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So should we be advising patients to avoid extreme sports and marathon runnning? There have been 10 deaths during the London marathon since its inception in 1981 (no data on the week or so after). The last death was in 2007 when a 22-year-old fitness instructor died of hyponatraemia,presumably due to overdrinking. Most fatalities are due to undiagnosed underlying heart problems (would that be conduction problems in the young?)
Given the numbers running, the fatality rate is reassuringly low. I suppose the question is whether an ecg to check for conduction defect and/ or echo to look for cardiomyopathy are worthwhile before embarking on training for a marathon. The pick up rate's going to be very low but is there any down side (apart from time,money and false reassurance)? Certainly, if there's a family history of sudden death, should we suggest investigations?