There’s a good article on Rouleur that gives some background on the heart issues experienced by Sonny Colbrelli and others in the pro peloton. It’s well worth a read. When you’ve read it here are some further thoughts and clarifications from Crickles’ own Cardio Mark…
I agree entirely that the image of Sonny Colbrelli collapsing was distressing – and sadly he was not the first sportsman to do so, nor will he be the last.
There are many different sorts of heart problems that cause rhythm disturbance. Some are life-threatening, others not.
Problems in the right atrium, such as those of Martina Fidanza, are likely to be a so-called re-entrant tachycardia, or atrial flutter. These are not life-threatening, generally not associated in young people with disease of the heart structure, and relatively easy to treat with a high success rate and low complication rate.
Myocarditis is not a heart rhythm problem per se – it is a disease of the heart muscle – often caused by a viral infection, most topically COVID-19. It can cause a reduction in the ability of the heart to pump. It is rare and often, but not always, recovers. It is thought to be exacerbated by training too hard and too soon after being ill. But it’s perfectly possible to have a sedentary life and get it. Anything that makes the heart work less well can cause heart rhythm problems – from “benign” ectopic beats – where extra heart beats periodically interrupt the normal steady rhythm of the heart (very unnerving, but not dangerous) through to serious life-threatening rhythm problems that originate in the ventricles – the principal pumping chambers of the heart.
An arrhythmia is any irregularity in heart rhythm. They can lead to blood clots – which can fly off and around the body causing a stroke, for example. This is typically associated with the specific rhythm problems of atrial fibrillation and flutter only – and not the other rhythm problems that people experience – and typically only in people with other risk factors for stroke – such as old age and high blood pressure. Heart failure is typically a cause rather than a consequence of rhythm problems – but developing atrial fibrillation which is sustained and rapid can slowly (or sometimes quite quickly) lead to heart failure. Ventricular rhythm problems can lead to heart failure very rapidly sometimes or cardiac arrest.
Ventricular fibrillation does result in quivering of the ventricles. Patients do not pump blood round the body and almost always die without intervention. It is a particular ventricular arrhythmia.
Unstable arrhythmias are typically arrhythmias that put a patient into a situation where without treatment they will die. Typically these are ventricular rhythm problems, but occasionally atrial rhythm problems can cause such issues.
In the UK we do not typically use the word primitive – rather we would say without underlying conditions or sometimes primary. The list of conditions which cause rhythm problems is not exhaustive, but does cover the principal problems seen. You wouldn’t tend to refer to HCM or ARVC as primitive.
It’s certainly true that Italy is more proactive in screening athletes than the UK and many other countries – and this is arguably a good thing. And I agree entirely that too much of anything can be unhealthy – even exercise, but where those limits are remains to be determined. It’s a valuable point that many amateurs have to try to fit in a job and family and cannot rest and are not supervised in the way that professionals are, so should not try to emulate their training.