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Sudden Cardiac Death in Athletes

by Robert S. McKelvie, MD, PhD, MSc

An estimated 1/200,000 apparently healthy young athletes develops an abrupt-onset heart rhythm abnormality and dies suddenly during exercise. Males are affected 10 times more often than females. Basketball and football players in the United States and soccer players in Europe may be at highest risk.

The most common cause of sudden cardiac death in young athletes is undetected thickening of the heart muscle (hypertrophic cardiomyopathy—see Hypertrophic Cardiomyopathy ). Other heart disorders, such as long QT syndrome (see Long QT Syndrome and Torsades de Pointes Ventricular Tachycardia) or Brugada syndrome (see Brugada Syndrome) that cause abnormal heart rhythms, and aortic aneurysms may also cause sudden death in young athletes.

Rarely, young, thin athletes may also have sudden heart rhythm disturbances if they experience a blow to the area directly over the heart (commotio cordis) even when they have no heart disorder. The blow often involves a fast-moving projectile such as a baseball, hockey puck, or lacrosse ball or impact with another player.

The most common cause in older athletes is coronary artery disease.

Asthma, heatstroke, and the use of performance-enhancing drugs may also cause death due to sudden abnormal heart rhythms.

Some athletes have warning signs such as fainting or shortness of breath. Often, however, athletes, do not recognize or report these symptoms.

The person suddenly stops breathing and collapses. Immediate treatment is with cardiopulmonary resuscitation (CPR) or use of an automated external defibrillator if available. Resuscitation is continued in the emergency department. If the person survives, doctors treat the condition that caused the abnormal rhythm. Sometimes doctors place an implantable cardioverter-defibrillator, which continually monitors the person's heart rhythm and delivers a shock to return the rhythm to normal if needed.

Screening

Athletes are commonly screened by their doctor before participating in sports.

Doctors ask questions about family history, particularly any history of family members who were younger than about age 50 and died suddenly, and about the person's medical history and use of drugs. They do a physical examination, including listening to the heart with a stethoscope and measuring blood pressure with the person lying down and again while the person is standing. People are reevaluated every 2 to 4 years.

In younger people, doctors typically do not do any tests unless something abnormal is identified in the person's history or is found during the physical examination. Routine use of ECG screening of young athletes is not considered practical. However, if findings suggest a heart problem, doctors typically do ECG, echocardiography, or both. For men over about age 45, and women over age 55, doctors typically also routinely do exercise stress testing (see Stress Testing) before approving vigorous exercise.

If a heart disorder is found, the person may need to stop participating in competitive sports.