Can a Marathon Trigger a Hidden Heart Problem? Dr. Ashish Jai Kishan Explains

Dr. Ashish Jai Kishan, Senior Consultant, Interventional Cardiologist, Fortis Escorts Heart Institute, New Delhi, explains the hidden cardiac risks runners should understand

On August 9, at the Nandi Hills Monsoon Marathon near Bengaluru, 31-year-old tech professional Amandeep Singh Jagade reportedly collapsed while participating in the 21-km category. He had covered roughly half the distance when the medical emergency occurred. Fellow runners and volunteers rushed to help, and he was taken to a nearby hospital, where efforts to revive him were unsuccessful. Preliminary reports have suggested cardiac arrest, although the definitive cause of death would need to be medically established.

The tragedy has once again raised a difficult question for runners and their families: How can someone who is young, active and apparently fit suffer a fatal cardiac event while running?

According to Dr. Ashish Jai Kishan, Senior Consultant, Interventional Cardiologist at Fortis Escorts Heart Institute, New Delhi, the answer lies somewhere between two dangerous extremes — assuming that marathons are inherently unsafe, or believing that fitness makes someone completely immune to a cardiac emergency.

“Running remains one of the best things most people can do for their hearts,” is the central message behind Dr. Kishan’s perspective. But he stresses that endurance exercise should be approached with awareness, preparation and respect for individual cardiovascular risk.

Exercise Still Protects the Heart

Regular physical activity remains one of the most powerful tools for reducing cardiovascular risk.

Aerobic exercise can improve blood pressure, insulin sensitivity, cardiovascular fitness and several other factors associated with heart disease. At a population level, physically active people generally have better cardiovascular outcomes than sedentary individuals.

Sudden cardiac arrest during endurance races is uncommon. However, rare does not mean impossible.

For runners, the important question is therefore not whether exercise is dangerous, but whether an individual may have an underlying cardiac condition that intense exercise could expose.

In Younger Runners, the Problem May Be Hidden

In runners under 35, sudden cardiac events can sometimes be associated with conditions that remain undiagnosed until intense physical exertion places considerable stress on the heart.

These may include:

• Hypertrophic cardiomyopathy — abnormal thickening of the heart muscle that can increase the risk of dangerous rhythms.
• Anomalous coronary arteries — abnormalities in the origin or course of the arteries supplying the heart.
• Myocarditis — inflammation of the heart muscle, sometimes associated with a recent infection.
• Inherited electrical disorders — conditions affecting the heart’s electrical system that may exist even when the heart appears structurally normal.

This is why appearance and athletic performance alone cannot establish cardiovascular health.

A person can have excellent stamina, a healthy body weight and years of running experience while still having an underlying condition that has never produced an obvious symptom.

For runners over 40, the risk profile changes. Coronary artery disease becomes increasingly important and can sometimes remain silent until significant exertion exposes the underlying problem.

The Hill and Humidity Add to the Challenge

The Nandi Hills event was not simply a flat road race. The half-marathon course involved significant elevation gain and was conducted during monsoon conditions.

Uphill running substantially increases cardiovascular demand. Humidity can further increase physiological stress because the body has greater difficulty losing heat through evaporation.

Dehydration, inappropriate pacing and electrolyte disturbances can add to the challenge, although these factors should not automatically be assumed to have caused any individual cardiac event.

The important lesson is that a 21-km race on a demanding hill course is not physiologically equivalent to an easy 21-km run on a flat, cool morning.

What Dr. Ashish Jai Kishan Would Tell Runners

Dr. Kishan does not advocate using such tragedies as an argument against marathon running. Instead, he believes they should encourage runners to approach endurance sport more intelligently.

Get Evaluated Before Serious Endurance Training

If you are moving from recreational jogging to structured long-distance training, particularly if you have cardiovascular risk factors or symptoms, discuss your health with a doctor.

Depending on your medical history and examination, evaluation may include an ECG, blood tests, echocardiography or other investigations.

The important point is that cardiovascular assessment should be individualised rather than treated as a one-size-fits-all requirement.

Know Your Family History

A history of unexplained sudden death, particularly at a young age or during exercise, is an important warning sign.

Tell your doctor about it. Family history can provide clues to inherited cardiac conditions that might otherwise remain undetected.

Never Ignore Warning Symptoms

Chest discomfort, unusual breathlessness, racing or irregular heartbeats, dizziness, fainting or near-fainting during exercise should never simply be pushed through.

These symptoms warrant medical evaluation before returning to intense training.

Respect Recent Illness

A recent viral infection accompanied by ongoing fatigue, chest discomfort, breathlessness or palpitations deserves particular attention.

Myocarditis can occur after infections, and strenuous exercise while the heart is inflamed can be dangerous.

Train for the Conditions, Not Just the Distance

Preparing for a marathon means more than accumulating kilometres.

If the race involves hills, heat or humidity, training should account for those demands. Pacing, hydration, recovery and acclimatisation are all part of responsible preparation.

Race Organisers Need Real Emergency Preparedness

When cardiac arrest occurs, minutes matter.

Immediate CPR and rapid access to an automated external defibrillator can be critical to survival. For endurance events, trained medical personnel, accessible AEDs and an effective emergency response plan are therefore not optional extras.

The Bigger Picture

When a young, apparently fit person dies during a run, it is natural to feel that exercise has somehow betrayed them.

But according to Dr. Ashish Jai Kishan, that should not be the conclusion.

Running remains one of the best things most people can do for their cardiovascular health. At the same time, being fit does not guarantee that an underlying cardiac condition is absent.

The goal is not to fear the marathon.

The goal is to respect what the marathon demands — and to make sure the heart carrying you to the finish line has been given the attention it deserves.

About the Expert

Dr. Ashish Jai Kishan is a Senior Consultant, Interventional Cardiologist at Fortis Escorts Heart Institute, New Delhi. His perspective highlights the importance of balancing the cardiovascular benefits of endurance exercise with appropriate awareness of hidden cardiac risks, warning symptoms and race-day emergency preparedness.