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SINGAPORE - Young, fit and in their prime, they die suddenly from heart problems.
A coroner's court on Thursday heard how Mr Malcolm Sng, 22, who collapsed after a half marathon last December, had an abnormal coronary artery which had gone undetected since birth.
Blood flow to the heart muscle was insufficient during physical exertion and he died.
Before him, cases of young people suffering sudden cardiac death during exercise have made news headlines: NSF Joe Foo, 20, who was halfway into a routine exercise and doing chin-ups on Sept 30, 2008; Captain Ho Si Qiu, 25, platoon commander at the Officer Cadet School, who had just finished the Safra Sheares Bridge Run and Army Half Marathon on Aug 26, 2007.
Despite these examples, the number of deaths caused by heart attacks in the younger population 34 years old and below has remained very low in the last 10 years, a Ministry of Health spokesman said, adding that sudden cardiac death rates parallel the rate of heart attacks as most cases are due to blockage in the coronary arteries, which also causes heart attacks.
Among this younger population, there were three deaths from heart attacks in 2011, five in 2010, two in 2009, five in 2008 and three in 2007.
Only in 2002 and 2003 did the high of 10 cases occur.
Still, heart attack deaths have risen in the past few years for those slightly older at 35 to 45 years old, said Dr Dinesh Nair, consultant cardiologist at Mount Elizabeth Hospital.
He added that many of these come in as emergency cases especially following sports activities like football games.
One such case is Singaporean Arulanandan Sundararaju, 37, who had a sudden heart attack at his sister's home in Canberra, Australia, on Oct 30.
The master's degree student and high school teacher had returned from a movie and said he felt unwell. After helping his sister's husband lift a box, he went to his room.
No history of heart problems
No one was around him when the attack struck. Immediate family members reportedly said he never had any history of heart problems.
Sudden deaths during exercise would typically be the result of congenital problems for younger people, said Dr Hsu Li Fern, consultant cardiologist at the Novena Heart Centre.
This includes other electrical heart abnormalities, such as an irregular heartbeat.
For older people, a more common cause of death would be coronary artery disease, where arteries are blocked off, usually by cholesterol deposits, he said.
Cardiologists noted that more young people have been getting check-ups for symptoms of chest pains, palpitations, giddiness or fainting in the past five years, attributing the increase to greater awareness.
They also do so before participating in extreme sports, said Dr Bernard Kwok, president of the Singapore Cardiac Society, who estimated the increase at 20 to 30 per cent.
While more diagnoses are being made, some conditions are very difficult to detect, said Dr Peter Yan, medical director of the Parkway Heart and Vascular Centre.
According to Dr Tan Ju Le, director of the National Heart Centre's adult congenital heart disease programme, the rare condition Mr Sng suffered from would be difficult to detect even through tests such as electrocardiograph (ECG) or the echocardiogram, a heart ultrasound.
Computed tomography (CT) scans may, however, be able to pick up this condition, said Dr Tan.
Dr Yan added that sudden cardiac death would usually occur at the last phase of a run, while a runner attempts to do a "burst".
Dr Ruth Kam, a cardiologist at Mount Elizabeth Hospital, said extreme endurance athletes such as marathoners, cyclists and triathletes are at increased risk of developing heart problems.
"Competitive athletes stress their hearts much more than recreational athletes because they exercise at far greater intensities than normal weekend warriors.
"However people who don't exercise at all are at greater risk of developing obesity, diabetes, hypertension and heart attacks," she said.
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