• Cardiac Arrest in Healthy, Young Athletes

    IMAGE A young, college basketball player was rumored to be a potential top pick in the professional basketball draft. Yet, during a game midseason, he experienced heart arrhythmias (irregular heartbeats). He was removed immediately from the game and was treated. Three months later during a tournament game, he collapsed and died. The cause of death was ruled as sudden cardiac arrest. Statistics show that this condition is rare, but it does happen to both amateur and professional athletes. In some cases, death occurs in athletes who do not have evidence of any underlying heart problems.

    About Cardiac Arrest

    Sudden cardiac arrest in its simplest terms means an abrupt cessation of the blood flow when the heart stops beating effectively. Although there is usually no forewarning of a problem, symptoms can sometimes be be missed or ignored. Symptoms might include fainting spells, chest pain, or shortness of breath.
    Sudden cardiac arrest is not the same as a heart attack. During a heart attack, the loss of blood supply causes heart muscle tissue to die. With sudden cardiac arrest, the body's electrical system becomes defective and the heart is not able to beat in an organized manor, leading to rapid and chaotic activity.

    Causes of Sudden Cardiac Arrest

    Genetics plays a large role in sudden cardiac death. Hypertrophic cardiomyopathy is the most common cause. The damaged heart does not pump blood correctly. Over the course of time, the heart works harder causing the heart wall muscles to thicken. This leaves less room for blood in the chambers to be pumped to the lungs and body. The extra stress can cause life-threatening arrhythmias. Although cardiomyopathy may be present at birth, it may not fully develop until the teen years.
    Other causes may include:
    • Abnormal electrical conducting system in the heart—also a cause of life-threatening arrhythmias
    • Narrowing or blockage in the coronary arteries—coronary artery disease
    • Heart is unable to pump enough blood to meet the body's demands—heart failure
    • Infection in the muscle of the heart wall—myocarditis
    • Valvular heart diseases such as aortic stenosis, mitral stenosis, or mitral valve prolapse
    • Bulging or rupture of a major artery—aneurysm
    • Other syndromes present at birth which affect the stability of the heart
    Some causes of sudden cardiac arrest may remain unknown.

    Preventing Sudden Cardiac Arrest

    The American Heart Association (AHA) and American College of Cardiology (ACC) recommend that young athletes be screened before participation in sports to determine their risk for sudden cardiac arrest. During the screening, the doctor will ask questions about whether the young person has a:
    • Personal history of chest pain or discomfort, fainting, heart murmur, or high blood pressure
    • Family member who has died or heart disease at an early age
    • Family history of heart conditions such as cardiomyopathy
    During the physical exam, the doctor will also listen to the heart to check for a murmur, take a pulse rate and blood pressure reading, and look for other signs such as abnormal pulses or shortness of breath. An electrocardiogram may be done. In addition to these preparticipation screenings, schools, colleges, and professional teams should have personnel trained in cardiopulmonary resuscitation (CPR) and have a defibrillator nearby in case of an emergency.
    In some cases, athletes with a pacemaker or automatic implantable cardioverter defibrillator may still be eligible to compete.

    RESOURCES

    American Heart Association http://www.heart.org

    Sudden Cardiac Arrest Association http://www.suddencardiacarrest.org

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca

    Canadian Society of Exercise Physiology http://www.csep.ca

    References

    Maron BJ, Levine BD, Washington RL, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 2: preparticipation screening for cardiovascular disease in competitive athletes: a scientific statement from the American Heart Association and American College of Cardiology. Circulation. 2015;132(22):e267-e272.

    Preparticipation cardiovascular screening for athletes. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T576497/Preparticipation-cardiovascular-screening-for-athletes. Updated September 22, 2017. Accessed October 5, 2017.

    Sudden cardiac death. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T905842/Sudden-cardiac-death. Updated June 29, 2017. Accessed October 5, 2017.

    10/12/06 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T576497/Preparticipation-cardiovascular-screening-for-athletes: Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296(13):1593-601.

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