Sudden Death in Young Athletes

Sudden death generally occurs in older individuals with a known or expected history of cardiovascular disease. Very rarely is it expected in those individuals who are young and who participate in sports that improve their cardiac state of wellbeing. Recent analyses, however, have indicated that there are more cases of sudden cardiac death among young athletes than previously thought.

It is estimated that approximately one out of 43,770 NCAA athletes will suffer from a sudden cardiac death each year. The athletes can be those involved in anything from gymnastics to basketball to football and soccer. In a study that was performed from the years 2004 to 2008 showed that, of the nearly 44 thousand athletes, there were 273 deaths. Of these, the vast majority were from traumatic causes (187 deaths), while 80 percent were from medical reasons, including sudden cardiac death. The deaths from cardiac arrest primarily involved deaths that occurred during or shortly following a physical activity such as working out, practicing or being involved in an athletic event.

It was discovered that black athletes had a higher rate of death due to sudden cardiac death than white athletes. The difference was so dramatic as to say that black athletes should be screened more carefully than white athletes. Far more men were involved in a cardiac-related death than women. Basketball players suffered the most, followed by those who swim, play football and participate in cross country track events.

It appears that it is the sports training itself that causes the cardiac event. Some students who participate in sports have hidden birth defects such as idiopathic hypertrophic subaortic stenosis (IHSS). It is a condition that isn’t dangerous unless someone is exerting themselves and has a rapid pulse and a high cardiac output. Other conditions include coronary artery disease, which may be congenital or acquired.

So what is the best way to screen these individuals prior to athletic participation? One could do an ECG on all sports participants but this tells nothing about what the heart is doing at rest. One could perform an echocardiogram on all sports athletes but this can only show congenital diseases like IHSS and valvular diseases. It is not a good test for coronary insufficiency. Finally, doctors could perform an exercise stress test on all athletic participants. Such a test would be expensive to do but would show changes in the ECG during activity and might pick up blood pressure or rhythm changes during activity.