Sudden cardiac death (SCD) affects nearly 500,000 people in the United States every year. SCD occurs most often in people with significant heart disease, such as congestive heart failure or coronary artery disease after a heart attack. However, on rare but upsetting occasions we hear about a young person who dies suddenly on the playing field during a sporting event.  We used to think that the reason for this devastating event is that the person might have exercised too strenuously. However, recent evidence suggests that this may not be true. 

Causes of Sudden Death

In the vast majority of cases, the cause of sudden collapse is a very rapid heart rhythm disturbance due to an underlying cardiac problem. Most victims were not even aware of the problem. The most common problems that lead to lethal heart arrhythmias include an excessively thickened heart muscle (hypertrophic cardiomyopathy), congenital abnormalities in the coronary anatomy, and the Wolff-Parkinson-White syndrome. Another common cause of cardiac arrest on the playing field is an inherited disease of the heart muscle cells known as the “congenital long QT syndrome.” These conditions result in such a rapid heart rhythm disturbance that the heart cannot pump effectively and the circulation essentially collapses. Usually, the only way to stop such an arrhythmia is by shocking the heart back into a normal rhythm with the paddles or pads of an external device known as a defibrillator. 

Research on SCD

There’s a widespread belief that high adrenaline levels during vigorous exercise may trigger these lethal arrhythmias to occur in athletes with a preexisting heart problem. However, a recent study published in the British Medical Journal demonstrated that the opposite might be true. They made this determination by studying video footage of sudden cardiac death events to better understand the mechanisms that lead to collapse. Luckily, sudden death in young athletes occurs rarely, and so they were only able to find 35 events in total, 26 from professional and 9 from amateur sporting events. The vast majority of the victims were young men. Luckily, 21 of the victims survived.

sudden death on the playing field

After analyzing the videos carefully, they found that 19 events occurred during low-intensity activity, six during moderate-activity and only three occurred during high intensity activity. Cardiac resuscitation was carried out in 20 cases, with about half of those being treated with defibrillation from an automatic external defibrillator (AED).  They reported that 13 of the 20 victims that were resuscitated received an intervention within one minute after collapse, which is an outstanding finding that undoubtedly contributed to the high survival. 

Preventive Measures

Currently, AEDs can be found at sports arenas, shopping malls, hospitals, and high-intensity many businesses and schools. These devices are becoming more affordable, so that any small business can have one readily available for use in case someone nearby collapses. These are truly lifesaving when used properly, and CPR (cardiopulmonary resuscitation) training and AEDs are becoming more widespread.

Currently, doctors recommend that young people who plan to compete in sports should be evaluated before beginning to work out vigorously. Unfortunately, the conditions that can lead to sudden death on the playing field may be difficult to diagnose ahead of time without costly medical testing like an electrocardiogram (ECG) and an echocardiogram. The cost-effectiveness of doing such cardiac testing on every young athlete may not be justified when the risk of these events is so rare. Nevertheless, this study would suggest that very vigorous exercise is not the problem. We need to find better ways to screen young people for potential cardiac conditions that could pose a grave risk, even in someone who just wants to shoot a few hoops with their buddies. 

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