One of the most unexpected and tragic events to occur during athletic competition is sudden cardiac death. A young athlete collapses without warning, often initially unnoticed. Everyone in attendance is stunned before realizing what is happening.
The risk of sudden cardiac death is rare, estimated to affect one in 200,000 high school athletes per year. Such episodes are devastating to the family, school and community. Athletes are supposed to be fit and healthy. They are not supposed to collapse and die while participating in an activity usually considered safe and fun.
While sudden death during athletic events may occur because of trauma or heat stroke, the majority of cases occur because of underlying cardiovascular disease. With the intense demands of physical exertion, the condition makes the heart prone to developing a rapid chaotic rhythm called ventricular fibrillation. The rhythm can be restored to normal and the athlete’s life saved only if it is rapidly recognized and external defibrillation performed.
Many of the conditions that put athletes at risk can be identified through careful screening at the pre-participation sports physical and, if necessary, further diagnostic testing.
Warning symptoms may include:
- Chest pain during exertion
- Shortness of breath
- Light headedness
- Fainting spells
- Sensations of rapid heart beating (palpitations)
Any prospective athlete with these symptoms needs further assessment. Additional evaluation may include an electrocardiogram (ECG), ultrasound of the heart (echocardiogram), stress testing, referral to a pediatric cardiologist, or referral and testing by a cardiac electrophysiologist (heart rhythm specialist).
If certain, specific cardiac diseases are identified, the student should not be allowed to participate in competitive athletics. Because many of these conditions are hereditary, it is important that parents know their family history regarding heart disease or any relatives that have died suddenly, particularly at a young age.
Considering how rare sudden death during athletics occurs, there is controversy over whether widespread screening (such as routine ECGs) should be applied to all potential athletes. Any screening test has costs as well as limitations that could expose subjects to the risks of more in-depth testing, and unnecessarily restrict some from athletic participation.
No single test will guarantee sudden cardiac arrest will not occur. For this reason, and because sudden death can be prevented if identified and treated rapidly, efforts should continue to educate coaches, parents and students how to recognize and treat cardiac arrest appropriately.
When an athlete goes down, attend to the athlete. If the athlete is not conscious, check for the presence of a pulse. If no pulse is found, cardio-pulmonary resuscitation (CPR) should be started without delay and an automatic external defibrillator (AED) applied as soon as possible. Activating the 911 emergency response system is critical, but the time it takes for responders to arrive may be too long. Resuscitation efforts cannot wait.
The most important factor in survival from sudden cardiac arrest is early defibrillation of the abnormal rhythm. Communities should strive to have AEDs available at all athletic events.
Sudden cardiac death is a rare occurrence. Regardless, we need to be prepared to deal with it. Seeing a young person survive this potential tragedy is one of the most heroic events to occur on the athletic field.
Article submitted by Electrophysiologist John J. Hayes, M.D., Marshfield Clinic
Share comments or questions on this information. E-mail sports.medicine@marshfieldclinic.org.
