What causes sudden cardiac death in athletes?


Last month I wrote about athletes and sudden cardiac death. Many people contacted me to learn more, so I have decided to expand on this topic a bit (I promise to keep it short and not bore you with too much medical jargon).

WHAT TO LOOK OUT FOR

Age

The most common causes of sudden cardiac death (SCD) and sudden cardiac arrest (SCA) in athletes are divided in two groups: 1) the structurally normal heart and 2) those related to a structurally "abnormal heart". Within these two groups, age will sub-divide them once more. Specifically, are you over or under 35 years old? I know, not fair, most would argue that 40's are the new 30's but that is how it goes for this.

Congenital vs. Acquired

Then we also divide between congenital (you received genetically from your mom or dad, which might increase your chances of having a cardiac problem); and acquired (meaning weather you have problems with your coronary arteries or not. How do you know congenital or not? Ask your parents. "Mom do we have a family history of anyone having serious cardiac problems young or dying young?" You would be surprised how many hear that they actually do have a history that might be relevant.

Normal vs. Abnormal

Next we divide between a structurally normal or abnormal heart. How do you know if your heart is normal or abnormal structured? Well it's simple, ask your doctor. Politics aside, most should have a primary MD, because it comes down to taking a medical history and physical exam (plus or minus a couple of simple tests like ECG and echo if your MD deems it appropriate).

RISK FACTORS

The coronary arteries are the vessels supplying blood to your heart muscle and sometimes they get clogged up with cholesterol plaque - increasing your chances of having a heart attack or arrythmias. For most, this is something that should not be a concern (at least not for years to come), but others do have risk factors that make them more susceptible much earlier. Some of those risk factors include HTN, diabetes, obesity, renal problems, smokers, cholesterol problems etc. For the purposes of SCD, it's a combination of age (35+) and family history (as discussed earlier).

The actual names of the things that cause SCD/SCA then are:

  • Hypertrophic cardiomyopathy

  • Arrythmogenic Right ventricular cardiomyopathy

  • Dilated cardiomyopathy

  • Congenital long QT syndrome

  • Wolf-Parkingson-White syndrome

  • Kawasaki's disease

  • Acquired long QT syndrome(drug-induced)

  • Myocarditis

OK, I promised I would not bore you with too much jargon, so I wont keep going. But admit it - some of these diagnosis names are so cool! The real point, though, is: ASK your trainer or coach if they are comfortable to begin or continue training if you have any of the things mentioned above. Particularly if the training regime calls for intense work outs and you are over 35, or if your trainer/coach feels you are not responding as expected, or if you simply do not feel right during or shortly after the sessions. And remember that SCD or SCA are rare overall, but they do occur and my intent is for you to be empowered with the basic knowledge to determine your personal risk factors. Hopefully it will help you, your family members or friends prevent ANY of these adverse events.

The actual overall incidence rate is 1 in 53,703 athletes / year.

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Melvin A. Martinez-Castrillon, MD