運動猝死前有身體會有哪些訊號
The recent death of the tech executive Dave Goldberg, reportedly during a treadmill workout on a vacation, has saddened and rattled the fitness community. The death of Mr. Goldberg, the chief executive of SurveyMonkey and husband of Sheryl Sandberg of Facebook, has left many people wondering if the exercise itself might have triggered a serious health event. Was it a heart attack? Another health problem? An unfortunate accident?
數月前，科技企業高管戴夫·戈德堡(Dave Goldberg)度假期間在跑步機上鍛鍊時突然去世的消息，令健身圈的人悲痛之餘也引發一片慌亂。戈德堡先生是SurveyMonkey公司的首席執行官，太太是Facebook首席運營官雪莉·桑德伯格(Sheryl Sandberg)；他的死亡讓許多人開始懷疑運動本身可能引發嚴重的健康事件。他究竟是死於心梗，還是其他健康問題？又或者，這只是一場不幸的意外事故？
While the circumstances surrounding Mr. Goldberg’s death are not fully known, the science on exercise and sudden death is both comforting and troubling. Someone who exercises has a much lower risk of dying from heart disease than someone who doesn’t. At the same time, it’s also true that during exercise, a person has a slightly higher risk of having a heart attack than when he or she is just sitting quietly in a chair.
雖然戈德堡先生的死亡詳情並不完全爲外人所知，不過，關於運動和猝死的科學中令人安心和不安的信息兼而有之。與不鍛鍊的人相比，從事體育鍛煉者因心臟病死亡的風險要低得多。另一方面，人在運動時發生心肌梗死的風險比安靜地坐在椅子上時略高，這也是事實。
To learn more about the relationship between exercise and heart risk, I spoke with two experts on the topic: Dr. Michael Blaha, the director of clinical research at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins Medicine in Baltimore, and Dr. Paul D. Thompson, the chief of cardiology at Hartford Hospital in Connecticut. Here are edited excerpts from our conversation.
爲了進一步瞭解運動與心臟病風險之間的關係，我與兩位專家討論了這個話題。他們分別是：巴爾的摩約翰斯·霍普金斯醫院Ciccarone心臟病預防中心(Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins Medicine)的臨牀研究部主任邁克爾·布萊哈(Michael Blaha)博士，以及康涅狄格州哈特福德醫院（Hartford Hospital）的心臟科主任保羅·D·湯普森(Paul D. Thompson)博士。以下是我們的對話節錄。
Q.
問：
How frequent are heart attacks, especially fatal heart attacks, during exercise?
在運動時，發生心肌梗死，尤其是致命性心肌梗死的可能性有多大？
A.
答：
Dr. Paul Thompson: They’re quite rare. Back in 1982, we published a study in JAMA, among the first on this topic, I think, where we tallied all of the deaths during jogging that had occurred in Rhode Island over a six-year period. We found that there was about one death for every 15,000 joggers. Since then, other studies have shown approximately the same number of deaths per number of joggers.
保羅·湯普森博士：這兩種情況都非常罕見。早在1982年，我們就在《美國醫學會期刊》(JAMA)上發表了一項研究，我想這或許是關於這個主題最早的研究之一。在該研究中，我們合計了6年時間羅德島州所有的慢跑時死亡案例。我們發現，大約每1.5萬名慢跑者中就會有1人死亡。此後的其他研究得出的慢跑者中的死亡率與此大致相同。
Q.
問：
But heart attacks during exercise do occur?
但是，在運動時確實可能發生心肌梗死，對吧？
A.
答：
Dr. Thompson: Yes, obviously they do. There’s no doubt that exercise substantially reduces the risks over all that someone will develop heart disease, but it doesn’t prevent them altogether. It’s important to understand, too, that deaths during exercise among young people are not usually due to atherosclerosis, but to previously undetected, inherited abnormalities, such as an enlarged heart. In older people, especially men, deaths during exercise are generally due to atherosclerosis, or narrowing of the heart arteries.
湯普森博士：是的，的確會發生。運動毫無疑問能大大降低患心臟病的總體風險，但它並不能杜絕心臟病。此外，大家需要了解的很重要一點是，年輕人在運動中死亡通常不是因爲動脈粥樣硬化，心臟肥大等此前未被發現的遺傳學異常纔是主要的死亡原因。而在老年人，尤其是男性中，運動中的死亡一般是動脈粥樣硬化，或心臟動脈狹窄造成的。
Q.
問：
Why would exercise lead to a heart attack in someone who’d been exercising? Wouldn’t they and their hearts be accustomed to the exertion?
爲什麼即使是在堅持鍛鍊的人當中運動也會導致心肌梗死？他們和他們的心臟不是應該已經習慣於體力消耗了麼？
A.
答：
Dr. Michael Blaha: Exercise is a form of stress, and like any stress, it stimulates reactions in the cardiovascular system that can abruptly overburden that system, even if it’s withstood those stresses before. The same thing can happen if you get too little sleep, or you’re rushing down the hall to make it to a meeting, or you’re under a lot of mental pressure. We had a doctor here, a woman, who was having a very difficult, busy day and started having pain in her left shoulder, which she ignored. It was a heart attack associated with mental stress. It’s not that there’s something unique about exercise that triggers heart attacks. It’s just another kind of stress.
邁克爾·布萊哈博士：運動是一種應激形式，像任何應激因素一樣，它會刺激心血管系統的反應。有時候會突發性地造成心血管系統超負荷——即使之前它可以承受這些應激壓力。如果你睡眠太少，或者急匆匆地衝下大廳趕着開會，又或者正承受着很大的精神壓力，都可能發生同樣的事情。我們這裏有一位女醫生，有一天她特別辛苦忙碌，還開始覺得左肩疼痛，但她忽略了這一點。結果這正好就是一次與精神壓力相關的心肌梗死。並不是運動中有什麼特殊的東西會觸發心肌梗死，它只是另外一種應激壓力罷了。
Q.
問：
Will an exercise stress test pick up heart problems?
運動負荷試驗(exercise stress test)能否發現心臟問題？
A.
答：
Dr. Thompson: The problem with an exercise stress test is that it identifies any narrowing of the arteries that already exists. But most exercise-induced heart attacks occur because a plaque abruptly ruptures, causes a blood clot and blocks the artery at that moment. An exercise stress test won’t predict these kinds of lurking heart problems. The best prevention is to pay attention to what your body is telling you.
湯普森博士：運動負荷試驗的問題在於它只能發現業已存在的動脈狹窄。但運動引發的心肌梗死大多是因爲斑塊突然破裂，導致臨時出現血栓並阻塞動脈。運動負荷試驗無法預測這類潛在的心臟問題。最好的預防方法就是多多注意自己身體發出的警訊。
Q.
問：
So what are the symptoms that someone who exercises should be most aware of?
那麼，人在鍛鍊的時候應該警惕哪些症狀呢？
A.
答：
Dr. Blaha: Obviously, chest pain associated with exercise, especially if it’s persistent; any shortness of breath that you haven’t felt that before; numbness or tingling in your left arm or jaw. Those are the easy warning signs. But there are usually subtler signs, too. I’ve had so many patients tell me, “I just couldn’t run the way I could six weeks ago.” They’ll think that they had a cold. But unusual fatigue is a sign you shouldn’t ignore. If you can’t cover the same distance that you could a little while before, see a doctor. You may have a cold. But you also might not.
布萊哈博士：顯然你需要注意與運動相關的胸痛，尤其是持續性胸痛；此外，如果出現了之前從未有過的氣短、左側手臂或下顎麻木、刺痛等，也需要多加小心。這些身體警訊都比較明顯，不過，也有些就沒那麼容易察覺。有很多患者曾跟我說過：“當時，我只是覺得怎麼也跑不到六週前那樣的水平了。”他們還以爲自己感冒了。但是，異乎尋常的疲勞是種不該被忽視的跡象。如果你發現你跑不了之前那麼遠，請儘快去看醫生。你可能是感冒了，但也可能是出了別的問題。
A.
答：
Dr. Thompson: I tell people, if you have discomfort during exercise that develops anywhere from around your earlobe to your belly button, that could be heart disease. It could be something insignificant, too, but it should be checked.
湯普森博士：我告訴人們，在運動時，上至耳垂附近下至肚臍周圍，這之間的任何部位出現不適都可能是心臟病的體徵。當然，也可能只是些微不足道的小毛病，但一旦出現這種情況，你就應該去做下檢查。
Q.
問：
Is it fair to say, though, that, over all, the benefits of exercise for the heart — and the rest of the body — outweigh the small risk of a heart attack during a workout?
儘管如此，但我們可以說，運動對心臟以及身體其餘部位的益處遠遠超過了在鍛鍊過程中出現心肌梗死的小小風險，對麼？
A.
答：
Dr. Blaha: Yes, although I’d argue that what’s really important is not exercise, per se, but fitness, meaning your body’s aerobic capacity. We published a study in February showing that there is no upper limit to the mortality benefits of fitness. The more fit you are, the less likely you are to die early — of a heart attack or anything else. Compared to the benefits of being fit, the transient risk of a heart attack during any given session of exercise is very slight. That doesn’t mean it can’t happen. But it is not a reason to avoid exercise.
布萊哈博士：沒錯。不過我認爲真正重要的並不是運動本身，而是運動可以健身，也就是你身體的有氧代謝能力。我們在2月發表的一項研究表明，運動健身在降低死亡率方面的效益是沒有上限的。你的身體素質越好，你因爲心肌梗死或任何其它疾病過早死亡的風險就越小。與健身效益相比，在任何一次特定的運動過程中出現心肌梗死的暫態風險可以說是非常小的。這並不意味着它不會發生，只是不能將其作爲摒棄運動的理由。
A.
答：
Dr. Thompson: The way I look at it is that exercise is medicine and it’s wonderful medicine, but like any medicine, it has potential side effects. So do most things. Having sex slightly increases the risk of a heart attack compared to not having sex, since it’s a form of exertion. But that doesn’t mean we should avoid sex. I tell people, if you want to live life as safely as possible, stay in bed alone. But who wants that?
湯普森博士：在我看來，運動就如同是靈丹妙藥，不過，就像任何藥物一樣，它也有潛在的副作用——世界上的大多數事情都是如此。做愛也會讓人勞累，所以與不做愛相比，做愛會稍微增加心肌梗死的風險。但這不代表我們都應該禁慾。我是這麼跟人說的：如果你想要生活得儘可能安全，就呆在牀上別下來好了。但是，有誰會願意這樣生活呢？
