Identical male twins both suffered a heatstroke during the 26.2-mile (about 42.1 km) London Marathon, according to a new case report.
The case report – published Feb. 5 in the journal BMJ Case Reports – stated that during the event, one of the two 26-year-old twins collapsed at mile 19; the second twin collapsed at the 21-mile mark. Doctors diagnosed both men with exertional heat stroke, according to the report.
Douglas Casa, a professor of kinesiology and director of athletic training education at the University of Connecticut at Storrs, said that exertional heat stroke (EHS) can occur in the absence of high environmental temperatures and it represents an overwhelming of the body’s thermoregulatory system – when a person’s body generates more heat than it can dissipate.
The likelihood of heart stroke to occur in athletes during the summer is higher, but it can also happen when the temperatures are not that high. According to the case report, the temperatures during the London Marathon – which was held in spring – were between 54 and 59 degrees Fahrenheit (12 and 15 degrees Celsius).
Both of the twins had previously run a marathon in under four hours and they were experienced runners. The men had also trained properly prior to the event; they had had enough sleep and were well hydrated. However, the brothers had never run a race pacer before – for which they were asked to run while carrying a backpack that weighed almost six pounds (2.72 kg), the case report stated.
One of the twins was hoping to finish the marathon in 4 hours and 45 minutes, while the other one was pacing hoping to cover the course in 4 hours and 30 minutes. Unfortunately, the faster-paced twin collapsed by mile 19. To cool the man down, volunteers at the medical tent removed his clothes and wrapped him a cold west sheet. The man developed muscle cramps when his body began to cool down, the case report stated.
About thirty minutes after the man was brought to the medical tent, his cramps had stopped, his body temperature had decreased by approximately five degrees and he was alert again. He was released after one hour, when his condition improved significantly.
The second twin collapsed by the 21 mile. When he was brought to the medical tent he showed similar symptoms to his brother: high temperature and leg cramps. He was also discharged after one hour.
During the London Marathon – which had about 38,000 participants – about fourteen runners had exertional heat stroke. According to Casa, a possible explanation as to why both twins experienced exertional heat stroke was the role as pacers.
Some of the factors that may explain the cause of exertional heat stroke even in trained athletes include: use of a new medication, an illness, lack of sleep, running in a new environment, maintaining a new pace, prior history of heat stroke, or dehydration, Casa explained.
Because they were first-time pace racers, the twins might have had a more difficult time in keeping a certain pace, and they might also have been pushing harder than normal. Casa said that the twins probably also have a genetic predisposition to exertional heat stroke – a trait called malignant hyperthermia, which is a genetic trait found more often in individuals prone to exertional heatstroke.
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