Kirchen has heart attack

[ProfRichie]

As a member of a major trauma unit, it's amazing how many cyclists we see each week- often really competent amateur racers, rarely the dainty commuters. So I suspect, if Pro cycling is counted as an occupation (which is certainly should be- it's how they earn their money), then it would definitely be in the top 10 most risky occupations. Looking at the above posted web page, most of that top 10 list are in the realms of 10% injury rate. Cycling is way above that, with well over 16 of the 160-200-odd starters of a Grand Tour having suffered a crash related injury that year.
Secondly, the cause for poor Kim Kirchen's "collapse" is a mystery to us all right now. In response to my esteemed colleague's informative post re: potential causes, I'm not sure about the hypertrophic cardiomyopathy differential. Ventricular hypertrophy obviously does occur in athletes. However, the etiology is very different to the hypertension patient. In elite rowers for instance, the significant hypertrophy exists with preservation of the ventricular lumen size. the theory being that high intrathoracic pressure generated during the initial "curled up" catch phase of the stroke plus strong muscle contraction alters the way the muscle hypertrophies. This position is very similar to cycling in the drops or TT and I would assume a similar mechanism. If I dig up the reference, I'll post it. What a great topic for a work-related "conference" in some ski resort or Mallorca in summer!
I agree, PE is less likely as is AMI. My money is on the same arrythmia problems he had previously. As was mentioned, this fits with a sudden collapse.
What ever the cause, the fact is that this poor fellow is in a lot of strife medically and the last thing anyone needs (ie. his family, the people who count here) is the instant conclusion that every collapse equals doping.

 

[Anonymous]

jesus h christ.. someone gets taken to hospital and everyone cries doper..
the guy is seriously ill, possibly life threatening/affecting.. catch the guy a break until hes better..

 

[onefastgear]

ProfRichie - your point is well taken with regards to ventricular hypertophy, and when I think about underlying principles it makes sense that more is involved than just peripheral vascular resistance as seen in the hypertensive population - I neglected to think about intrathoracic pressure and therefore transcardiac pressure. So, it is sort of like repeated Valsalva manoevures?
Ventricular hypertrophy without increasing LV size would decrease afterload, as venticular wall tension would fall. That makes sense from an evolutionary standpoint; increased stroke volume without needing to dilate the LV.
This is an interesting topic, and would be a good debate at a physiology conference (somewhere like Alpe d'Huez in July would be nice).

 

[Willy_Voet]

This leads me to wonder, is too much of a good thing bad for you?? I always think of pro cyclists as being so very healthy, with the healthiest hearts around, but are they actually destroying themselves by performing at such extreme levels for so many years?? This makes me worry about riding my bike too much! Do pro cyclists live shorter lives because they use their hearts too much?? scary stuff!!

Like all things, exercise in moderation is good, but too much is like a chronic illness. Lots of studies on this. Check PubMed, search "chronic+exercise+cortisol" and refine by reviews. You can just read the abstracts and get the gist of the review. I put in cortisol, but you could put in any hormone/molecule (growth hormone, testosterone, insulin, etc.).

An interesting one was "Effect of dietary intake on immune function in athletes."

 

[Polish]

As a member of a major trauma unit, it's amazing how many cyclists we see each week- often really competent amateur racers, rarely the dainty commuters.

ProfRichie, I'm guessing your "major trauma unit" is on the Island of Tenerife?

So I suspect, if Pro cycling is counted as an occupation (which is certainly should be- it's how they earn their money), then it would definitely be in the top 10 most risky occupations. Looking at the above posted web page, most of that top 10 list are in the realms of 10% injury rate. Cycling is way above that, with well over 16 of the 160-200-odd starters of a Grand Tour having suffered a crash related injury that year.

ProfRichie, the top 10 risky occupations is a ranking by Deaths on the job.
Getting sucked into a buzzsaw etc, NOT road rash, broken collarbones, or squirts.

What a classy way to start a post

And I said sport. I am perfectly aware that there are far far worse jobs out there.

The Hitch, if it makes you feel any better, me and many other forum members are keeping Mr Kirchen in our prayers.

 

[Martinello]

snip

Other conditions that may lead to susceptability for problems include long QT syndrome.

snip

Thanks for an informative post - I'd like to add to #2 that arrhytmias in (former) athletes are not uncommon, especially atrial fib. Aerobic exercise induces not only ventricular hypertrophia but also sub-clinical inflammation in myocytes. Inflammation may lead to fibrous scarring of the myocardium making it more suspectible to disfunctional propagation of the electrical impulses = arrhytmia.

Atrial fib wouldn't cause a cardiac arrest (ventricular arrhytmia) as seen in Kirchens case. I would at least consider a prolonged QT interval as a contributing factor to the cardiac arrest. Prolonged QT interval has numerous aetiologies, some of these suitable for a thread in the clinic.

 

[sportzchick]

Just read up on this - any news?

 

[ProfRichie]

Agreed, the deaths per head of population make Pro cycling well down the list of dangerous occupations. But certainly up there in the injury stakes. I think my idea for a conference in the "unbearable" location of the Alps in summer has been previously taken. Anyone noticed the 'Cycling medicine and physiology' conference in Adelaide at Tour Down Under time? Not exactly Bourg d'Oisans, but the only place where you can watch a stage and ride home with the Pro riders as they ride back to their hotel.

 

[craig1985]

Poor bloke, I hope he recovers. We had a local racer, who was in his early 20's who died in early 2007 (raced in France as an amateur) of a heart attack, and everybody who knew him inside out said he was 100% clean. So I really do wish Kirchen the best.

 

[MadonePro]

In response to my esteemed colleague's informative post

Got love that comment. Junior anaesthetic reg, within first 2 years of training. About to do Physiology exam, probably failed the Pharmaceuticals one. Only 4 years to go before we let him loss on his own.

Hmmm yet another medic who believes there own press!

 

[rgmerk]

This leads me to wonder, is too much of a good thing bad for you?? I always think of pro cyclists as being so very healthy, with the healthiest hearts around, but are they actually destroying themselves by performing at such extreme levels for so many years?? This makes me worry about riding my bike too much! Do pro cyclists live shorter lives because they use their hearts too much?? scary stuff!!

Pro athletes of many types do themselves long-term damage. American pro footballers seem to be giving themselves Alzheimer's at rates far beyond the general population from using their heads as battering rams, for instance.

It wouldn't be at all surprising if a sport that demands more from the heart muscle than just about any other could cause long-term problems.

That said, the risks of spending your work sitting at a desk and at home sitting on the couch eating junk food are also serious and very well established.

It would be an interesting thing to do a study of the health of former pro cyclists; there may well be some such in the sports medicine literature.

 

[born65]

statement in french:
http://kimkirchen.lu/cms/index.php?option=com_content&task=view&id=155&Itemid=1

recover well, please your kids will need you
(his wife is assumed to give birth to twins next week)

 

[Tubeless]

I agree. I know several cyclists that had arythmia problems and it was scary for them. One got a heart valve nerve that was mis-firing neutralized in an equally scary procedure and continues racing today. Kirchen needs some air for the time being.

If the earlier post about Kirchen having had an operation earlier this spring to correct a heart issue is correct, he's likely suffering from a heart rythm problem that can cause the symptoms reported. I have two xc-skier friends, both in their 40's that had a procedure to "zap" a nerve that was providing incorrect instructions to the heart, causing irregular heart beat at random times. Here's some background on this condition:

http://www.sciencedaily.com/releases/2010/02/100209200756.htm

The trigger for this condition can be a long pause (4-5 weeks) from training - e.g. due to illness. Blood volume drops and the heart, used to being stretched from within with ample amount of blood, loses is suppleness, like a balloon that has lost some of its air. The nerves that control the heart rythm may get confused, and the symptoms can vary from having a heart rate of 120 at dinner table (my friend's case) to not getting enough rpms out of the engine during a workout.

 

[ulrikmm]

I am a cycling fan and a cardiologist.Kirchen seems to have been resuscitated from cardiac arrest. Probably he did not wake up afterwards hence the hypothermia treatment to reduce brain damage. The reasons for his condition most probably is ventricular tachycardia/ibrillation. He has fainted before, and has been found unconsciuous previously on the road. The typical causes of sudden death in athletes are hypertrophic cardiomyopathy, arrythmogenic right ventricular cardiomyopathy, congenital coronary artery anomalies. Other causes of death in the young include atrial fibrillation in the presence of an accessory atrioventricular pathway, and long QT syndrome. With a resting ECG, an ambulatory ECG recording, and an Echocardiogram, you should be able to diagnose th majority of patients with these conditions ... sooner or later. Regrettably sometimes these conditions are diagnosed too late. I hope Kirchen will make it through in good shape. Hypothermia definitely helps.
ulrikmm

 

[Christian]

Being from Luxembourg I have followed Kim Kirchen's career for a long time and he has always been one of my favourite riders.

It is true that his former teams Fassa Bortolo and T-Mobile were shaken by doping scandals, but Kim has a much cleaner vest than Fränk Schleck, he was never involved in any scandal.

However he has always had to fight with health problems. In the beginning of his career he had serious problems with his back. At T-Mobile they worked out the perfect position for him, and he continues to this day to do a special workout for his back every day.

This season he has been battling with these problems since Tour des Flandres. Nothing could ever be diagnosed despite unnumerable tests. I did not know of his heart surgery, for some reason that was not shared with the public until now. During the Amstel Gold he almost fainted, couldn't breathe proberly ... so I was shocked when I heard about his heart-attack but not very surprised. One could almost have seen it coming - therefore I think it has nothing to do with PEDs.

It was going better ever since Tour de Luxembourg, he said his form was improving ... but I think he tried too hard, he was on the point of losing his TdF spot and wanted to impress the DS. He really forced himself in Suisse and might have ignored some of the alarm signs of his body because of the pressure he was under.

This story is especially terrible because Kim Kirchen's wife is pregnant with twins and if I remember correctly they are supposed to be born at the end of this month/beginning of July ....

Get well soon Kim !!

 

[BroDeal]

Okay, this is actually pretty scary. If someone as "checked out" as I assume KK has been can have problems like this then it makes me wonder about Joe Average Cyclist.

 

[onefastgear]

Got love that comment. Junior anaesthetic reg, within first 2 years of training. About to do Physiology exam, probably failed the Pharmaceuticals one. Only 4 years to go before we let him loss on his own.

Hmmm yet another medic who believes there own press!

It's easy to be a critic and hide behind the anonymity of the internet. Not sure why you've chosen to attack my credibility - I was just hoping to clarify a few things for the non-medico readers of this forum.

Yes, I am an Anaesthetic Registrar, about to sit the Primary Exam. I am sitting them separately, by choice, as I have a life outside work, and want to keep it that way. No, I have not failed the Pharmacology exam.

Apart from eight years at university, a degree in Medical Science and Honours in Medicine, systems-level physiology research leading to authoring and co-autoring articles in peer-reviewed journals, and five years post graduate experience in critical care, I don't know what else you want from me before I post here.

Critique my hypotheses (for that is all they are), but don't belittle my training, qualifications, or my ability without knowing anything about me.

I welcome your reply, but I think we should keep this thread OT. If you want to discuss this further, PM me.

 

[greenhulk]

The indication of PED use of course is relevant, but is IMO off the mark in this situation. There has been way to many heart attacks involving endurance athletes last several years: Ryan Shay, Salazar(lucky) Steve Larsen, Darryl Kollai, Patrick Bell, Daniel Bennett, Mike Janelle. Three alone in Detroit Marathon last year!


http://eurheartj.oxfordjournals.org/content/24/16/1469.full

 

[Christian]

Extracts from articles of today:

"Team Katusha was staying at the hotel "Sonne" in Dürnten, after the stage that arrived at Wetzikon. As usual, the team ate dinner together, then the riders went to bed. Before going to bed, Kirchen went to the restaurant of the hotel and sat down with his father Erny, Marc Joseph (a friend of the family), and three journalists who all stayed in the same hotel.

At 23:30, there was a lot of commotion all of a sudden: Joaquin Rodriguez, roommate and goot friend of Kirchen's, stormed out of their room and was screaming for the team doctor to come quickly. Kirchen was unconscious, laid on his back on the ground and could hardly breathe. Team doctor Mikhailov entered, and seconds later Kirchen gave no life signs: his heartbeat and pulse had stopped. The doctor immediately performed CPO, and Marc Joseph, a retired firefighter, tried to reanimate the rider with a breathing-bag (not sure what the exact translation of this is: "Beatmungsbeutel").

It took 20 minutes for the ambulance to arrive; two paramedics now took over control in Kirchen's room, and an emergency doctor - a renomated expert in cariology - was also present. They were now fighting for Kirchen's life behind closed doors.

Meanwhile on the hall the mood could not have been ghostlier. Katusha DS Serge Parsani, some riders (Robbie McEwen, J. Rodriguez, A. Kolobnev), members of the team staff, two journalists who happened to stay in the same hotel and Kim's father were anxiously awaiting news of the rider's state. When everyone already started to fear the worst, the emergency doctor came out: "We could stabilise his condition. Heartbeat and pulse are back. There is no reason to panic."

At 0:25, he was transported from the room, with an oxygen mask on his face, into the ambulance. During the drive to the University Clinic of Zurich, his condition could be further stabilized. First tests were run that night and the possibilty of an infarctus or a thrombosis could be excluded as cause for the heart attack. As a precaution, Kirchen was put into an induced coma, in which he still is.

A positive piece of information comes of Kirchen's luxembourgish cardiologist Charles Delagardelle: "When Kirchen arrived in the hospital, they artificially reduced his body temperature. This is done in order to improve the patient's brain acticity. This is always a very critical moment, but Kim's body reacted well to the treatment. However we have to wait and see whether his brain was damaged. It could be that we'll only know in three to four weeks"."

This was an extract of an article from today's Luxemburger Wort.

They also updated their web article at 17:30 today:

"Kim Kirchen's neurological condition is still unknown. However, many important body functions have improved throughout the day, says Charles Delagardelle, who is in contact with the swiss doctors. "There has been a slight improvement", Delagardelle said to Radio DNR. A pump which supported the heart could be removed and medicine could be reduced.

The coma will be reduced little by little over the next few days. Only when Kirchen is fully awake, one can examine his neurological condition."

Taken from: http://www.wort.lu/wort/web/sport/a...kirchen-in-ein-kuenstliches-koma-versetzt.php

Note: I am not a professional translator and there might be other terms for some of the specific medical treatments so feel free to correct me!

 

[Publicus]

So technically Kirchen died and was revived. Dam...I hope for his family's sake, he's able to recover.

 

[Christian]

Another article from Tageblatt:

"In top sports, sudden deaths of athletes due to heart failure are no rarity. 2003 was a tragical year fro cycling.

Before the start of the Deutschland-Tour, frenchman Fabrice Salanson was found dead in his hotel room in Dresden at 23 years of age. Cause of death: heart attack. The same year Italian Denis Zanette and Spain's José Maria Jiménez died because of heart failure outside of racing.

An inflamation of the heart muscle due to a virus was the cause of German runner René Herms' death in 2009. He was found dead in his appartment at 27 years of age.

The deaths of well-known football players attracted a lot of media attention in the last few years. Marc-Vivien Foé collapsed during a game of Cameroon's national team in the 2004 Confederation's Cup and died of heart failure. One year later Hungarian Miklos Feher died during a game of his team Benfica Lissabon at the age of 24 because of a heart attack. The last prominent case was that of Spain's Antonio Puerta, captain of FC Sevilla, who died three days after suffering a cardiovascular arrest on during a game, at age 22.

Even former top athletes have died of heart failure: Austria's former national football player Bruno Pezzey died in 1994 while playing ice hockey, at age 39."

 

[craig1985]

so technically kirchen died and was revived. Dam...i hope for his family's sake, he's able to recover.

+10000000000000000000000

 

[TRDean]

Get well Kim!! Very troubling...you and your family are in my thoughts!

 

[Beech Mtn]

It sounds like it is very fortunate that this happened before Rodridguez fell asleep. If this had happened later during the night, when everyone was sound asleep, he might not have been found until morning, and been another sad story from cycling.

Hopefully he can make a recovery and be around to see his children grow up. Hopefully his poor wife is holding up OK too. What a terrible thing to happen.

 

[Black-Balled]

Best wishes from the USA, Kim.