Although sudden arrhythmic death is usually unrelated to exertion, there is more than anecdotal evidence that strenuous exercise in patients with coronary heart disease carries an additional risk for sudden death. When cardiac arrest has been observed after exercise stress testing or within seconds after collapse associated with exertion, ventricular fibrillation has usually been present and has responded to the prompt application of a defibrillatory shock. Exertion-related cardiac arrest is typically a "primary" arrhythmic event notdue to acute myocardial infarction. As estimated here, the additional risk of exercise for cardiac arrest may be more than 100fold during or after a few minutes of vigorous exertion.
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This study was supported in part by grants from the Medic I-Emergency Medical Services Foundation, Seattle, Washington and the American Heart Association, Dallas, Texas, with funds contributed in part by the American Heart Association of Washington.