Preventing Sudden Cardiac Arrest in Young Athletes

What is sudden cardiac arrest?

Sudden cardiac arrest is among the leading killers of Americans, striking an estimated 382,800 people in the US each year.  Sudden cardiac arrest occurs when the heart loses its normal rhythm and stops beating due to an abrupt loss of heart function caused primarily by the rapid and/or chaotic electrical activity of the heart known as ventricular tachycardia (VT) or ventricular fibrillation (VF). During sudden cardiac arrest, the heart fails to pump blood to the vital organs. Signs of sudden cardiac arrest include unconsciousness and irregular or no breathing.  Unless the person is quickly resuscitated, it is often fatal. Sudden cardiac arrest renders a person clinically dead within minutes, unless treated immediately with defibrillation or with bystander CPR followed by defibrillation. For every minute that elapses after sudden cardiac arrest, the chances of survival diminish 10 percent.  The conditions that put young athletes at risk for sudden cardiac arrest are fairly common.

Sudden cardiac arrest is NOT a heart attack (myocardial infarction), which is caused by a blocked vessel leading to loss of blood supply to a portion of the heart muscle. However, sudden cardiac arrest often occurs secondary to a heart attack.

Who is at greater risk for sudden cardiac arrest?

As many as one in 250 to one in 300 young athletes have a heart disorder that may increase their risk of sudden cardiac arrest. The causes of sudden cardiac arrest in children and adolescents are varied and often include undiagnosed heart conditions that result from abnormal heart structure or function, primarily electrical abnormalities or outside factors such as a sudden blow to the chest or drug use.  In some cases, these disorders are inherited and sometimes they are ‘acquired’. For example, viral infections of the heart muscle, called myocarditis, increase the risk for sudden cardiac arrest.

In the United States, a young competitive athlete dies suddenly every three days. The average age when sudden cardiac death occurs in young athletes is 17.5 years.  The risk of sudden cardiac arrest is three times greater in competitive athletes. More than two-thirds of young athletes who die suddenly are basketball and football players (67%). Sudden cardiac arrest in athletes is more common among males; African Americans; and, while we don’t know why, basketball players, regardless of their race or ethnicity.

The majority of people with these heart disorders will never have problems, but an important subset of athletes will. If we identify the athletes with these conditions, we can reduce their risk of sudden cardiac death — sometimes with medication, a procedure or with a device.

Signs of sudden cardiac arrest include:

While most athletes who have had a sudden cardiac arrest didn’t display symptoms beforehand, few have physical signs that would be detected with a routine sports physical.  The following are also indications that should be further evaluated:

  • Fainting or lightheadedness during exercise
  • Chest pain/discomfort during exercise
  • Heart racing, skipping a beat, palpitations during exercise
  • Shortness of breath more than your friends
  • Tire more easily than friends
  • Unexplained seizure activity
  • Decrease in physical activity, new onset of fatigue
  • Family history of a relative having a heart problem at a young age, less than 50

Who should be screened for heart disorders?

Ideally, all young athletes should receive EKG screenings to distinguish any changes that are due to training, from changes that might be a result of a pathologic condition to identify those young athletes who are at risk and prevent more cases of sudden cardiac arrest before they occur.

Many cases of sudden cardiac death in teenagers, especially ages 13 to 18, can be prevented with a proper heart screening. MHS offers echocardiogram (ECHO) heart screenings designed for teenagers that also include an EKG, BMI, blood pressure reading and a thorough family history questionnaire. This screening is an ultrasound of the heart and can help detect heart defects and abnormalities, even when no symptoms are present. Pre-pay prices of $99.00 per screening are included for person’s without insurance or with high deductible plans who prefer to receive the discounted pricing.