By Akanksha
For 36-year-old Kommineni Gopi, an IBM software engineer, his completion of a full marathon should have been the highlight of his life. However, shortly after crossing the finish line at Gachibowli Stadium on Sunday morning, Gopi fell to the ground and passed away. Gopi had completed the 42.2 km marathon successfully and had received his medal.
However, shortly after the finish, during his walk towards the breakfast zone, he collapsed. He was given CPR by the event organizers and was transferred to a nearby hospital. Doctors at the hospital declared him dead at around 8:45 am. According to Gachibowli police, preliminary information suggested that Gopi had suffered a heart attack. However, the exact cause of death was to be established through a post-mortem examination.
Gopi is survived by his wife and their three-year-old child. His sudden demise has sent shockwaves through his family, colleagues, and fellow running enthusiasts.
The incident raised concerns about the medical provisions in place for endurance sports.
A 2018 review in the Indian Heart Journal also identified atherosclerotic coronary artery disease as a major cause of sports-related sudden cardiac death among athletes aged 35 and older. The review highlighted the importance of pre-participation cardiovascular screening and supervised, gradual exercise programmes, particularly for older individuals who are new to strenuous physical activity. 3
“Physical fitness and cardiovascular health are not necessarily the same thing. In athletes and recreational exercisers above 35 years of age, one of the leading causes of exercise-related sudden cardiac death is underlying coronary artery disease (CAD) that has never been detected. This is largely because fit and active people appear healthy, believe they are doing all things right, and may not be rigorous about getting themselves tested,” said Dr. Balbir Singh, Chairman of Cardiac Sciences at Max Healthcare, in an Indian Express article.
A heart attack is caused by a blockage in the arteries supplying blood to part of the heart muscle. Cardiac arrest is caused by an electrical issue in the heart. The heart stops beating effectively, and the individual collapses and stops breathing normally. A heart attack can cause cardiac arrest. However, cardiac arrest can occur due to arrhythmias or structural issues in the heart. Cardiac arrest survival largely depends on receiving CPR in the first few minutes and defibrillation.
According to the European Society of Cardiology, more than 80% of sudden cardiac deaths in athletes over 35 years old are due to coronary artery disease (CAD). A 2018 Indian Heart Journal review similarly reported that approximately 80% of sports-related sudden cardiac deaths in this age group were attributable to atherosclerotic CAD. 2
CAD develops over time due to cholesterol plaque build-up in the coronary arteries. This can occur without any noticeable symptoms for years. Therefore, the first sign of CAD in these individuals can be a heart attack or sudden cardiac arrest.
One important mechanism is plaque rupture. A cholesterol-rich plaque may remain relatively stable for years without causing major obstruction to blood flow. During intense physical exertion, however, heart rate, blood pressure, and the heart’s demand for oxygen rise considerably. In a susceptible individual, a vulnerable plaque can rupture, and the body’s clotting mechanism responds by forming a blood clot at the site of the rupture. If the clot suddenly blocks the coronary artery, blood supply to a portion of the heart muscle is interrupted. This can produce an acute heart attack or trigger a dangerous electrical disturbance called ventricular fibrillation, in which the heart’s electrical activity becomes chaotic and the heart can no longer pump blood effectively.
Also Read: Mindfulness May Help Marathon Runners Cope With “Hitting the Wall”: Three Strategies for Endurance
Regular exercise helps improve cardiovascular health, regulate blood pressure, and reduce the risk of diabetes. However, intense exercise can put extra strain on the cardiovascular system. This can occasionally cause an incident to occur in individuals with an underlying heart condition.
Even after crossing the finish line, the heart rate, blood pressure, and autonomic nervous system undergo rapid changes. The relative risk of a cardiac event is increased during and up to an hour after exercise. However, according to the American College of Cardiology, the absolute risk is low.
Not every collapse during or after a marathon is caused by a cardiac event. Exertional heat stroke and exercise-associated hyponatremia, a condition involving dangerously low blood sodium levels, are other potentially life-threatening emergencies in endurance athletes. Hyponatremia can occur when runners consume excessive amounts of fluid during prolonged exercise. These conditions require prompt medical assessment and should not be mistaken for ordinary post-exercise fatigue. 4,5
Across eight different race registries, with over 16 million runners, cardiac arrest occurred in 0.82 per 100,000 runners. Of these, 0.39 per 100,000 died.1 In the U.S., data shows that with improved medical provision at races, the proportion of cardiac arrests that are fatal has decreased from 71% to 34%.1
A more recent 2025 study published in JAMA analysed 29,311,597 marathon and half-marathon finishers in the United States between 2010 and 2023. Researchers identified 176 cardiac arrests, equivalent to 0.60 per 100,000 participants. Of these, 59 runners died, representing a case fatality rate of 34%.
The study also found that cardiac arrest incidence was higher among men than women (1.12 versus 0.19 per 100,000 participants) and among full-marathon participants compared with half-marathon participants (1.04 versus 0.47 per 100,000). Among cases with sufficient diagnostic information to establish a cause, coronary artery disease was the most common identified cause. The researchers associated improved survival with shorter CPR response times and emergency defibrillation. 6
India does not have a formal national sudden cardiac arrest registry. A 2023 review published in the Indian Heart Journal, titled "Outcomes of Out-of-Hospital Sudden Cardiac Arrest in India: A Review and Proposed Reforms," identified the absence of a formal registry and gaps in emergency medical services infrastructure.
An earlier 2018 review, "Prevention of Sudden Cardiac Death in Athletes, Sportspersons and Marathoners in India," also highlighted the need for better documentation, cardiovascular screening and emergency medical infrastructure at sporting events. The lack of comprehensive national data makes it difficult to establish the actual incidence of marathon-related cardiac arrests and evaluate emergency response outcomes in India. 3,6
Also Read: Cedars-Sinai Investigators Uncover Earliest Changes in Coronary Heart Disease
The causes vary depending on age1:
Under 35: Genetic heart muscle diseases such as hypertrophic or arrhythmogenic cardiomyopathy, unusual coronary artery anatomy, myocarditis, and unknown causes.
35 and over: Coronary artery disease is the most common cause. In a large Paris registry, 11 out of 18 confirmed cardiac arrests were due to a blockage in the arteries. Risk factors include high blood pressure, high cholesterol, diabetes, smoking and family history.
Men, older individuals, and those running a full marathon have a higher risk.1,2 Most incidents occur in the final stages of the marathon or immediately after crossing the finish line. Data from Japan shows the rate increases with age. Per 100,000 runners, the incidence is 0.9 for those in their 40s and 5.5 for those aged 60 and over.2
If runners experience chest pain, pressure or tightness, fainting or feeling faint, unusual breathlessness, or a fast or irregular heartbeat, they should stop and seek help.
If they experience any of these symptoms during training, have a family history of sudden death or early heart disease, have high blood pressure, high cholesterol or, diabetes, or have recently had an infection, they should seek help.1
Guidelines in Europe recommend a resting ECG for competitive athletes. Guidelines in the U.S. recommend taking a medical history and performing an examination. Recreational athletes over 35 should complete a validated self-screening questionnaire. If any of the answers are positive, they should have a clinical assessment.1
Runners should increase their mileage gradually. They should avoid intense training if they are unwell. Return to running gradually after an infection, and keep blood pressure, diabetes, and cholesterol under control.
During the marathon, do not ignore any symptoms. Once you have crossed the finish line, you should continue to move gently.
Event organisers should ensure that trained responders can recognise cardiac arrest and initiate CPR immediately, with rapid access to an automated external defibrillator (AED). A 2022 prospective observational study in Japan examined 42 marathon-related sudden cardiac arrests among 3,214,701 runners. Among 22 cases in which bystander CPR began within one minute and defibrillation was performed within three minutes, 95.5% achieved favourable neurological outcomes at both one month and one year. These findings highlight the importance of rapid intervention, although the results should not be interpreted as a guaranteed outcome for every cardiac arrest. 8
Check that the race has marked AED points and medical teams along the route. If someone collapses and is not breathing normally, call 112 or 108. Give hands only chest compressions in the center of the chest. Send someone to get an AED.
References:
1. Zhang, X., S. Li, Y. Mai, H. Chen, H. Wu, C. Li, L. Zhao, and J. Peng. “Marathon-Associated Sudden Cardiac Death: A Mini Review of Risk Perception, Pathophysiological Mechanisms, and Prevention Strategies.” Frontiers in Cardiovascular Medicine 13 (2026): 1847561. https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2026.1847561/full.
2. van der Wall, E. E. “Marathon Running: Small or Increased Risk for Cardiac Arrest?” Netherlands Heart Journal 20, no. 3 (2012): 89–90. https://link.springer.com/article/10.1007/s12471-012-0246-1.
3. Vora, Amit, Nitin Burkule, Ashish Contractor, and Kartikeya Bhargava. “Prevention of Sudden Cardiac Death in Athletes, Sportspersons and Marathoners in India.” Indian Heart Journal 70, no. 1 (2018): 137–145. https://doi.org/10.1016/j.ihj.2017.12.004.
4. “Exertional Heat Stroke and Exercise-Associated Hyponatremia in Collapsed Endurance Athletes.” Sports Medicine and Health Science. Published online May 27, 2026. https://doi.org/10.1016/j.smhs.2026.05.005.
5. Bennett, Brad L., Tamara Hew-Butler, Mitchell H. Rosner, Thomas Myers, and Grant S. Lipman. “Wilderness Medical Society Clinical Practice Guidelines for the Management of Exercise-Associated Hyponatremia: 2019 Update.” Wilderness & Environmental Medicine 31, no. 1 (2020). https://doi.org/10.1016/j.wem.2019.11.003.
6. Kim, Jonathan H., Austin J. Rim, James T. Miller, et al. “Cardiac Arrest During Long-Distance Running Races.” JAMA 333, no. 19 (2025): 1699–1707. https://doi.org/10.1001/jama.2025.3026.
7. Patel, Hiren, Arun Umesh Mahtani, Laxmi S. Mehta, et al. “Outcomes of Out-of-Hospital Sudden Cardiac Arrest in India: A Review and Proposed Reforms.” Indian Heart Journal 75, no. 5 (2023): 321–326. https://doi.org/10.1016/j.ihj.2023.08.005.
8. “Prehospital Interventions and Neurological Outcomes in Marathon-Related Sudden Cardiac Arrest Using a Rapid Mobile Automated External Defibrillator System in Japan: A Prospective Observational Study.” British Journal of Sports Medicine (2022). https://doi.org/10.1136/bjsports-2021-104964.
(Rh/APC/MSM)