T Nation

Vascular Injury During Heavy Attempts


#1

I am a hopeful future medical professional, and I recently have been wondering about the effects that weightlifting has on our vascular system.

I am specifically addressing major adverse events secondary to the amount of strain that a valsalva places on your arterial system during a max effort lift.

I am aware of things like subconjuntival hemorrhages, and anterior epistaxis, however I am wondering about other vascular injuries, specifically the development of posterior epistaxis, aneurysms, kidney function, and negative changes in vision due to extreme loads and strains.

I have personally never heard of anyone having a major event who was not already at risk, and I have been unable to find a scientific study to link me to any conclusions one way or another.

Can anyone help me gain insight into this matter?


#2

Similar to you, I havent heard of anything happening to someone who didnt already have numerous risk factors. I remember from a lab in my undergrad leg pressing 225lbs my systolic blood pressure reached 290 during the concentric phase. That is nowhere near a maximal lift for me, so I can only imagine the pressure that occurs on a 1RM.

As for aneurysm, decreased kidney function, and vision changes I believe that occurs more from a chronic CV overload, training triples and doubles isnt going to be detrimental.

Which field of medicine are you interested in?


#3

[quote]dzmendon wrote:
Similar to you, I havent heard of anything happening to someone who didnt already have numerous risk factors. I remember from a lab in my undergrad leg pressing 225lbs my systolic blood pressure reached 290 during the concentric phase. That is nowhere near a maximal lift for me, so I can only imagine the pressure that occurs on a 1RM.

As for aneurysm, decreased kidney function, and vision changes I believe that occurs more from a chronic CV overload, training triples and doubles isnt going to be detrimental.

Which field of medicine are you interested in?[/quote]

Well, I have 5 more rotations left before I get my masters MPA.

In all honesty, I just hope to pass right now. I think general practice sounds pretty chill, however I could do just about anything if I have the right people around me.

What about you?


#4

[quote]trivium wrote:
Well, I have 5 more rotations left before I get my masters MPA.

In all honesty, I just hope to pass right now. I think general practice sounds pretty chill, however I could do just about anything if I have the right people around me.

What about you?[/quote]

Sports medicine is definitely my scene.

Just finished my certificate in athletic therapy (athletic training in the states), I have another year on my bachelor of science in kinesiology, then I can attempt our national exam and hopefully become a certified athletic therapist. Looking to add a CSCS for sure and potentially some sort of masters degree on top… then comes actually finding a job haha, not too picky on where I would end up, baseball, football, basketball, hockey… I would take anything tbh. Im sort of curious if I could be successful as a combo therapist/S&C coach/cutman for a boxer.


#5

I have long been interested in trying to referee boxing/MMA/pro wrestling.

Who would be better to be in the ring than a healthcare professional?


#6

Re eyes/vision loss and weightlifting: Valsalva retinopathy is an uncommon entity associated with weightlifting. It involves a spontaneous hemorrhage into the preretinal space, usually resulting in profound vision loss (until the blood clears). While certain vasculopathic conditions pre-dispose an individual to experiencing such a bleed, it definitely occurs in individuals with no known risk factors.

Fundus photograph of Valsalva retinopathy after weightlifting:

In-depth info concerning Valsalva retinopathy:

http://emedicine.medscape.com/article/1228106-overview

Other than catastrophic events in pre-disposed individuals, the main cardiovascular result of chronic heavy weightlifting iinvolves cardiac remodelling in response to the increased afterload imposed by the elevated SBP. This leads to the ‘concentric’ form of left ventricular hypertrophy (LVH), as opposed to the eccentric form more commonly associated with endurance activities. Such changes are known colloquially as ‘athlete’s heart.’ If severe, concentric LVH produces diastolic cardiac dysfunction (ie, impaired filling of the LV during diastole), which can in turn produce clinically evident heart failure. Note that this is NOT the same entity as hypertrophic cardiomyopathy [HCM], the most common cause of cardiac sudden death in young athletes.

Overview comparing cardiac remodelling in strength vs endurance athletes:

Overview comparing morphologic and function differences between HCM hearts and ‘athelet’s heart’:


#7

[quote]EyeDentist wrote:
Re eyes/vision loss and weightlifting: Valsalva retinopathy is an uncommon entity associated with weightlifting. It involves a spontaneous hemorrhage into the preretinal space, usually resulting in profound vision loss (until the blood clears). While certain vasculopathic conditions pre-dispose an individual to experiencing such a bleed, it definitely occurs in individuals with no known risk factors.

Fundus photograph of Valsalva retinopathy after weightlifting:

In-depth info concerning Valsalva retinopathy:

http://emedicine.medscape.com/article/1228106-overview

Other than catastrophic events in pre-disposed individuals, the main cardiovascular result of chronic heavy weightlifting iinvolves cardiac remodelling in response to the increased afterload imposed by the elevated SBP. This leads to the ‘concentric’ form of left ventricular hypertrophy (LVH), as opposed to the eccentric form more commonly associated with endurance activities. Such changes are known colloquially as ‘athlete’s heart.’ If severe, concentric LVH produces diastolic cardiac dysfunction (ie, impaired filling of the LV during diastole), which can in turn produce clinically evident heart failure. Note that this is NOT the same entity as hypertrophic cardiomyopathy [HCM], the most common cause of cardiac sudden death in young athletes.

Overview comparing cardiac remodelling in strength vs endurance athletes:

Overview comparing morphologic and function differences between HCM hearts and ‘athelet’s heart’:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769182/[/quote]

This is a great post.

So essentially, other than the valsalva retinopathy, there is nothing to worry about with lifting as a young man, unless you have a preexisting genetic condition (marfans, ehlers-danlos, etc) a preexisting aneurysm, or hypertrophic cardiomyopathy?


#8

[quote]trivium wrote:

[quote]EyeDentist wrote:
Re eyes/vision loss and weightlifting: Valsalva retinopathy is an uncommon entity associated with weightlifting. It involves a spontaneous hemorrhage into the preretinal space, usually resulting in profound vision loss (until the blood clears). While certain vasculopathic conditions pre-dispose an individual to experiencing such a bleed, it definitely occurs in individuals with no known risk factors.

Fundus photograph of Valsalva retinopathy after weightlifting:

In-depth info concerning Valsalva retinopathy:

http://emedicine.medscape.com/article/1228106-overview

Other than catastrophic events in pre-disposed individuals, the main cardiovascular result of chronic heavy weightlifting iinvolves cardiac remodelling in response to the increased afterload imposed by the elevated SBP. This leads to the ‘concentric’ form of left ventricular hypertrophy (LVH), as opposed to the eccentric form more commonly associated with endurance activities. Such changes are known colloquially as ‘athlete’s heart.’ If severe, concentric LVH produces diastolic cardiac dysfunction (ie, impaired filling of the LV during diastole), which can in turn produce clinically evident heart failure. Note that this is NOT the same entity as hypertrophic cardiomyopathy [HCM], the most common cause of cardiac sudden death in young athletes.

Overview comparing cardiac remodelling in strength vs endurance athletes:

Overview comparing morphologic and function differences between HCM hearts and ‘athelet’s heart’:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769182/[/quote]

This is a great post.

So essentially, other than the valsalva retinopathy, there is nothing to worry about with lifting as a young man, unless you have a preexisting genetic condition (marfans, ehlers-danlos, etc) a preexisting aneurysm, or hypertrophic cardiomyopathy?[/quote]

To my knowledge, that just about covers the short-term risks of catastrophic vascular events for young healthy individuals. (Although I hasten to add this is NOT my area of medical expertise.) But it bears emphasizing that risk factors such as aneurysms and HCM can ‘lurk’ asymptomatically until they result in a catastrophic event. So, absent a very expensive (and low-yield) evaluation of both cardiac status and the arterial tree, even a healthy young individual can’t be certain of having ‘nothing to worry about.’ (That said, I am NOT recommending such a workup. Case in point: I have a 21 y.o. son who lifts, and I never even considered putting him through any sort of out-of-the-ordinary medical evaluation.)

Further, assuming the young weightlifter eventually becomes an old weightlifter–and trust me when I say it sneaks up on you, and happens a lot faster than you think–there is a (poorly-defined) risk of experiencing the ‘slow-motion’ vascular catastrophe of ending up with concentric LVH and CHF. Caveat emptor.


#9

[quote]EyeDentist wrote:

[quote]trivium wrote:

[quote]EyeDentist wrote:
Re eyes/vision loss and weightlifting: Valsalva retinopathy is an uncommon entity associated with weightlifting. It involves a spontaneous hemorrhage into the preretinal space, usually resulting in profound vision loss (until the blood clears). While certain vasculopathic conditions pre-dispose an individual to experiencing such a bleed, it definitely occurs in individuals with no known risk factors.

Fundus photograph of Valsalva retinopathy after weightlifting:

In-depth info concerning Valsalva retinopathy:

http://emedicine.medscape.com/article/1228106-overview

Other than catastrophic events in pre-disposed individuals, the main cardiovascular result of chronic heavy weightlifting iinvolves cardiac remodelling in response to the increased afterload imposed by the elevated SBP. This leads to the ‘concentric’ form of left ventricular hypertrophy (LVH), as opposed to the eccentric form more commonly associated with endurance activities. Such changes are known colloquially as ‘athlete’s heart.’ If severe, concentric LVH produces diastolic cardiac dysfunction (ie, impaired filling of the LV during diastole), which can in turn produce clinically evident heart failure. Note that this is NOT the same entity as hypertrophic cardiomyopathy [HCM], the most common cause of cardiac sudden death in young athletes.

Overview comparing cardiac remodelling in strength vs endurance athletes:

Overview comparing morphologic and function differences between HCM hearts and ‘athelet’s heart’:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769182/[/quote]

This is a great post.

So essentially, other than the valsalva retinopathy, there is nothing to worry about with lifting as a young man, unless you have a preexisting genetic condition (marfans, ehlers-danlos, etc) a preexisting aneurysm, or hypertrophic cardiomyopathy?[/quote]

To my knowledge, that just about covers the short-term risks of catastrophic vascular events for young healthy individuals. (Although I hasten to add this is NOT my area of medical expertise.) But it bears emphasizing that risk factors such as aneurysms and HCM can ‘lurk’ asymptomatically until they result in a catastrophic event. So, absent a very expensive (and low-yield) evaluation of both cardiac status and the arterial tree, even a healthy young individual can’t be certain of having ‘nothing to worry about.’ (That said, I am NOT recommending such a workup. Case in point: I have a 21 y.o. son who lifts, and I never even considered putting him through any sort of out-of-the-ordinary medical evaluation.)

Further, assuming the young weightlifter eventually becomes an old weightlifter–and trust me when I say it sneaks up on you, and happens a lot faster than you think–there is a (poorly-defined) risk of experiencing the ‘slow-motion’ vascular catastrophe of ending up with concentric LVH and CHF. Caveat emptor.[/quote]

Well, there are a lot of people who get CHF with LVH who never lift a day in their lives.

I always thought that steroids had a major effect on cardiac remodeling as well. Perhaps PED’s accelerate the process?


#10

[quote]trivium wrote:
Well, there are a lot of people who get CHF with LVH who never lift a day in their lives.
[/quote]

The vast majority are undertreated HTNives.

[quote]
I always thought that steroids had a major effect on cardiac remodeling as well. Perhaps PED’s accelerate the process?[/quote]

I thought so as well, but just to make sure I asked my colleague Dr Google his opinion.

Androgen receptors are present in human cardiac tissue:

It seems clear that steroid use has an effect upon LVH over-and-above that of weight training alone:

I would say these and similar studies provide compelling evidence for the assertion of a direct effect of androgens on cardiac morphology (and function).


#11

Ok, so far we can conclude that:

  1. Unless you have a pre-existing cardiac condition, vascular abnormality, or connective tissue disorder, it would be extremely rare for you to develop an aneurysm secondary to the effect of a max effort lift.

  2. Hemorrhagic changes with the eyes are possible, however they resolve with time.

  3. The effect of weightlifting on the heart is to cause excess strain over time, however the use of androgenic anabolic steroids is even more damaging to cardiac tissue.

So, to sum this up…taking into account all three of these conclusions, someone who is an otherwise healthy young man not taking PED’s should have not worry much about unforeseen possibilities of adverse cardiac and vascular events due to their rarity?


#12

By the way, thanks for being patient and finding good research to back claims. I hoped that this thread would generate the good scientific discussion that it did rather than just a bunch of people saying things like “man up” or “go to church.”


#13

[quote]trivium wrote:
Ok, so far we can conclude that:

  1. Unless you have a pre-existing cardiac condition, vascular abnormality, or connective tissue disorder, it would be extremely rare for you to develop an aneurysm secondary to the effect of a max effort lift.

  2. Hemorrhagic changes with the eyes are possible, however they resolve with time.

  3. The effect of weightlifting on the heart is to cause excess strain over time, however the use of androgenic anabolic steroids is even more damaging to cardiac tissue.

So, to sum this up…taking into account all three of these conclusions, someone who is an otherwise healthy young man not taking PED’s should have not worry much about unforeseen possibilities of adverse cardiac and vascular events due to their rarity?[/quote]

I would agree with that.

Also, it’s important to remember that such risks must be evaluated in the context of a risk/benefit ratio, and that vigorous weightlifting has a demonstrable positive effect on multiple cardiovascular-related parameters. On balance, these benefits would seem to vastly outweigh the risk of either catastrophic or insidious adverse cardiovascular outcomes associated with weightlifting.


#14

[quote]trivium wrote:
By the way, thanks for being patient and finding good research to back claims. I hoped that this thread would generate the good scientific discussion that it did rather than just a bunch of people saying things like “man up” or “go to church.”[/quote]

My pleasure. I’ve enjoyed the conversation.


#15

[quote]EyeDentist wrote:

[quote]trivium wrote:
By the way, thanks for being patient and finding good research to back claims. I hoped that this thread would generate the good scientific discussion that it did rather than just a bunch of people saying things like “man up” or “go to church.”[/quote]

My pleasure. I’ve enjoyed the conversation.[/quote]

So are you a dentist or an ophthalmologist?


#16

Ophthalmologist. (Sometimes disparagingly referred to as an ‘eye dentist’ by other physicians, because our area of expertise seems so far-removed from the rest of medicine.)


#17

[quote]EyeDentist wrote:
Ophthalmologist. (Sometimes disparagingly referred to as an ‘eye dentist’ by other physicians, because our area of expertise seems so far-removed from the rest of medicine.) [/quote]

Yeah, that may be true, but you have to really know your shit to do that job. So many systemic disorders may affect the eye. I have heard that it is not uncommon for you guys to catch things that others may miss.


#18

[quote]trivium wrote:
I am a hopeful future medical professional, and I recently have been wondering about the effects that weightlifting has on our vascular system.

I am specifically addressing major adverse events secondary to the amount of strain that a valsalva places on your arterial system during a max effort lift.

I am aware of things like subconjuntival hemorrhages, and anterior epistaxis, however I am wondering about other vascular injuries, specifically the development of posterior epistaxis, aneurysms, kidney function, and negative changes in vision due to extreme loads and strains.

I have personally never heard of anyone having a major event who was not already at risk, and I have been unable to find a scientific study to link me to any conclusions one way or another.

Can anyone help me gain insight into this matter?[/quote]

If you are cardiovascular fit, then minimal risk. Repetitive heavy straining does stiffen arterial walls, which is why I recommend at least some sort of cardiovascular training whether it be sprints v low intensity


#19

[quote]BHOLL wrote:

[quote]trivium wrote:
I am a hopeful future medical professional, and I recently have been wondering about the effects that weightlifting has on our vascular system.

I am specifically addressing major adverse events secondary to the amount of strain that a valsalva places on your arterial system during a max effort lift.

I am aware of things like subconjuntival hemorrhages, and anterior epistaxis, however I am wondering about other vascular injuries, specifically the development of posterior epistaxis, aneurysms, kidney function, and negative changes in vision due to extreme loads and strains.

I have personally never heard of anyone having a major event who was not already at risk, and I have been unable to find a scientific study to link me to any conclusions one way or another.

Can anyone help me gain insight into this matter?[/quote]

If you are cardiovascular fit, then minimal risk. Repetitive heavy straining does stiffen arterial walls, which is why I recommend at least some sort of cardiovascular training whether it be sprints v low intensity
[/quote]

How does half an hour of walking 3x a week sound?


#20

[quote]trivium wrote:

[quote]BHOLL wrote:

[quote]trivium wrote:
I am a hopeful future medical professional, and I recently have been wondering about the effects that weightlifting has on our vascular system.

I am specifically addressing major adverse events secondary to the amount of strain that a valsalva places on your arterial system during a max effort lift.

I am aware of things like subconjuntival hemorrhages, and anterior epistaxis, however I am wondering about other vascular injuries, specifically the development of posterior epistaxis, aneurysms, kidney function, and negative changes in vision due to extreme loads and strains.

I have personally never heard of anyone having a major event who was not already at risk, and I have been unable to find a scientific study to link me to any conclusions one way or another.

Can anyone help me gain insight into this matter?[/quote]

If you are cardiovascular fit, then minimal risk. Repetitive heavy straining does stiffen arterial walls, which is why I recommend at least some sort of cardiovascular training whether it be sprints v low intensity
[/quote]

How does half an hour of walking 3x a week sound?[/quote]

not bad, just make sure it doesnt contradict trainng goals/effects