Sudden cardiac arrest is gaining wide media coverage as more athletes are dying from it during games and practice sessions. Most people associate heart attacks with the unhealthy, the stressed and the elderly.
Much surprise fuels questions as to why young, healthy athletes are dying from heart problems.
Pre-existing genetic or conditions from birth, many of which can be tested for, are generally the cause. Being male increases the odds and immediate treatment can definitely work if used properly.
The risk of sudden cardiac death should not keep people from enrolling their kids in basketball camp, but rather should prompt them to get their kids a physical before training begins.
The Big Debate
The majority of sudden cardiac death in athletes comes from pre-existing conditions. According to a study led by Dr. Annukka Lahtinen, MD, from the Department of Medicine at the University of Helsinki in Finland, genetic variants and rare mutations that contribute to atrial fibrillation and ventricular arrhythmias are common contributors.
Requiring all kids to get a pre-screening physical that includes a 12-lead electrocardiogram (ECG) could catch most of the cases before they have a heart attack on the playing field. The problem is the expense.
In a study done by Dr. Brett Anderson, MD, from the Children’s Hospital of Philadelphia, ECGs can detect the risk of hypertrophic cardiomyopathy and long QT syndrome that can cause sudden cardiac arrest.
If total cost of medical care for sudden cardiac arrest and possible death are factored in comparison to the cost of pre-screening, then it is cost effective. But that doesn’t mean that sports programs and parents are always going to have the upfront money to cover the costs of screening.
Norwegian Olympic swimmer Alexander Dale Oen died at the age of 26 from sudden cardiac death at an Arizona training facility. He collapsed on the bathroom floor on April 30, 2012. 25 year-old Italian soccer player, Piermario Morosini, collapsed on the field during a game and died on route to the hospital.
High school football player Hayward Demison’s heart stopped from a heart attack after he made a play in a game. Fortunately, there was a cardiac nurse in the stands at his game who performed CPR and saved his life.
High school basketball player Zach Gabbard collapsed from a heart attack during a game in 2011. Revived with a portable defibrillator, Gabbard made it to the hospital for surgery and is now alive and well.
The difference in the first two cases vs. the last two: proper immediate medical intervention. Trained CPR medical professionals and working defibrillator machines administered as soon as the athlete collapsed saved their lives.
Who’s at Risk?
Doctors from Italy, Sweden and Switzerland evaluated the incidence and causes of sudden death in young athletes. They claim that, in the presence of an underlying cardiovascular abnormality, risk of sudden cardiac death is 3 to 9 times higher in males than in females.
Hereditary cardiac disease, like cardiomyopathies and coronary abnormalities that have been present since birth, put an athlete at high risk for sudden cardiac death. They may have gone their whole life without knowing of this risk, but when blunt chest trauma from a contact sport causes a ventricular fibrillation in an otherwise normally structured heart —the risk presents a real problem.
It is significant to note that 6 out of 34 sports-related sudden cardiac deaths have no known cause. Meaning that no hereditary, structural or electrical cardiac dysfunctions could be located.
Athletes are also at a greater risk when they are sick. Something simple like the flu can put strain on the heart and greatly increase the risk of sudden cardiac arrest.
Some kids have pre-existing conditions that might never surface if they weren’t pushing their body’s limits. A study done by Dr. Domenico Corrado, MD, from the Department of Cardiac, Thoracic and Vascular Science at the University of Padua Medical School in Italy, suggests that previously asymptomatic cardiovascular disease can be the underlying cause of sudden cardiac arrest.
There are two major problems with requiring evaluation and testing of athletes before they’re cleared to play: one is that a false-positive could keep some perfectly healthy athletes out of sports and the second is the high cost of testing every athlete for pre-existing cardiac conditions.
Doctors studying sudden cardiac death in athletics are starting to advocate for the implementation of a ‘comprehensive medical action plan’ at sports venues. The European Society of Cardiology (ESC) in particular is pushing for people certified in cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) to be on hand for both practice times and sporting events.
Their argument is that, to increase the chances for survival for athletes, a safety plan including quickly routed transportation and properly trained staff, ways for trained staff to move throughout the arena in a crowd and collaboration with close emergency facilities needs to be in place.
ESC spokesperson, Dr. Mats Borjesson, MD, wrote the “Position stand from the European Association of Cardiovascular Prevention and Rehabilitation (EACPR) section of Sports Cardiology” to outline a game plan for sports arenas in Europe to be better prepared for cardiac arrest and improving survival rates.
There’s no need to panic or shut down sports over the recent cardiac deaths in the international sports arena. Rather the implementation of a medical game plan that includes educating coaches and trainers in CPR and defibrillator use and ECG screenings will reduce the incidence of sudden cardiac death in otherwise healthy athletes.