Sudden Cardiac Death in Athletes: Prevention
In the United States, sudden cardiac death occurs most commonly in basketball and football, accounting for 2/3 of incidents. In the rest of the world, soccer (football) is the sport most commonly associated with sudden death.
According to the American Heart Association:
"Most young athletes who die suddenly are found to have a previously unknown heart defect with which they were born. A condition called hypertrophic cardiomyopathy is most common cause of sudden death in young athletes in the United States, accounting for one-third of all mortalities"Cardiomyopathy is a weakening of the heart muscle or a change in heart muscle structure such that the heart no longer pumps blood well."
"Young" often refers to high school and college athletes, but applies in general to individuals under the age of 35. Older athletes include individuals over the age of 35, in whom sudden death is most commonly due to coronary heart disease.
So, how can we prevent a tragedy from occurring in our young and older athletes?
There's no doubt about it, raising awareness among parents, teachers, coaches and the players themselves about the causes of sudden cardiac death in athletes is essential.
Screening for cardiac problems
A 12-point screening process may help reduce sudden cardiac death in high school and college competitive athletes. The screening includes 12 questions about personal and family medical history, and a physical examination to uncover any cardiovascular problems.
Questions cover subjects, such as:
- Chest pain/discomfort upon exertion
- Unexplained fainting or near-fainting
- Excessive and unexplained fatigue associated with exercise
- Heart murmur
- High blood pressure
- One or more relatives who died of heart disease (sudden/unexpected or otherwise) before age 50
- Close relative under age 50 with disability from heart disease
- Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy in which the heart cavity or wall becomes enlarged, long QT syndrome which affects the heart's electrical rhythm, Marfan syndrome in which the walls of the heart's major arteries are weakened, or clinically important arrhythmias or heart rhythms.
- Heart murmur
- Femoral pulses to exclude narrowing of the aorta
- Physical appearance of Marfan syndrome
- Brachial artery blood pressure (taken in a sitting position)
Many sporting institutes already have requirements for physical examinations prior to enrolment in organized athletic activities. However, each year over five million high school and college students, and 5,000 professional athletes take part in sports. Therefore screening presents a significant challenge.
A study published in the American Journal of Cardiology (2008) found that 'bulking up' by athletes playing sports, such as American football, might lead to an increased risk for cardiovascular disease.
The study showed a higher prevalence of metabolic syndrome, an established cardiovascular risk factor, among retired NFL linemen, with around 60% of linemen having metabolic syndrome, compared with 30% of those playing other positions.
What can you do to lower your risk of cardiac problems?
- Be aware of sudden cardiac death and let coaches, parents, and other team mates know about the risks.
- Encourage your sporting institute to invest in defibrillators.
- Ensure regular screening with your doctor.
- If you've been screened, and found to have abnormal results, postpone participation in competitive activities until further tests have been performed.
- Don't forget the major health benefits to be gained from organized athletics. Complete abstinence from any physical activity is also dangerous to your health.
- Ex-athletes should endeavor to follow a healthy lifestyle in their post-professional years. Younger athletes need to know about potential long-term health consequences of 'bulking up' and should be discouraged from achieving unhealthy body weights.