What to know if you experience a cardiac event on court

It’s one of the scariest occurrences on a tennis court: Experiencing medical duress, or witnessing it happen to an opponent or doubles partner. In honor of American Heart Month, we spoke to Dr. Ersilia M. DeFilippis, an advanced heart failure and transplant cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center, about how to best handle cardiac emergencies should they happen during a match. Below, she identifies the warning signs to watch for, what you can do to help, and what to discuss with your doctor about playing with heart conditions.

What are some of the signs that you may be overexerting yourself on a tennis court?

DR. DEFILIPPIS: If you feel any chest pain, dizziness, lightheadedness or shortness of breath that goes beyond what you normally feel running to chase down a ball, take that as your signal to stop. Wearing a smart watch to monitor your heart rate while playing can also be helpful.

What is actually happening in the body when you experience a cardiac emergency?

DR. DEFILIPPIS: When you are having a heart attack, an artery in the heart is blocked, and no blood is getting to that part of the heart muscle. If the artery remains completely blocked for a certain period of time, that part of the heart muscle can suffer permanent damage. Sometimes a heart attack can lead to abnormal heart rhythms, which prompts the heart to stop beating. A person may collapse if they are standing and lose consciousness. This is called cardiac arrest.

What are the symptoms that may indicate you are experiencing a heart attack?

DR. DEFILIPPIS: The most common sign of a heart attack is chest pain. Some people describe it as an elephant sitting on their chest. However, others may not experience this. They may instead feel a pain that radiates down the arm or up to the jaw. Other symptoms include shortness of breath, nausea, vomiting or abdominal pain that comes on with exercise. Dizziness and lightheadedness might just be due to dehydration, but they are also signs that can indicate an abnormal heart rhythm, especially if chest pain is also present. If you are newly experiencing any of these symptoms while playing, and they continue even after you get off the court, call 911.

How might these symptoms differ for a woman versus a man?

DR. DEFILIPPIS: Chest pain is still the most common sign of a heart attack in both women and men. However, women are more likely to experience what we call atypical symptoms, such as pain that spreads to the shoulders or arms, nausea and indigestion, stomach pain or dizziness. And although heart disease is the number one killer of women, a 2019 survey showed that less than 50% of women were aware of this. They were more likely to identify breast cancer as the leading cause of death in women.

How might activity, such as running around on a tennis court, influence a cardiac emergency? Would the symptoms change?

DR. DEFILIPPIS: During exercise, your heart works harder to pump more blood to your organs than it normally would when you’re simply resting. If the blood vessels in the heart contain blockages, the [increased effort] would make you more likely to experience chest pain. So, the symptoms are the same, but you would be more likely to experience them during exercise than if you were at rest. When cardiologists try to determine if someone’s chest pain is originating in the heart, two of the questions we ask are: Did the pain get worse with exercise or some kind of exertion? Did the pain stop with rest? If the chest pain is worse with exercise and improves with rest, this makes us more concerned it could be coming from the heart.

How might another person on court (a doubles partner or opponent) support a person experiencing a cardiac emergency while waiting for EMTs to arrive? Is aspirin helpful?

DR. DEFILIPPIS: If someone is experiencing chest pain and you’re worried they may be having a heart attack, aspirin could be helpful. Call 911 and do not let the person drive to the hospital. If someone collapsed and is not responding, and you believe they had a cardiac arrest, start CPR as soon as possible. CPR will help restart the blood flow to the heart and rest of the body—it can save someone’s life! Surveys have shown that only about half of Americans would know how to perform CPR in these situations. Organizations like the American Heart Association have resources on their website that can help you find a nearby CPR class. The longer someone is without oxygen while waiting for EMTs, the longer vital organs, such as the brain, are not getting any blood flow. If another person is around, ask them to check to see if the facility has an automated external defibrillator (AED) or other type of defibrillator. This can help determine if there is a dangerous heart rhythm and if they need to be shocked back into a normal heart rhythm.