Sudden Cardiac Death in Athletes
By Roberta Dennison, MD
Most people recognize that physical fitness is important for overall health. Benefits include lower blood pressure, healthier weight, decreased risk of diabetes, and better mental health1. Given the health benefits of exercise, the Center for Disease Control in the United States recommends adults get 150 minutes of moderate-intensity aerobic exercise per week and that children and adolescents get 60 minutes of physical activity each day. Of course, with exercise comes risk of injury to muscles, tendons, ligaments, and bones, but other more rare and serious complications can occur. The most devastating of these is the sudden death of a young, active, otherwise seemingly healthy individual during exercise or sport.
The definition of sudden cardiac death (SCD) is death due to cardiac cause occurring within 1 hour of developing symptoms. While this is a relatively rare event in athletes, SCD is the leading cause of identifiable medical death in young athletes. Recognition of this phenomenon reached medical communities in the 1970s and 1980s when a number of cases of SCD during exercise were published in medical journals. The general population caught word of some of these early cases, however, it wasn’t until vast media coverage of the deaths of two famous athletes in the early 1990s that the public became increasingly aware of this risk.
In 1990, Hank Gathers, a 23 year-old NCAA Division I All-American basketball player at Loyola Marymount University, collapsed in a game and perished shortly after. Just 3 years later, another basketball star, Reggie Lewis, team captain of the Boston Celtics, collapsed and died at age 27 at a practice facility in the off-season. Media attention to these cases and subsequent ones have increased awareness of SCD in athletes and also prompted a movement aimed at prevention.
Primary prevention has been sought through the preparticipation physical examination (PPE). As early as 1976 the American Medical Association recommended the PPE to identify athletes with conditions deemed unsafe for participation. There was very little consensus in the medical community on how screening should be approached and what should be required. Following the explosion of awareness of SCD in athletes in the 1990s, the American Heart Association published a position statement in 1996 detailing a preparticipation protocol aimed at identify athletes at risk of SCD. These recommendations have been updated periodically but preparticipation screening remains controversial. In the US, screening requirements are left up to local communities and despite widespread use of PPEs over the past 3 decades, rates of SCD in the US have not declined.
As the medical community works to improve the PPE to help prevent cases of SCD, the best way to help save lives is to be prepared for the event of sudden cardiac arrest in an athlete. Quick resuscitation is an intervention that has been shown to improve survival. To this end, the NCAA Cardiac Task Force convened in 2014 to develop best practices for collegiate athletic programs. The outcome was the “Cardiovascular Care Checklist” with recommendations including ensuring athletic trainers and strength and conditioning coaches are certified in CPR and Automated External Defibrillator (AED) use and that AEDs are readily available for use at athletic events and training areas.
While it is important to be aware of the risk of SCD in athletes and aim to improve prevention, it is also important to recognize that the overall risk is relatively low and the health benefits from exercise are great. With adequate preparation, engagement in physical activity and sport is a safe and healthy practice that should be encouraged at all ages to improve overall wellbeing. #
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