A marathon runner can spend months preparing for race day. They follow training schedules, build up distances, watch their diets, and chase personal targets. Some runners even know their pace, heart rate, and recovery time down to the smallest detail.
But how many actually know the condition of their heart?
I believe more Malaysians need to ask this question, especially as running events, marathons, and other endurance sports become increasingly popular.
The recent death of a runner who collapsed during the Garmin Run in Putrajaya on 1 November was deeply saddening. A sporting event that should have been an occasion of personal achievement ended in tragedy. My thoughts are with the runner’s family and those affected by his passing.
At the time of writing, the precise medical cause of his death has not been established publicly. It would therefore be inappropriate to speculate about what happened or whether the incident could have been prevented.
Nevertheless, incidents such as this should encourage us to have a serious conversation about heart health, particularly among people who consider themselves fit and healthy.
“There is a common belief that someone who exercises regularly, runs long distances or participates in marathons must have a healthy heart. Unfortunately, that is not always the case. Being fit does not necessarily mean being free from heart disease.
Dato’ Sri Dr Azmee Mohd Ghazi
I have encountered patients who look perfectly healthy, maintain active lifestyles, and have no obvious difficulty exercising, only to discover that they have significant cardiovascular problems.
Some have high blood pressure or elevated cholesterol that has gone untreated for years. Others may have underlying coronary artery disease without experiencing the symptoms we normally associate with heart problems. The ability to run 10 or 20 kilometres does not automatically rule out these conditions—and this is something I would particularly like recreational runners to understand.
When a Runner Becomes a Heart Patient
Just last month, IJN treated a participant from the Kuala Lumpur Standard Chartered Marathon who suffered a heart attack during the event.
The event medical team recognised the seriousness of his condition and arranged for his immediate transfer to hospital, followed by onward transfer to Institut Jantung Negara (IJN). Further assessment confirmed that he was experiencing an acute heart attack.
Our team performed an emergency procedure known as primary percutaneous coronary intervention, or primary PCI, to restore blood flow to the affected part of his heart. The patient subsequently recovered sufficiently to be discharged from hospital. He had a history of hypertension and high cholesterol, two well-established risk factors for coronary artery disease.
What concerns me is the tendency to assume that regular exercise somehow cancels out these risks. It does not. Exercise is extremely beneficial for the heart, but physical activity is not a substitute for managing blood pressure, cholesterol, diabetes or other underlying medical conditions.”
Dato’ Sri Dr Azmee Mohd Ghazi
Someone may be able to complete several running events without difficulty and still have coronary artery disease. In the case of the Standard Chartered Marathon participant, he developed symptoms early in the race and received emergency medical attention. We should recognise the importance of that response. When someone is having a heart attack, every minute matters. The sooner we can restore blood flow to the heart, the better the opportunity to limit damage to the heart muscle.
His case is also a reminder that runners should never dismiss chest pain or unusual discomfort simply because they have trained for an event.
Why Heart Problems Can Go Unnoticed
People often ask how someone who appears healthy can suddenly experience a serious cardiac event. The answer is that cardiovascular disease does not always announce itself through obvious symptoms.
Coronary artery disease, for example, develops when plaque builds up in the arteries supplying blood to the heart. This process can take place over many years. Some people experience chest discomfort or breathlessness during exertion. Others may have few symptoms, or none that they recognise as being related to the heart. A heart attack can occur when a plaque ruptures and a blood clot forms, suddenly restricting blood flow.
There are also other cardiovascular conditions that may affect athletes and active individuals, including:
- Abnormalities of the heart muscle
- Inherited cardiac conditions
- Disturbances in the heart’s electrical system that can cause dangerous heart rhythms
The risks and underlying causes vary according to age, medical history, and other factors. For younger athletes, inherited or structural heart conditions may be particularly relevant. Among middle-aged and older recreational athletes, coronary artery disease becomes an increasingly important concern.
This is why we should not assume that all cardiac emergencies during sporting events have the same cause, nor should we conclude that a person who collapses during a run must have suffered a heart attack.
Strenuous exercise places greater demands on the cardiovascular system. As exercise intensity increases, the heart beats faster and pumps more blood to deliver oxygen to working muscles. For most healthy individuals, the heart adapts well to these demands. But where significant cardiovascular disease is present, intense exertion can sometimes bring an underlying problem to the surface.
We Prepare Our Legs. What About Our Hearts?
I find it encouraging to see more Malaysians taking up running. Running clubs have grown, community events attract participants from different age groups, and many people who were previously inactive are now setting themselves fitness goals. What I would like to see, however, is the same enthusiasm being extended to cardiovascular health.
Think about how runners prepare for a marathon. They invest in proper running shoes, monitor their pace and mileage, work on endurance, hydration, and nutrition, and some even engage coaches to improve their performance.
Yet a medical assessment is often missing from that preparation. A person may spend six months training for a half-marathon without ever checking whether their blood pressure is properly controlled or whether they have cardiovascular risk factors that need attention.
"The objective is not to frighten people away from running. It is to help them continue running safely. I am not suggesting that everyone who wants to run must undergo an extensive series of heart investigations.
That would neither be practical nor medically necessary. But I do believe that individuals should understand their personal risk, particularly if they are middle-aged, have existing medical conditions, experience symptoms during exercise, or have a family history of premature heart disease or sudden cardiac death.
What Should Runners Look Out For?
One concern I have is that runners sometimes become accustomed to pushing through discomfort. During training, tiredness, muscle soreness, and breathlessness are expected to some extent. But not every symptom should be treated as part of the challenge.
Symptoms that require immediate medical attention:
- Chest discomfort: Pain, pressure, or tightness during exercise.
- Referred pain: Discomfort in the jaw, back, or arms rather than the chest.
- Breathing issues: Unexplained breathlessness that is disproportionate to the activity.
- Neurological signs: Dizziness, fainting, unusual palpitations, or a sudden decline in exercise capacity.
- Systemic symptoms: Cold sweats, nausea, or an unusual sense of weakness.
I would strongly advise runners not to continue exercising when they experience concerning symptoms. Stop, inform someone nearby, and seek medical help. Where a heart attack is suspected, emergency medical services should be activated immediately. It is far better to have a symptom investigated and discover that it is not serious than to ignore a potentially dangerous warning.
Race organisers also have an important responsibility. Medical personnel, emergency response arrangements, and access to automated external defibrillators (AEDs) are essential at mass-participation sporting events. Screening and emergency preparedness must go hand in hand.
Is an Ordinary Health Screening Sufficient?
A routine health screening is a good starting point to identify hypertension, diabetes, elevated cholesterol, and other risk factors. However, for individuals involved in endurance sports, there may be reasons to consider a more specialised assessment through sports cardiology.
Sports cardiology focuses on the relationship between exercise and cardiovascular health. It is not limited to professional athletes; recreational runners, cyclists, triathletes, and gym enthusiasts can also benefit from appropriate specialist advice.
At IJN, our assessment includes:
- Clinical Evaluation: Understanding exercise type, training frequency, event goals, symptoms, and medical/family history.
- Targeted Investigations: Depending on findings, this may include an electrocardiogram (ECG), an echocardiogram, or exercise stress testing.
No screening programme can guarantee that a cardiac emergency will never occur, but appropriate screening helps identify relevant risk factors so individuals can adjust their training or receive proper medical treatment.
Sports Cardiology is About Keeping People Active
At IJN, we have developed dedicated Sports Cardiology Services because the needs of physically active individuals differ from patients seeking treatment for established heart disease.
- Sports Fitness Screening: Caters to general fitness and recreational activities.
- Sports Endurance Screening: Provides a comprehensive pathway for individuals preparing for demanding events such as marathons and triathlons.
"In 2026, IJN received Centre Accreditation in Sports Cardiology from the European Association of Preventive Cardiology, becoming the first and only centre in Asia to achieve this recognition at the time."As Malaysia’s national heart specialist centre, our objective is simple: to help people enjoy sport without overlooking their health.
A Conversation Worth Having Before the Next Race
Whenever a cardiac emergency occurs during a sporting event, public concern is understandably considerable. Running remains an excellent form of physical activity, and we should continue encouraging Malaysians to be active. At the same time, we need to move away from the assumption that being physically active automatically means there is nothing wrong with the heart.
For runners with hypertension, diabetes, high cholesterol, concerning symptoms, or a family history of heart disease, I encourage a conversation with a doctor before undertaking demanding endurance events.
I would like to see heart health become a normal part of the conversation within Malaysia’s running community. We talk about training plans, finishing times, and personal bests; there should also be room to talk about blood pressure, cholesterol, family history, and knowing when to seek medical advice.
Before your next race, ask yourself one more question: You know how far your legs can take you. But how well do you know your heart?
About the Author: Dato’ Sri Dr Azmee Mohd Ghazi is Head of Cardiology and Director of Sports Cardiology Services at Institut Jantung Negara (IJN), Malaysia’s national heart specialist centre. For information on IJN’s Sports Cardiology Services and screening programmes, visit www.ijn.com.my.
