Sudden Cardiac Death in Young Athletes
Written by Director/CEO Dr. Eric D. Fethke
Every year in the United States about 2 out of every 100,000 dies suddenly from unrecognized or under-appreciated natural cardiac problems. This results in a total of 60-80 deaths per year. Though a relatively rare problem, this event, known as Sudden Cardiac Death, is understandably very tragic and receives a lot of recognition in the news when such a death occurs.
In Sudden Cardiac Death, essentially the heart just gives out – a cardiac arrest - and the individual usually dies within one or two hours from the time that symptoms begin. Many terms have been used to describe this situation, including a “heart attack”. The truth is that a true heart attack (myocardial infarction), caused by a lack of blood supply to the heart itself due to clogged coronary arteries, is only one type of problem that can result in a sudden cardiac death. It is also mainly a problem for adults, not young people.
The other known cardiac problems are more likely causes of a sudden cardiac arrest in young people, particularly the athletic individual. The good news is that there are only a handful of such potentially lethal problems.
1. an enlarged heart (cardiomyopathy)
2. a birth defect involving abnormal coronary arteries
3. an inflamed heart (myocarditis)
4. an elevation of blood pressure into the lungs (pulmonary or right heart hypertension)
5.blocked or narrowed heart valves
6. an excessively fast or irregular heart beat originating from an abnormally located spot in the top or bottom portion of the heart instead of the normal sinus node location (an atrial or ventricular tachycardia).
A trained and experience pediatric cardiologist can usually identify such problems in an individual through a combination of a thorough medical and family history, a medical examination, and an electrocardiogram test. Sometimes a picture of the heart with a special ultrasound known as an echocardiogram or an exercise stress test is required. Once such a problem is identified, the individual is usually restricted from participating in competitive sports until appropriate treatment – medicine, surgery or special pacemakers - is provided; a life saving measure.
The bad news is the medical and public health experts do not all agree on how to screen or prevent these deaths or even if it is cost effective to try. There is essentially no standard or uniform system being widely used to screen for such problems in schools or medical facilities across the United States, despite clear guidelines from medical professional agencies such as the American Heart Association. Also many individuals identified with such problems, will never be medically permitted to play competitive sports again due to the high risk this activity would pose.
The best advice we can give at this time is that, if you have a young family member who wants to participate in competitive sports, we urge you to first seek medical evaluation by your personal trusted physician who knows your child. If there is a family history of any of the problems mentioned above or your child has any symptoms associated with exercise or physical exertion such as chest pain, palpitations, excessive shortness of breath, dizziness or fainting, ask your child’s physician about being referred to a pediatric cardiologist for evaluation prior to sports participation. The bottom line is that being your child’s advocate in such circumstances can be life saving and avoid unnecessary tragedy.