[vc_row][vc_column][vc_column_text]The underlying causes of sudden cardiac death during sports include heart attack (coronary artery disease), hypertrophic cardiomyopathy, coronary anomaly, congenital long QT syndrome, Brugada’s syndrome, dilated cardiomyopathy, arrhytmogenic right ventricular dysplasia, myocarditis, mitral valve prolapse, aortic stenosis, and Wolff-Parkinson-White.
Additionally, there are genetic factors such as the presence of mutations in the α-tropomyosin as well as in the ß-myosin heavy chain gene has been associated with sudden cardiac death.
The majority of sudden cardiac death events in athletes are due to ventricular arrhythmias, usually from sustained ventricular tachycardia or ventricular fibrillation. In individuals with certain cardiac disorders (such as hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and more), athletics may increase the likelihood of ventricular tachycardia or ventricular fibrillation in two ways:
- In certain susceptible individuals (with inherited arrhythmogenic cardiomyopathy), prolonged physical training may induce changes in cardiac structure (interstitial fibrosis, disruption of normal myocardial architecture, dilation of right and left ventricle) that may create pathologic arrhythmogenic substrate.
- The immediate physiologic demands of intense athletics (hemodynamic overload, catecholamine release, electrolyte imbalance, autonomic neural dysfunction, physical or emotional stress) may trigger malignant arrhythmias in susceptible individuals with underlying cardiac abnormalities.
In essence, the interaction between the anomalies in anatomical or functional substrates from the underlying heart disease and triggering factors initiates the dangerous ventricular arrhythmias leading to sudden cardiac death.
Cases of sudden cardiac death have been reported among male and female athletes from all sports. Although sudden cardiac death in athletes is rare, media coverage often makes it seem like it is more prevalent.
In the younger population, most sudden cardiac deaths occur while playing team sports such as football and basketball, in about one in 100,000 to one in 300,000 athletes, and more often in males. In older athletes (35 years and older), sudden cardiac deaths occur more often while running or jogging, in about one in 15,000 joggers and one in 50,000 marathon runners.
Basically, there is a high probability that any intense athletic training is likely to increase the risk for sudden cardiac death (or disease progression) in trained athletes with clinically important underlying structural heart disease as a result of structural cardiac changes, although at present it is not possible to quantify that risk. Certainly, the vast majority of young athletes who die suddenly do so during athletic training or competition.
WARNING SIGNS
The clinical presentation of sudden cardiac arrest in athletes is abrupt, and, unfortunately, the player usually has had no warning symptoms before the catastrophic event. In the report by Maron et al, 90 percent of the 158 athletes experiencing sudden cardiac arrest collapsed during or immediately after a training session or scheduled athletic contest. Only 12 of the 158 athletes reported symptoms before the fatal event. At their pre-participation physical examination, athletes may not report the symptoms that alert medical personnel to their risk of sudden cardiac arrest. Thus, the arrhythmia is usually instantaneous in an asymptomatic athlete and occurs during or at the end of intense physical activity, with death quickly following.
Cardiac arrest is characterized by abrupt loss of consciousness caused by a lack of adequate cerebral blood flow which leads to sudden cardiac death in the absence of an active intervention, although spontaneous reversions occur rarely. There are no specific warning symptoms for predicting sudden cardiac death. Signs such as cardiac rhythm abnormalities, cardiac ischemia or cardiac failure which present hours or minutes before cardiac arrest are more specific for heart diseases. However, patients at risk for sudden cardiac death can have warning symptoms such as chest pain, shortness of breath, palpitations, weakness or fatigue, and a number of non-specific complaints. Such symptoms can precede coronary events, particularly heart attack and sudden cardiac death.
WHAT TO DO AFTER CARDIAC ARREST
If a person survives a sudden cardiac arrest during sports, he will most probably be treated with an implantable cardioverter defibrillator together with medications to reduce the risk of recurrent cardiac arrest. They will need to keep up with regular follow-up appointments with the doctor and make certain lifestyle changes, meaning that they will have to give up certain sports especially competitive sports. They may be allowed certain low intensity exercise to keep fit, depending on the underlying cardiac condition.
Before you take up any sports, it is important that you see a cardiologist for a cardiac screening especially if you have a family history of sudden cardiac death in the young and/or coronary risk factors such as smoking, diabetes, hypertension or hypercholesterolaemia.[/vc_column_text][/vc_column][/vc_row]
