Ron Clarke question...

[lovetorun]

The interesting front page article said that Ron Clarke suffered "permanent heart damage" from running in the altitude of Mexico City in the 1968 OG's. I've never heard that before and it just doesn't sound right...anyone know the facts on this?

[eldrick]

i've never read a diagnosis, but extreme exertion at altitude ( like climbers on everest ( they don't exert as much, but more altitude of 29k v 8k ) ) suggests the climber's ailment of heart failure

heart gets gets stretched like rubber close to/at it's permanently-stretched out point & ends up permanently dilated & not able to pump blood around as effectively as some of it's elasticity has gone for good

not technically a heart attack ( infarction ) as that requires loss of blood to actual heart muscle thru blockage of coronary arteries & death of heart muscle, but severe cases are miserable, with vast majority dead within 5y without a heart transplant ( little chance of getting one - jus luck if you get a cross-match )

the diagnosis was very likely mild heart failure ( dilated heart & poor pumping ) but which can be managed well with diuretics & now modern ACE-inhibitors, but you aren't going to set 5k/10k wr after that

[ed gee]

Old news.

Clarke states that he damaged the mitral valve in Mexico City, ultimately leading to replacement fifteen years later.

[paulthefan]

I think his heart broke 4 years earlier when a certain American Indian ran by him like he was standing still!!

[catson52]

I think his heart broke 4 years earlier when a certain American Indian ran by him like he was standing still!!

Not to cast aspersions on Clarke (or Mills for that matter). Clarke was much more despondent after his loss to Temu (and Keino) in 1966 in Kingston at BCG. He was not a prohibitive favorite before Tokyo, but was figured to take the 10K fairly easily in Kingston. The loss in Tokyo was a narrow one (a definite shocker), whereas Temu beat him quite handily in the heat at Kingston.

[kuha]

Old news.

Clarke states that he damaged the mitral valve in Mexico City, ultimately leading to replacement fifteen years later.

Correct. He collapsed unconscious at the end of the Mexico City 10,000; it's not a stretch at all to think there was a cause/effect relationship there.

[dukehjsteve]

Time for our famed Orthopedic Doc's opinion. Check in, BamBam...

[bambam]

Time for our famed Orthopedic Doc's opinion. Check in, BamBam...

You are correct - orthopaedic doc. To me, the main purpose of the heart is to pump blood to the bones (in my cases, specifically the shoulder). I don't know much about this. DrJay is probably a better source (especially with his climbing and altitude knowledge), but I think it would be difficult to indict a single extreme effort, even at altitude, as the sole cause of his mitral valve problems.

[ed gee]

They did not run the 10,000 m at the 1966 Commonwealth Games.

I think his heart broke 4 years earlier when a certain American Indian ran by him like he was standing still!!

Not to cast aspersions on Clarke (or Mills for that matter). Clarke was much more despondent after his loss to Temu (and Keino) in 1966 in Kingston at BCG. He was not a prohibitive favorite before Tokyo, but was figured to take the 10K fairly easily in Kingston. The loss in Tokyo was a narrow one (a definite shocker), whereas Temu beat him quite handily in the heat at Kingston.

[runforlife]

Not to cast aspersions on Clarke.

Well, Percy certainly did as he thought altitude had no effect.

[DrJay]

Re: Ron Clarke question...

As per the initial post, this doesn't sound right to me, either. It sounds like a fact that Clarke needed mitral valve replacement, but just because he thinks Mexico City caused it doesn't mean it's so. Tens of thousands of people who never ran to their limit anywhere at all, need mitral or aortic valve replacment each year. One of my climbing partners, who has never been over 23,000 ft., may need his mitral or aortic valve (I can't remember which) replaced in the next decade, it's become incompetent, allowing a moderate amount of blood to go back through it to the chamber the blood just came from.

The valve itself is a pretty lifeless bit of flimsy tissue, I just don't see how it could be damaged by the Mexico City effort, or any short-term stress (i.e., clmbing Everest). Could the papillary muscles have been damaged? Seems unlikely. They are the extensions of heart wall muscle to which the mitral valve leaflets are anchored:

http://en.wikipedia.org/wiki/Papillary_muscle

(There's probably a better reference online, but wiki was quick.)

They contract as one with the wall of the left ventricle, pulling on the MV leaflets so they don't balloon toward/into the left atrium so blood is prevented from regurgitating back into the left atrium. The papillary muscles (PM) can be damaged in a heart attack, thus allowing mitral regurgitation, or even rupture at the point of attachment of the MV tethering fibers to the PM (flail MV, a surgical urgency).

Could Clarke's effort at altitude have caused significant enough hypoxia (low oxygen level in the bloodstream, and hence body tissues like the PM) to damage the PM? I doubt it. I've never heard of such a problem among climbers on the two or three highest peaks who don't use oxygen, and the hypoxia they endure is truly amazing, probably far more severe than that Clarke could induce at 7500 ft and, compared to a 30 minute 10K, much more prolonged. A simulated climb of Everest in an altitude chamber (Operation Everest II) provided direct measurements of arterial O2 and CO2 and the numbers, while not at my fingertips, were apallingly low. A healthy and trained human body has an incredible reserve. We haven't heard of endurance athletes at sea level damaging their heart valves and thousands upon thousands of all abilites will sometimes have that race in which they could not have gone 0.1 sec faster, even with a gun to their head. I suspect Clarke would had have his mitral valve replaced even w/o Mexico City, just like my climbing partner may require.

[DrJay]

An abstract from Everest II:

http://www.ncbi.nlm.nih.gov/pubmed/3654411

Note the O2 saturation of less than 50%. At rest at sea level, it's close to 100%. At rest at 14,000 feet on Denali, I was 80% and my partner 75%. Don't know what Clarke was at max effort at 7400 ft but I'd bet in the 80-85% range. I'm sure there's a lot of data out there that would approximate it.

Heck, I'm at 6600 feet. Maybe I'll grab our little pulse oximeter this week and go do some intervals. Or not.

[AS]

The story is repeated here:

http://www.athletics.com.au/fanzone/hal ... ron_clarke

[Bruce Kritzler]

Think Clarke mentioned the mitral valve problem as the reason he was never a great kicker, so guessing it was a lifetime problem, not something that happened in 1968.

[lovetorun]

Dr. Jay...your analysis makes the most sense to me i.e. that even though Clarke needed the miral valve replacement, it wasn't the strain of the races in Mexico City that caused the mal function.