CONVERSATIONS FOR THE HEART – Why Would A Young Athlete Die So Suddenly?
It is always such a tragedy when a young person dies. It seems even more shocking when it happens suddenly to someone that seems so healthy like our student athletes.
How could this happen?
Did they know something was wrong and didn’t say anything?
How could we prevent this?
Can this run in my family?
These are all questions that run through everyone’s mind. Not just the family who suffers such a tragic loss but the other students, friends and the medical providers.
How common is such a tragedy?
Sudden cardiac death occurs in approximately one per 200,000 young athletes per year. The risk is higher in males, African Americans and in basketball players. The most common finding at autopsy is a seemingly “normal looking heart”. But the most common abnormal finding is an inherited condition called “Hypertrophic Cardiomyopathy”. This is where the heart muscle thickens and increases the chances for dangerous heart rhythms which can lead to fainting and in some cases sudden death. Other symptoms include shortness of breath and chest pain. Sometimes there is a murmur or high blood pressure, but there can also be a lack of symptoms until something sudden happens.
Other possible causes for sudden death in a young athlete include a “blow to the chest” which can stop the heart, coronary arteries that are not in the correct location (congenital or at birth), Myocarditis (infection or inflammation of heart muscle), Aortic valve disease (usually a tightening of valve called aortic stenosis), rupture of the Aorta (large artery that comes off the top of the heart) which can happen with Marfan’s Syndrome (genetic). There are more rare conditions such as long QT syndrome, Brugada Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia that can cause life-threatening heart rhythms.
As athletes get older (>35 yrs) the most common finding that leads to SCD (Sudden Cardiac Death) is disease of the heart arteries (Coronary Artery Disease or CAD)
What can I watch for that may give some kind of warning??
If there are symptoms they should be checked out as soon as possible before continuing sports activity. Especially dizziness or fainting which can sometimes be the only warning that occurs.
If an athlete is noticing a decrease in exercise endurance, or shortness of breath, chest pain or palpitations they should be evaluated.
Avoiding overheating and dehydration are crucial. Also avoiding stimulants such as too much caffeine or some of the medications used for ADD/ADHD treatment.
Sports physicals usually include questions about family history of sudden death, student symptoms, an exam for heart murmurs or physical findings suspicious for Marfan Syndrome (unusually tall in height or long arm span). Some physicals have included an EKG (electrocardiogram) to screen for heart thickness or other findings that point to an obvious heart issue, but usually are only done if the student has some finding that is suspicious. If the history, exam or EKG is abnormal, an echocardiogram (ultrasound of the heart) can be very helpful.
General screening of every student with an EKG or echocardiogram is not possible in part because of the cost involved. Sometimes the testing can be abnormal and not necessarily be a life-threatening issue, so it can lead to unnecessary testing. It is best to keep up with regular wellness checks with your primary care provider.
Tests can also be normal and the tragedy can still occur.
That’s why there has been such a push to have portable defibrillators available at sporting events.
BUT THE MOST IMPORTANT POINT IS IF YOUR LOVED ONE IS ACTIVE IN A SPORT THAT IS VERY STRENUOUS, PLEASE ENCOURAGE THEM TO ALERT SOMEONE IF THEY DO NOT FEEL WELL.
Written by: Alicia Williams, D.O.
Dr. Alicia Williams is an Integrative Cardiologist at The Center for Optimal Health and offers cardiac screenings for athletes age 16 and older. Call (517) 324-9400 to set up your cardiac screening with Dr. Williams at The Center for Optimal Health in East Lansing, Michigan.
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