Physical activity and sudden cardiac death in elders - a Croatian study [Rekreacijska tjelovježba i nagla kardijalna smrt u osoba starije dobi u Hrvatskoj]

Duraković, Zijad and Mišigoj Duraković, Marjeta and Škavić, Josip and Definis Gojanović, Marija (2011) Physical activity and sudden cardiac death in elders - a Croatian study [Rekreacijska tjelovježba i nagla kardijalna smrt u osoba starije dobi u Hrvatskoj]. Collegium Antropologicum, 35 (1). pp. 103-106. ISSN 0350-6134

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Abstract

The paper deals with the sudden cardiac death in elders due to physical activity in Croatia and to compare it to other population groups who practice physical activity. The data are a part of a retrospective study dealing with 59 sudden death due to physical activity in men in Croatia: from January 1, 1988 to December 31, 2008. Fifteen aged 65 to 82 years were recreationally engaged in physical activity: six in swimming, four in tennis, one in driving a bicycle, one in jogging, two in bowling and one died during sexual act. Only one had symptoms of pectoral angina, two suffered from arterial hypertension, and two had congestive heart failure. Eleven were without symptoms before exercise. At forensic autopsy, fourteen had coronary heart disease, seven had critical coronary artery stenosis, three had occluded left descendens anterior coronary artery and four critical coronary stenosis, four had a recent myocardial infarctions, and eleven had myocardial scars due to previous myocardial infarctions. Twelve of them had left ventricular hypertrophy: 15-25 mm. In Croatia, about 7per cent of the entire male population undertake recreational physical activity, while 13 per cent of them are elders. A sudden cardiac death due to recreational physical activity in elders reached 1.71/100 000 yearly, in the entire male population engaged in recreational physical exercise: 0.75/100 000 (p = 0.05730), in the total male population aged 15-40 engaged in sports and recreational physical exercise: 0.57/100.0000 (p = 0.00387), in young athletes: 0.15/100 000 (p = 0.00000). Medical examination of all elderly persons has to be done before starting of recreational physical activity: by clinical examination, searching for risk factors for atherosclerosis, performing ECG at rest, stress ECG, and echocardiography and to repeat the medical examination at least once a year Physical activity should start with a warm-up period and with a gradually increasing load, and usually not to exceed 6-7 metabolic equivalents (METs).

Abstract in Croatian

U vremenu 1988.–2008. u Hrvatskoj je zabilježeno 59 naglih i neočekivanih smrtnih ishoda za vrijeme ili neposredno nakon tjelesnog vježbanja (<1 sat) u muškaraca u Zagrebačkoj i Splitskog regiji. Petnaest muškaraca dobi 65–82 godine bavili su se rekreacijskom tjelovježbom: 6 plivanjem u moru, 4 tenisom, 1 je vozio bicikl, 2 rekreacijskim trčanjem, 2 kuglanjem, a jedan je preminuo za vrijeme seksualnih aktivnosti. Samo je jedan imao simptome angine pektoris, dva su bolovali od arterijske hipertenzije, a dvojica simptome kroničnog popuštanja crpne funkcije srca. Jedanaest nije imalo simptoma prije tjelovježbe. U 8 provedene su mjere reanimacije, neuspješno. Sudsko-medicinskom obdukcijom, 14 imalo je bolest vjenačnih krvnih žila srca: 5 kritično vjenačno suženje, 2 od njih uz recentni infarkt mišića srca prednje stijenke, 3 su imali začepljenu prednju silaznu vjenačnu arteriju, jedan od njih uz akutni infarkt mišića srca prednje stijenke, 12 imalo je ožiljke mišića srca nakon preboljelih infarkta, jedan je imao difuznu fibrozu mišića srca. Dvanaest je imao zadebljanje lijeve stijenke srca 15–25 mm. U Hrvatskoj se oko 7% muškaraca bavi rekreacijskom tjelovježbom, a od njih oko 13% kronološki su starije dobi. U muškaraca starije dobi u Hrvatskoj stopa smrtnosti iznosi 1,71/100 000 godišnje, što je više nego u ostalog muškog pučanstva koje se bavi rekreacijskom tjelovježbom 0,75/100 000 godišnje, iako razlika nije značajna (p=0,05730). To je viša incidencija nego u pučanstva muškaraca dobi 15–40 godina, koji su uključeni u rekreacijsku tjelovježbu: 0,57/100 000 godišnje (p=0,00387), i viša je nego u takmičarskih mladih sportaša: 0,15/100 000 (p=0,00000). Prije odluke o rekreacijskom vježbanju u svih osoba starije dobi treba provesti liječnički klinički pregled, analizu čimbenika ateroskleroze u perifernoj krvi, elektrokardiograma u mirovanju, tijekom i nakon pokusa opterećenjem, analizu ehokardiograma, kao i periodične preglede najmanje jednom godišnje.

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