Deaths in triathletes: immersion pulmonary oedema as a possible cause
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    The altered right/left heart stroke volume balance could play an essential role in the development of immersion pulmonary edema.
    • olivier castagna, Scuba doctor Underwater research team (ERRSO) from the Military biomedical research institute (IRBA) Toulon, France
    • Other Contributors:
      • david mac Iver, Visiting Professor & Consultant Cardiologist

    To the editor,
    The postulated mechanisms of immersion pulmonary edema (IPE) or swimming induced pulmonary edema (SIPE) are not well understood. Most groups agree that an increase of cardiac preload plays a primary role. Several groups have assessed the effects of cold water and exercise on the increase of the filling of the heart right and pulmonary pressure.
    In a recent report by Moon et al1, the authors investigated, in a series of sudden deaths during triathlon training. They identified 58 deaths, of which 42 (72.4%) occurred during the swim. They found that, when compared with healthy triathletes and the general population, individuals who died during a triathlon or in training had a higher prevalence of cardiac anomalies that could predispose to immersion pulmonary oedema (IPO). The authors suggested that triathletes susceptible to IPO may have abnormal myocardial diastolic compliance (lusitropy) -or stiff hearts. They proposed that abnormal left ventricle (LV) diastolic compliance is partly responsible for elevated LV end-diastolic pressure similar to that observed in patients suffering from heart failure with preserved ejection fraction.
    It was shown, in a previous study by Moon et al. in this journal,2 that pulmonary artery and pulmonary artery wedge pressures are higher in SIPE-susceptible individuals during submerged exercise compared with the general population and these pressures are reduced by sildenafil. They confirmed the important role of...

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    Conflict of Interest:
    None declared.