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Old 06-28-2011   #1
Grand Junction, Colorado
Join Date: Mar 2010
Posts: 434
Swim Induced Heart Attacks

I am so very sorry about the recent MFS tragic incident! My heart goes out to family and friends of the victim. While reading this, I thought I would pass on a little info that I recently learned regarding drowning.

We often hear that people die in similar situations with dry lungs and are officially pronounced dead of a heart attack. While the victim may very well have had a heart attack due to the stress of being in an intense situation (i.e. swimming hard and cold water), the other frequent cause of a heart attack in these circumstances is dry drowning. I think for us boaters, it's often easier to think that someone just had a heart attack due to physical demands, but a drowning victim can easily have a heart attack due to drowning. There are 2 types of drowning statistically; dry drowning (accounts for 20% of victims) and wet drowning (80% of victims). Wet drowning occurs as a result of aspirating water to the point that the lungs are partially filled with water and non-functional. On the other hand, dry drowning is a completely different process. Dry drowning involves water reaching the larynx, which results in a spasm that closes the lungs to water. The lungs don't fill with water and the victim suffers a heart attack from the lack of oxygen to the heart muscles.

Although it really doesn't make any difference in the end, I think it's important for us boaters to realize that this could happen to any of us (regardless of our level of fitness). I am so sorry to the family and friends for their loss in the recent MFS case. Although I don't have any idea of the specific circumstances, I think that dry drowning occurs more often than we think. I simply want to bring about awareness, so that perhaps it may help someone in the future.

~A current student of respiratory care

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Old 06-29-2011   #2
Bruceton Mills, West Virginia
Paddling Since: 1967
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Posts: 37
Swimming big rapids is incredibly strenuous; you often see people so tired they can barely move. It's not surprising that heart attacks result.

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Old 06-29-2011   #3
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Longmont, Colorado
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I've seen this nearly every year. The death last week in the Poudre here in Colorado was a 69 yr-old man. Coroner said death due to drowning complicated by heart disease.
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Old 06-29-2011   #4
Join Date: Apr 2006
Posts: 49
I think the OP makes a really good point we often don't realize - one can have a heart attack due to a dry drowning with no history of heart disease and in spite of being in good health. Age is only partially relevant. It's not something we can do a lot about, but it is a risk to be aware of, particularly in a long, cold swim.
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Old 06-29-2011   #5
Haley Station, Ontario
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All good points but I was just wondering where you got the 20 percent stats from? I had always heard it was closer to 5? Not a big deal but when I teach SRT I speak about these things and what to make sure my numbers are right.
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Old 06-29-2011   #6
Carbondale, Colorado
Paddling Since: 2007
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I too was on the MFoS trip that launched the day after this incident and ran into the rest of the group at Big Loon. Unfortunate event indeed and my thoughts and prayers go out to his family and friends.

One thing that I learned in a Swift Water class was that when you initially get dumped in very cold water it is very important to exhale a first deep breath which I believe helps to keep the lungs working. I haven't done any research on this but do believe it helps cause I sure do practically "lock up" with the initial shock of the water which I think could result in cardiac arrest if I wasn't in shape and relatively young?

Just a thought...
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Old 06-29-2011   #7
GAtoCSU's Avatar
Eagle, Colorado
Paddling Since: 1994
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Originally Posted by DanC View Post
All good points but I was just wondering where you got the 20 percent stats from? I had always heard it was closer to 5? Not a big deal but when I teach SRT I speak about these things and what to make sure my numbers are right.
Our forensic pathology lectures have also states the 80:20 rule for drownings (medical school).

Most people who drown protect their airway (so you get a dry drowning). I was also under the impression that a person who has an acute MI, that leads to death while in the water, has no ability to protect his/her airway and there would be water in the respiratory tree.

Like he said... it really doesn't matter either way.
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Old 06-29-2011   #8
dark center, of the universe
Paddling Since: 1996
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While there is a component of dry drowning (laryngospasm) it does not seem to be the big killer. Anecdotally speaking here, based on my experiences, about 30% of the deaths on the river are due to drowning (not oxygenating whether wet or dry in nature), the other 50% is the poorly understood and poorly researched cold water immersion syndrome that causes a lethal arrhythmia quickly leading to cardiac arrest.

These are the people that die shortly after a swim, or they fall in the water and die while "their head never went below the water". These are the folks that have no typical cardiac risk factors (CAD, obese, smoke, etc) and are relatively young and healthy; they go for a swim and suddenly die. Some of these folks may have congenital heart diseases (ventricular hypertrophy, long QT, Brugada's, etc).

There are theories out there on the patho-phys of this, but it is hard to do actual studies on it.

and maybe 20% of folks that have a true MI, where there is a blockage of coronary blood flow due to a thrombus / emboli - exacerbated by stress and an increase in cardiac output and physical exertion.

Again. those aren't facts, just what I have seen.
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Old 06-29-2011   #9
Buena Vista, Colorado
Paddling Since: 1985
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Posts: 88
A new definition of drowning

Here’s a new (and more accurate view IMHO) of the drowning process. This is the approach we are taking when teaching the Rescue 3 curriculum through Sawatch Rescue.

A new definition of drowning

"Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid." Furthermore, drowning outcomes should be classified as: death, morbidity, and no morbidity.

To fully understand the breadth of the physiological responses that occur during "drowning", a familiarity with the "drowning process" is essential. The "drowning process" is the continuum that begins when the victim's airway lies below the surface of the liquid, usually water, at which time the victim voluntarily holds his or her breath. Breath-holding may be followed by an involuntary period of laryngospasm secondary to the presence of liquid in the oropharynx or larynx. During this period of breath-holding and laryngospasm, the victim is unable to breathe gas. This results in oxygen being depleted and carbon dioxide not being eliminated. The victim then becomes hypercarbic, hypoxaemic and acidotic. Because hypercarbia stimulates respiration, the victim's respiratory movements become very active, but there is no exchange of air because of the obstruction or impairment at the level of the larynx. As the victim's arterial oxygen tension drops further, laryngeal spasm and obstruction abate, and the victim actively breathes liquid. The amount of liquid inhaled varies considerably from victim to victim. Changes occur in the lungs, body fluids, blood–gas tensions, acid–base balance and electrolyte concentrations, which are dependent on the composition and volume of the liquid aspirated and the duration of submersion.

A victim can be rescued at any time during the drowning process and may not require any intervention, or may receive appropriate resuscitative measures, in which case the drowning process is interrupted. The victim may recover from the initial resuscitation efforts, with or without subsequent therapy to eliminate hypoxia, hypercarbia and acidosis, and normal organ function may be restored. However, if the victim's lungs are not ventilated in a timely fashion, or he or she does not start to breathe air spontaneously, circulatory arrest will ensue, and, in the absence of effective resuscitative efforts, multiple organ dysfunction and death will result, primarily because of tissue hypoxia. All these events are covered by this new definition of drowning.

Recent publications have raised questions as to whether "dry" drowning actually occurs or whether its victims died of another cause. Also, victims labeled as having experienced "passive" or "silent" drowning may not have been passive or silent at all but simply were not observed. Finally, "secondary" drowning is a misnomer because people who develop acute respiratory distress syndrome after drowning have not undergone a second submersion episode. Thus, we believe the terms "wet", "dry", "active", "passive", "silent" and "secondary" should no longer be applied to describe a drowning victim.

The proposed new definition of drowning is expected to support future activities in worldwide drowning surveillance. This should lead to more reliable and comprehensive information on this public health problem. Only following worldwide implementation will it be possible to determine whether the new definition is actually better suited for epidemiological purposes and whether the major requirements listed have been met. Researchers are invited to use the new definition and to report on the advantages and disadvantages they observe. It is recommended that all water safety and health organizations involved follow WHO and Centers for Disease Control and Prevention in adopting the new definition and include it in their glossaries. We expect that this will lead to a more inclusive description of the global drowning problem and the identification of specific risk factors in specific regions. If our expectations are correct, the new definition of drowning will more accurately quantify, and finally help to reduce this global, but frequently preventable, public health problem.
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Old 06-29-2011   #10
earthNRG's Avatar
Snowmass, Colorado
Paddling Since: 1983
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Originally Posted by GAtoCSU View Post
Our forensic pathology lectures have also states the 80:20 rule for drownings (medical school).

Most people who drown protect their airway (so you get a dry drowning). I was also under the impression that a person who has an acute MI, that leads to death while in the water, has no ability to protect his/her airway and there would be water in the respiratory tree.

Like he said... it really doesn't matter either way.
You say "most" drownings are "dry"? So you learned the 80:20 rule to be 80% dry, 20% wet? Wow, the stats in this thread are all over the place. So far we have:

5% dry per DanC
20% dry per Outlaw
80% dry per GAtoCSU (med school)
Nearly everyone agrees that drowning is death, and in the end the details don't make any difference.

"A witty saying proves nothing."
- Voltaire (1694-1778)
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