Exercise is associated with many health benefits. Exercise has been shown to be beneficial to those with many medical conditions including established heart disease and prior myocardial infarction (heart attack).1,2
Still, medical emergencies can happen before, during or after exercise. In vulnerable individuals, exercise may even precipitate a medical emergency.3 The intent of this article is to highlight some of the warning signs associated with non-traumatic (I.e. not resulting from a physical injury) medical emergencies that may occur at the gym and discuss how to manage these occurrences. While the target audience for this article is trainers and gym owners, much of the information is relevant to anyone, particularly if they spend a fair amount of time exercising or at the gym.
Risk factors for having a sudden medical emergency are familiar to most people, and include known history of medical conditions like heart disease, diabetes or high blood pressure as well as poor physical condition, obesity and so on, but these risk factors are generally not helpful in deciding when a given individual should seek medical care. If an athlete experiences chest pressure during or after a workout, they should get an ambulance ride to the hospital regardless of whether they are on blood pressure medication with three prior heart attacks or if they are 22 years old, seemingly healthy and came in fifth at the CrossFit Regionals last year.
Much of the information in this article is geared toward identifying symptoms associated with a cardiac event, but medical emergencies include stroke and other vascular events, asthma, choking and many other causes. Every attempt is made to make the guidelines provided apply generally to all situations, but a healthy dose of common sense will also help identify cases where someone needs emergent medical evaluation.
If someone collapses, immediately activate emergency medical services and manage them according to American Heart Association CPR or similar guidelines. If an automated external defibrillator (AED) is available, use it. There is lots of information online at heart.org and everyone is encouraged to at least attend a basic CPR course. The methods are easy to learn and carry very low risk for transmission of disease to the provider if they use hands-only CPR or other modern protocols which de-emphasize the giving of rescue breaths (mouth-to-mouth). This training will help prepare one to deal with the obvious medical emergency of collapse and particularly loss of pulse.
While few people would miss the need for acute medical intervention when someone collapses and doesn’t have a pulse, many medical emergencies start out with less obvious signs and symptoms.
Perhaps the most widely known symptom of a cardiac emergency is chest pain, though people are often reluctant to describe what they experience as pain, instead using terms such as tightness or pressure. Discomfort in the neck or jaw, arms, back or upper abdomen also may be associated with a cardiac event.
Shortness of breath, even without chest discomfort, may be a symptom of a heart attack or other medical emergency. Needless to say, this is a common experience at the gym even for the healthiest individuals during or immediately following a workout. The thing to watch for would be shortness of breath that seems out of proportion to the situation or that lasts longer than expected – patients often complain “I just can’t catch my breath” – or for some characteristic that would not be expected for purely exertional symptoms, such as wheezing in an athlete having an asthma attack.
Unfortunately, many other vague symptoms can be associated with a cardiac event: lightheadedness, sweating and nausea among them. Again, the rule of thumb would be to watch for what seems out of the ordinary for the circumstances.
While less commonly thought of as associated with exercise, strokes also constitute a medical emergency that requires immediate care. Signs and symptoms of a stroke include sudden headache, confusion or difficulty with word finding, slurred speech, visual changes, incoordination and numbness, tingling or weakness particularly on one side of the face or body.
What constitutes a true medical emergency can often be a challenging judgment call, and when in doubt it is best to send the athlete to an emergency department to let the professionals sort it out. Occasionally, individuals may prefer to go to an urgent care or doctor’s office, but these facilities will generally not have the resources to evaluate or manage a true emergency and should be reserved for routine medical care or what are clearly more minor issues.
Individuals may also want to avoid the drama or expense of calling an ambulance. Keep in mind that if the person is experiencing a heart attack or stroke, minutes count, and the amount of time from the start of the event to definitive therapy affects how much heart muscle or brain is lost in the event – often dramatically altering outcome. In the United States and many other countries, the best course is to activate emergency medical services by calling the established emergency number as soon as possible.
Symptoms that, if unexplained or out of proportion to the circumstance, should prompt an immediate visit to an emergency department:
- Chest pain or discomfort.
- Shortness of breath or difficulty breathing.
- Altered mental status.
- Sudden headache (“thunderclap headache”).
- Visual changes.
- Slurred speech.
- Difficulty with word finding, comprehension of language or confusion.
- Numbness, tingling or weakness to one side of the face or body.
Note there are many other reasons to go to the emergency department like abdominal pain, persistent vomiting or many infections. It’s just that the symptoms above are most associated with a very time critical medical emergency.
After a Myocardial Infarction. Retrieved September 27, 2013, from Patient.co.uk: http://www.patient.co.uk/health/Myocardial-Infarction-After-the-MI.htm ↩
Robert A. Kloner, M. P., & Boris Z. Simkhovich, M. P. J Am Coll Cardiol. Retrieved September 27, 2013, from J Am Coll Cardiol: http://content.onlinejacc.org/article.aspx?articleid=1136443 ↩
Murray A. Mittleman, M. M. Triggering of Acute Myocardial Infarction by Heavy Physical Exertion — Protection against Triggering by Regular Exertion. Retrieved September 27, 2013, from www.nejm.org: http://www.nejm.org/doi/full/10.1056/NEJM199312023292301 ↩