

But. This is the clinic, as Benotti said. And I don't have an issue with evidence that shows the use of sleeping pills or caffeine or blood transfusions or EPO or whatever is known to have an impact on the incidence of cardiac anomalies. So, if it's out there, let's see it.

 

[King Boonen]

It's just too hard to really draw any conclusion based on the small number of known cases I think. There's much too much missing information and there is no comparable baseline against which it could be judged. Even with the recent high-profile cases of footballers suffering cardiac arrest, the incidence is no higher than in the general population, probably a lot lower.

If we are going to assume that the drugs used in professional sport, and in particular cycling, cause heart conditions, and that drug use is rife, we have to expect a much higher incidence of heart conditions, but there is no evidence for that.

Of course, none of that negates doping at any level, but it does make it hard to use heart conditions as evidence for doping.

On a personal level, I do have to admit that after seriously big, hard rides I sometimes wonder if it was either beneficial or detrimental to my overall health. I do some very big rides, 280km with mates, 200km solo on my fixed wheel etc. and sometimes I'll get home and just feel utterly wiped out.

 

[fmk_RoI]

Re:

If we are going to assume that the drugs used in professional sport, and in particular cycling, cause heart conditions, and that drug use is rife, we have to expect a much higher incidence of heart conditions, but there is no evidence for that.

That is something I think that needs to be considered. If we say that doping causes this problem, why does the real problem appear to be so small?

(If we're not careful here, we'll prove there is no doping and have to close the Clinic down.)

 

[Huapango]

Re: Re:

Please include Charlie Craig to this list.

Absolutely not. Now you're just being silly.

It wasn't meant to be silly. Although not an elite professional, one could argue he was an elite junior. http://www.c-r-y.org.uk/charlie-craig/

 

[Merckx index]

Arrhythmia definitely increases with age. I remember a review saying it affected I think 1-2% of American adults over 60, with the % increasing with age. This is entirely to be expected for what is basically a degenerative disease.

Keep in mind, though, that this is not a circulatory problem. To make an analogy with physical systems, it's not the plumbing, it's the wiring. Arrhythmias, at least the most common kinds, result from electrical impulses that cause heart contractions beginning or continuing at places they normally don't. I mention this because it's not obvious that the enormous stress placed on the circulatory system by pros training and racing would put one at increased risk for this problem. I'm not saying this isn't possible, but there's no particular reason why it should, and no evidence for it that I'm aware of.

 

[red_flanders]

I have a benign arrhythmia. Dehydration, caffeine, stress, and some other factors can make it flare up. Seems like the kind of thing that would generally be exacerbated by cycling. No idea if that is a complete explanation for these instances, and no idea if there is any increase over time in the number of issues with arrhythmias in the pro cycling population.

Not sure how that would ever be determined given the often shady nature of "medical" professional practice in cycling. Truth in medical records not exactly being at a premium in this sport...

 

[fmk_RoI]

Re:

Arrhythmia definitely increases with age. I remember a review saying it affected I think 1-2% of American adults over 60, with the % increasing with age. This is entirely to be expected for what is basically a degenerative disease.

Keep in mind, though, that this is not a circulatory problem. To make an analogy with physical systems, it's not the plumbing, it's the wiring. Arrhythmias, at least the most common kinds, result from electrical impulses that cause heart contractions beginning or continuing at places they normally don't. I mention this because it's not obvious that the enormous stress placed on the circulatory system by pros training and racing would put one at increased risk for this problem. I'm not saying this isn't possible, but there's no particular reason why it should, and no evidence for it that I'm aware of.

While I did read the Haywire Heart book, excuse if much didn't actually register. But one of the issues here is a build up of scar tissue that effectively blocks the electrical pulses, correct? And the causes of that scar tissue are many and various, yes?

You mentioned a genetic connection, in an earlier comment. I have seen in several places people saying don't look to elite athlete's hearts because the genes that get them to the top could also be a factor there. (This is likely to be said in response to pointing out the (good) mortality statistics and the like for ex cyclists.)

 

[armchairclimber]

Two athletes I am involved with have heart conditions. I know of one other nearby and one friend who is an ex-endurance athlete. two of them have conditions associated with their lives as athletes (bradycardia and arhythmia) the other two from genetic disease that they were unaware of until things went badly awry. None take PEDs, legal or otherwise. "Athlete's heart" issues are not uncommon.

 

[Benotti69]

Re: Re:

If we are going to assume that the drugs used in professional sport, and in particular cycling, cause heart conditions, and that drug use is rife, we have to expect a much higher incidence of heart conditions, but there is no evidence for that.

That is something I think that needs to be considered. If we say that doping causes this problem, why does the real problem appear to be so small?

(If we're not careful here, we'll prove there is no doping and have to close the Clinic down.)

Bit of a leap to assume that Doctors ( team or otherwise) who give riders PEDs of varying doses for alleged conditions or no conditions just purely to enhance performance give a fig about arrhythmia's. I guess it would have to be a pretty serious arrhythmia before an athlete or Doc is going to say stop and rest or retire, never mind team owners wanting to pay athletes to sit out any time......

The peloton could be full of guys with mild 'health conditions' due to the PEDs but most of them are not going to stop racing because of it.