With marathon season underway, runners everywhere are pushing their limits. But with sudden collapses and medical emergencies on the rise during long-distance events, prioritising heart health and proper training protocols is vital. Doctors emphasise that crossing the finish line should never come at the expense of your health.
Two recent marathon deaths—a 36-year-old software engineer in Hyderabad and a 24-year-old former college field hockey player in Pennsylvania—have sent shockwaves through the running community.
Kommineni Gopi, a 36-year-old IBM software engineer, successfully completed the 42.2 km Hyderabad Hi-Tech Full Marathon and received his finisher medal. However, while walking toward the refreshment zone shortly after crossing the finish line, he collapsed.
Rachel Apa, a 24-year-old former Division 1 college athlete from Pennsylvania, collapsed near Mile 24 (around Central Park) during the New York City Marathon. She was running her very first marathon to raise funds for Parkinson's disease research in memory of her late grandfather.
She collapsed Less than two miles from the finish line, she collapsed on the course. A bystander initiated CPR before race medical staff intervened with a defibrillator, transferring her to Mount Sinai Hospital. Later, doctors confirmed that her death was caused by rhabdomyolysis, a condition in which the heart muscle breaks down.
What is rhabdomyolysis?
According to Cleveland Clinic, Rhabdomyolysis is a life-threatening condition that can happen after an injury or excessive exercise without rest. It is a rare muscle injury where your muscles break down, which leads to muscle death.
What are the causes of rhabdomyolysis?
Causes of rhabdomyolysis include:
*Injury or trauma
*High-intensity exercise
*Severe dehydration and overheating
*Antipsychotic, antidepressant and antiviral medications
*Substance use disorder
*Long periods of inactivity
*Certain medical conditions, including genetic or metabolic
Marathons are not dangerous
Studies have estimated approximately one cardiac arrest for every 1,00, 000 to 2,00,000 race participants.
Preparing for and running a marathon demands physical endurance and strict health monitoring. High muscular fitness does not automatically guarantee cardiovascular safety, so runners should keep several medical and operational safety principles in mind:
Dr Praveen M., a cardiologist based in Bengaluru, said that in runners older than 35 and 40 years, hidden coronary artery disease is the most common cause of exercise-related cardiac arrest. "Marathons need preparation; they cannot be treated as a casual weekend activity," he said.
Also, screening for hidden risks is important, as asymptomatic coronary artery disease or congenital conditions like hypertrophic cardiomyopathy (in younger runners) can go unnoticed at rest.
"If you are over 35 and you are entering your first marathon, or have a family history of heart disease, then better to take an ECG or an exercise stress test before embarking on a intense training block," said Dr Praveen.
Running a marathon while recovering from a viral infection (such as the flu or COVID-19) can trigger viral myocarditis (inflammation of the heart muscle), significantly increasing the risk of arrhythmias, said Dr Ashwini Kumar, an ENT specialist in Chennai.
Recognise the warning signs
Medical experts warn runners never to push through red-flag symptoms. Discontinue the race immediately if you experience chest tightness, sudden severe breathlessness, or neurological warning signs such as dizziness, confusion, and blurred vision. Similarly, severe muscle pain accompanied by dark, tea-colored urine should never be ignored—it is a classic symptom of rhabdomyolysis and requires immediate medical attention.
*Avoid over-hydration: Drinking excessive amounts of plain water without replenishing electrolytes can dangerously dilute blood sodium levels, leading to brain swelling, confusion, and collapse.
*Alternate plain water with sports drinks containing sodium and potassium.
*Monitor weight: Weighing significantly more after a race than before is a sign of fluid retention and over-hydration.
Post-race cool-down safety
Keep walking after the finish line: Stopping dead in your tracks causes blood to pool in your lower extremities, causing a sudden drop in blood pressure that leads to fainting or cardiac strain. Keep walking for 10–15 minutes after crossing the finish line to allow your heart rate to settle gradually.
Refueling: Consume carbohydrates and proteins within 30 to 60 minutes post-race to begin muscle recovery and prevent systemic fatigue.
