Weightlifting Death Risk

Sadly, Elefteriades says similar scenarios all too often end in the death of a healthy young man. "A problem and a tragedy arises in the fact that it's uncommon for physicians to think of an internal tear of the aorta in healthy young athletes," Elefteriades says.

In 2003, he and his team wrote in the Journal of the American Medical Association that they'd noticed a pattern: five young patients, including Linski, with torn aortas following heavy lifting. All had a previously undetected aneurysm, or enlargement of the aorta.

Now, they report even stronger evidence of this association in the journal Cardiology, where they've documented that link in 31 patients.

"Of the 31 patients," says Elefteriades, "10 of them are dead."

His team's new recommendations are based solely on trying to prevent such terrible losses, he says. "For heavy strength training involving weight lifting or similar activities like pushups, we're recommending screening for unknown or undetected aortic aneurysm."

Elefteriades says that includes people who do heavy lifting on the job, and that the team defines heavy lifting as more than half your body weight.

The screening test they recommend is a heart echo exam, technically called transthoracic echocardiography, also commonly called a heart ultrasound. It's "a very simple test which is painless, it's fun to have and relatively inexpensive," he says.

"I recognize that there are serious social and especially economic implications of making such a recommendation, and that depends on other aspects of our healthcare system whether the echo can be made generally available and whether echo exams can be paid for," says Elefteriades. "The alternative is to accept that every year we will lose some young athletes because of unknown enlargement of their aorta."

Aneurysms: An Inherited Risk

Elefteriades and his colleagues say aneurysms kill more Americans than AIDS largely because they go undetected and undiagnosed until a catastrophic tear occurs. Detecting them means patients can have preventive surgery before it's too late. Their ongoing research has uncovered a big clue to detecting them -- they tend to run in families.

Elefteriades, who enjoys weightlifting, notes that he and his team strongly encourage weight training to maintain muscle mass and bone health. "The only proviso is that we recommend that you check your aorta by ultrasound to be sure it's not enlarged, so you can safely engage in the wonderful and important weightlifting activity," he says.

With his aorta repaired, Linski, now 28, can lift with no fear. "I went back to the gym six weeks and one day after surgery," he says. But it took him nearly four years to get back into shape. Under his doctors' guidance, he had to start out with five-pound dumbbells.

"It was painful in my sternum," he says. "Almost two and a half years I couldn't do much with my sternum because of the pulling and it just ached and it hurt and it took me a while to work through that."

It was also psychologically traumatic. Although his father died of a heart attack at 37 when Linksi was only eight, he never thought he could be struck down so young. Instead he had focused on exercise and health, and began bodybuilding at age 16. So when people at the gym would ask if he had had a heart attack, and mention the link of heart problems with steroid use, it bothered him a lot. "Why would I ever want to put something, with the history in my family and as I promote health, something that was foreign in my body, that would have any kind of adverse effect?" he asks.

Now looking forward to experiencing fatherhood, Linski hopes Elefteriades's research will spare others. "If I can say anything," he says, "I'm just extremely blessed and thank God every night."

Elefteriades' research was published in Cardiology online on July 14, 2006. His work was funded by Yale-New Haven Hospital, the Berkus Fund, and the Fariola Fund.