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.
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.
Many Malaysians live with these conditions. Some are aware of them but may not appreciate their long-term implications. Others may not even know they have them.
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. In fact, I would encourage Malaysians to remain physically active because regular exercise helps reduce cardiovascular risk.
However, physical activity is not a substitute for managing blood pressure, cholesterol, diabetes or other underlying medical conditions.
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.
These include abnormalities of the heart muscle, inherited cardiac conditions and 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. Several medical explanations are possible, and proper investigation is necessary.
We can say that 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.
This is one reason understanding your cardiovascular risk becomes increasingly important as you take on more demanding physical activities.
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.
These are positive developments.
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. They monitor their pace and mileage. They work on endurance, hydration and nutrition. Some 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.
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.
Someone who has been inactive for several years and suddenly decides to train for a marathon may also benefit from medical advice before progressing to strenuous exercise.
The objective is not to frighten people away from running.
It is to help them continue running safely.
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.
Chest pain, pressure or tightness during exercise should always be taken seriously.
The same applies to unexplained breathlessness that is disproportionate to the activity, dizziness, fainting, unusual palpitations or a sudden decline in exercise capacity.
Some people experience discomfort in the jaw, back or arms rather than the chest.
Others may develop cold sweats, nausea or an unusual sense of weakness.
These symptoms do not automatically mean someone is having a heart attack, but they warrant appropriate medical attention.
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, or AEDs, are essential at mass-participation sporting events.
If someone collapses, is unresponsive and is not breathing normally, immediate CPR and early defibrillation can be lifesaving.
Screening and emergency preparedness must go hand in hand. Neither replaces the other.
Is an ordinary health screening sufficient?
A routine health screening is a good starting point.
It can help identify hypertension, diabetes, elevated cholesterol and other conditions that contribute to cardiovascular disease.
But for individuals involved in endurance sports, there may be reasons to consider a more specialised assessment.
This is where sports cardiology comes in.
Sports cardiology focuses on the relationship between exercise and cardiovascular health.
It is not limited to professional athletes. Recreational runners, cyclists, triathletes, gym enthusiasts and people returning to strenuous physical activity can also benefit from appropriate specialist advice.
At IJN, we begin by understanding the individual.
What type of exercise do they do? How frequently do they train? Are they preparing for a particular event? Have they experienced unusual symptoms? Do they have existing medical conditions or a family history of heart disease?
These questions help us determine whether further assessment is necessary.
Depending on the findings, investigations may include an electrocardiogram to assess the heart’s electrical activity, an echocardiogram to examine its structure and function, or exercise testing to evaluate how the cardiovascular system responds to physical exertion.
Some individuals may require additional investigations, while others may not.
The important point is that screening should be guided by clinical assessment rather than simply undergoing as many tests as possible.
We must also be realistic about what screening can achieve.
No screening programme can guarantee that a cardiac emergency will never occur.
A normal result today does not mean a person will remain free from cardiovascular disease indefinitely.
Appropriate screening can help identify relevant risk factors and certain underlying conditions, allowing individuals to receive medical advice, treatment, or further evaluation where needed.
For some, that may mean better control of blood pressure or cholesterol.
For others, it may involve additional cardiac investigations or adjustments to their training programme.
And for many people, the assessment may provide useful reassurance and guidance on continuing to exercise.
Sports cardiology is about keeping people active
At IJN, we have developed dedicated Sports Cardiology Services because we recognise that the needs of physically active individuals are not always the same as those of patients seeking treatment for established heart disease.
Our Sports Fitness Screening caters to people involved in general fitness and recreational activities, while our Sports Endurance Screening provides a more comprehensive assessment pathway for individuals preparing for demanding events such as marathons and triathlons.
The intention is not simply to issue a report declaring someone fit or unfit.
We want individuals to understand their cardiovascular health, identify concerns that may require attention and receive appropriate advice about exercising safely.
Where necessary, they can also access further specialist investigations and treatment through IJN’s wider cardiovascular services.
This integrated approach is particularly important when screening identifies a condition that requires more than a routine follow-up.
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.
For us, this is more than an institutional achievement.
As Malaysia’s national heart specialist centre, we have a responsibility to support not only people who are already living with cardiovascular disease, but also those who want to protect their heart health while remaining active.
It also positions Malaysia to provide internationally benchmarked sports cardiology services to athletes and active individuals from across the region, complementing IJN’s role as a participating hospital under the Flagship Medical Tourism Hospital Programme.
As more Malaysians and international visitors participate in endurance events, access to specialised cardiovascular expertise will become increasingly relevant.
But ultimately, 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.
People begin asking whether running is safe, whether marathons are too demanding or whether everyone should undergo heart screening before participating.
I would caution against drawing sweeping conclusions from individual incidents.
Running remains an excellent form of physical activity, and the cardiovascular benefits of regular exercise are well established.
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.
The two are not interchangeable.
The recent tragedy in Putrajaya and the heart attack involving the Standard Chartered Marathon participant remind us that cardiovascular emergencies can affect people taking part in sporting activities.
They do not mean that every runner is at high risk, nor do they establish that screening would necessarily have prevented either event.
But they do give us a reason to pay closer attention to cardiovascular health.
For runners with hypertension, diabetes, high cholesterol, concerning symptoms or a family history of heart disease, I would encourage a conversation with a doctor before undertaking demanding endurance events.
If you’re new to running, build up gradually and give your body time to adapt.
For experienced runners, don’t assume years of training make you immune to heart problems.
And for everyone, remember that recognising symptoms and seeking medical attention early can be just as important as preparing properly before a race.
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.
After all, most people take up running because they want to live healthier, longer lives.
That should remain the goal.
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?