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October 1, 2007

U-M Health Minute: Today's top health issues and medical research

Hunters: Don't let heart trouble ruin your season!

U-M Cardiovascular Center expert advises pre-hunt checkups and workouts, and offers tips for while you're out in the woods or at camp

ANN ARBOR, MI – For the next two months, Michigan’s woods will be filled with tens of thousands of hunters, armed with bows and rifles, and searching for turkeys, deer and other wild game.

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You might think that the greatest risk they face is an accidental shooting, or maybe a fall from a tree stand. But for many, the danger of a heart attack or cardiac arrest is much greater.

Every year, an unknown number of hunters never make it back home because their hearts suffer problems brought on by the strenuous exercise and dramatic bursts of activity that hunting can bring.

Fortunately, hunters can take steps now to protect themselves from heart problems during the hunt – and to make sure they know what to do if a fellow hunter goes down.

One of the easiest things to do right away is to get a pre-hunt medical checkup, with special attention to the heart for those who have had heart problems in the past. Hunters who don’t already exercise regularly may want to start a daily walking routine or other exercise regimen in the weeks before hitting the woods. And every hunter should know CPR and first aid, to be able to help their hunting buddies in an emergency.

“People don’t think of hunting season as strenuous, but it actually can be quite demanding,” says Eric Good, D.O., a U-M Cardiovascular Center physician who specializes in treating heart rhythm disorders. “Hunters can experience cardiac stress that’s equivalent to what might be produced by the treadmill stress test that doctors use to detect heart problems. In other words, hunters are achieving levels of activity that might put them at risk for heart attack or sudden death.”

Even those who survive a heart crisis out in the woods, he adds, may suffer more lasting damage to their heart because of delays in getting to hospitals in rural areas.

The hunters who need to pay the most attention to this risk, Good notes, are those who have a history of heart disease. That includes anyone who has had a heart attack or even one episode of heart-related chest pain known as angina, as well as anyone whose doctor has diagnosed them with a heart condition, and anyone who has had a stent, an angioplasty, or bypass surgery. Most of them can still enjoy hunting, says Good, but they should get a medical checkup before hitting the woods.

Even people who have never had heart trouble can suffer problems in the woods – especially if they’re longtime smokers, have diabetes, have several relatives who have had heart problems before they turned 55, or are overweight.

So, the bottom line is, hunters who haven’t had a checkup in the past year or two should schedule an appointment now, and perhaps every fall. Checkups should include tests to measure blood pressure, cholesterol and blood sugar, as well as a discussion of concerns like weight and smoking.

All hunters should also ask their doctor what level of exercise – such as dragging a deer back to camp – is safe for them. And those with a history of heart problems should ask their doctors if they should carry aspirin or nitroglycerin tablets, to increase blood flow to their hearts if they suffer chest pain or a heart attack. If the doctor prescribes medication, including cholesterol-reducing pills, hunters should make sure to bring it to camp, and take it on schedule just as they would at home.

Health Minute ImageThose who have a significant risk of heart problems may also be asked to take a treadmill stress test, or to have a stress test that doesn’t involve exercise but instead stresses the heart by injecting a drug. These tests can help a doctor understand if the “peak demands” on the heart that may occur during hunting could lead to problems with heart rhythm.

Says Good, “The adrenaline rush that comes with spotting your prey, and the sudden activity after sitting still for hours, can be a dangerous combination — especially for people who are already at high risk of a heart problem.” He notes a recent study from another Michigan hospital, which had 25 male hunters wear heart monitors during a day of hunting, and showed that typical hunting activities can change heart rhythm and rate in a way that could be dangerous for those with high heart risk.

One of the worst things that can happen in the woods is sudden cardiac death, which occurs when the electrical signals that control the heart’s rhythm suddenly go violently haywire. This results in a chaotic heart beat, or “electrical storm” in the heart, which keeps it from beating effectively – a situation called cardiac arrest. And while patients can often be revived with a shock from an automated defibrillator — such as those that are now available at many airports and malls — hunters are often miles away from the nearest source of help.

To prevent this, some hunters with a history of heart disease may receive a recommendation to have a pacemaker, or an advanced device called an implanted cardioverter-defibrillator, placed in their chest, to detect an irregular heartbeat and shock the heart back into rhythm.

Even if you have no history of heart trouble and no major risk factors, it’s still a good idea to get in shape for hunting, says Good, who is an assistant professor of cardiovascular medicine at the U-M Medical School. “Even a 30-minute fast walk several times a week can help – anything that gets your heart pumping at 60 to 80 percent of your maximum heart rate,” he says. That rate is calculated by subtracting a person’s age from 220.

Once you get to camp, treat the night before a hunt as if you were an athlete with a big match the next day. Big meals, staying up late, and lots of smoking and drinking might be a tradition for many hunters, but they can really drag a person down the next morning.

Another important part of safe hunting, Good says, is looking out for your hunting buddies. Never go hunting alone, and always have an exit plan and a way to communicate by radio or cell phone in case something happens. Learn CPR and other first aid techniques before you head out.

“If you’re with someone and they start getting short of breath, looking pale, breaking into a cold sweat, or feeling faint or nauseous, get help immediately. The same is true if they feel sudden pain in their chest, jaw or shoulder, or if they suddently lose feeling in any part of their body, or have trouble speaking,” Good says.

“Even if the sensation goes away within a few minutes, don’t ignore it – it can be a warning sign that something even worse is about to happen. Call 911 from your cell phone if you can get reception, or radio to someone who can. Every minute you hesitate could mean your buddy’s life.”

Facts about hunting and the heart:

  • A recent study of 25 middle-aged male hunters, 17 of whom had coronary artery disease (clogged heart blood vessels), found that their normal hunting activities raised heart rates and caused irregular heartbeats in a way that could be dangerous – and sometimes exceeded the levels produced by cardiac stress tests.
  • Hunters who have a history of heart problems, or even a high risk of heart problems due to risk factors such as diabetes and family history, should consult with their doctor or other health care provider before going out hunting.
  • Any hunter who isn’t already active (exercising several times a week) should begin an exercise program a few weeks before hunting season, but only with their doctor’s permission if they have existing health problems.
  • All hunters should hunt with at least one buddy, have an exit plan, learn CPR and first aid, and know how to call for help if it’s needed.
  • If a hunting buddy begins experiencing sudden symptoms such as pain, weakness or numbness, or has shortness of breath or nausea when they exert themselves, hunters should call 911 or radio for help immediately – even if the sensations go away after a few minutes.

Learn more on the web at:

South Dakota Department of Health: Healthy Hunter pre-season training

American Red Cross: CPR and first aid courses

National Heart, Lung and Blood Institute: Act In Time: Heart attack risks and response

U-M Cardiovascular Center: Visit www.umcvc.org or call 1-888-287-1082.

Written by Kara Gavin

 

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