Preventing Sudden Death in Young Athletes
The sudden death of a young athlete is a tragic event that has devastating effects on families and communities. Sudden death in young athletes is usually due to unsuspected heart disease or other heart problems that are not detected by routine screening measures.
Prevalence of Sudden Death in Athletes
There are approximately 75 deaths per year in both male and female athletes between the ages of 13 and 25. Most sudden deaths occur during or immediately after exercise.
Mechanism of Sudden Death in Athletes
Certain heart conditions react adversely to exercise. Exercise causes the heart to fibrillate, usually ventricular fibrillation, and then stop. The athlete collapses suddenly and if not resuscitated dies within minutes.
Cardiac Causes of Sudden Death
- Hypertrophic cardiomyopathy: 36%
- Coronary anomalies: 17%
- Myocarditis: 6%
- Arrhythmogenic right ventricular dysplasia: 4%
- Long QT syndrome: 4%
|Diagram of the 3 major coronary arteries which supply the heart with nutrition and oxygen.
Coronary anomalies occur when the arteries originate and/or course in an abnormal way. In the diagram to the right, the labels indicate the normal origin points for key heart structures. If the left coronary artery originated from the site of the right coronary artery, for example, it would have to course across the heart to reach its intended heart muscle. This abnormal course could result in compression of the artery between the aorta and the pulmonary artery during exertion resulting in chest pain, shortness of breath or sudden death.
The diagnosis can only be made if an athlete with chest pain or shortness of breath undergoes a detailed Echocardiogram looking at the coronary arteries, a CAT Scan of the heart or a MRI of the heart.
Other Causes of Sudden Death
Myocarditis is a virus that affects the heart. Symptoms include fever, chest pain and shortness of breath. Treatment involves bed rest until it resolves. Athletes with a fever or viral illness should not exercise.
Arrhythmogenic Right Ventricular Dysplasia (ARVD)
ARVD accounts for 4 percent of cardiac deaths in the U.S. ARVD is a genetic condition causing the heart to be replaced by fat and fibrous tissue. Symptoms include palpitations or passing out. Diagnosis is made by family history of ARVD, ECG & Echocardiogram. ARVD is difficult to detect in routine athletic screening.
Commotio cordis accounts for 3 percent of deaths in athletes. The mean age of the athlete is 14 years. When a hockey puck, a baseball or blow strikes the chest, the heart can be hit at a vulnerable point of its electrical cycle causing the heart to fibrillate and stop. Softer baseballs and chest barriers may protect the athlete.
Pre-Participation History and Exam
The goal of screening is to detect an abnormal medical condition that could harm or kill the athlete when they exert themselves. The American Heart Association has recommendations on screening athletes that should be followed by all medical providers. The recommendations include a focused medical history and physical examination. This should be repeated every 2 years for high school athletes and every 3 years for college athletes.
Questions to ask Athletes:
- Chest discomfort
- Dizziness or passing out
- Shortness of breath
- Heart murmur
- Elevated blood pressure
- Family history of a serious heart condition
- Blood pressure
- Listen for a heart murmur lying down, standing and squatting
- Check pulses in all extremities
- Look for signs of Marfan's Syndrome including long limbs and mobile joints
Pitfalls in Screening Athletes
There are millions of athletes that need screening and there are an inadequate number of trained medical personnel. Screening is often performed by medical personnel who have not been trained to screen athletes and the American Heart Association guidelines are not adhered to. Many of the deadly heart conditions are difficult to detect.
- Ensure that athletes with chest pain, shortness of breath, palpitations or passing out undergo a thorough medical evaluation.
- Train athletes with a graded program gradually building up their fitness level.
- Keep athletes well hydrated.
- Respond immediately to an athlete who has collapsed and be aware that the athlete may have suffered a cardiac arrest.
- Train your staff to perform cardiac life support and have trained staff available at every practice and sporting event.
- Purchase a debrillator and ensure it is readily accessible.
Dr. Keith Mankowitz, the Director of the Sudden Death in Athletes Prevention Program at Barnes-Jewish Hospital and Washington University School of Medicine, offers the following to St. Louis High Schools:
- Advice on measures to prevent injury and death in athletes.
- Review their current screening forms to ensure they comply with the American Heart Association guidelines.
- Encourage coaches and sports personnel to be certified in cardiac resuscitation.
Interested schools can email Dr. Mankowitz at firstname.lastname@example.org.
For athletes 18 years and older who wish to make an appointment with Dr. Mankowitz or another Washington University heart specialist, please call