Sudden cardiac death in athletes: causes, symptoms, diagnosis, treatment

Presumably, one in 200,000 apparently healthy young athletes develop sudden ventricular tachycardia or fibrillation, and they die suddenly during sports. Men suffer 9 times more often. Basketball players and football players in the US and football players in Europe have the highest risk.

Sudden cardiac death in young athletes occurs for many reasons, but more often because of unrecognized hypertrophic cardiomyopathy. Athletes with a thin, supple chest are at risk of commotio cordis (sudden ventricular tachycardia or fibrillation after a heart attack), even if cardiovascular disorders are absent. Violations of cardiac function can occur with a moderate impact (for example, a baseball, a hockey puck, a ball for lacrosse) or a collision with another player during the vulnerable phase of myocardial repolarization. Some young athletes die from aortic aneurysm rupture (with Marfan syndrome).

[1], [2], [3], [4], [5], [6], [7]

Causes of sudden cardiac death in young athletes

• Obstructive hypertrophic cardiomyopathy
• Heart contusion (Commotio cordis)
• Anomalies of the coronary arteries (for example, abnormal circulation of the left main coronary artery, abnormal circulation of the right coronary artery, hypoplasia of the coronary arteries)
• Increased heart mass
• Myocarditis
• Rupture of the aortic aneurysm
• Right ventricular arrhythmogenic dysplasia
• Tunneled left anterior descending coronary artery
• Aortic stenosis
• Early atherosclerosis of the coronary artery
• Dilated cardiomyopathy
• Mikromatous degeneration of the mitral valve
• Syndrome of prolonged interval PQ
• Syndrome Brugada
• Wolff-Parkinson-White Syndrome (antegrade alone)
• Catecholaminergic polymorphic tachycardia
• Tachycardia of the outflow tract of the right ventricle
• Spasm of coronary arteries
• Sarcoidosis of the heart
• Injury of the heart
• Rupture of cerebral artery aneurysm

* The reasons are listed in descending order of frequency.

An unseen cardiac death in older athletes is most often due to ischemic heart disease. Sometimes the causes may be hypertrophic cardiomyopathy, mitral valve prolapse or acquired valvular disease.

In other conditions leading to sudden death in athletes (for example, bronchial asthma, heat stroke, complications associated with the use of illegal or increasing the workability of drugs), ventricular tachycardia or fibrillation becomes the final and not the primary event.

Symptoms are similar to those in cardiovascular collapse, the diagnosis is obvious. Emergency treatment with the maintenance of vital organs functions is successful in less than 20% of cases. This figure may increase, as the distribution of publicly available automated external defibrillators expands. The survivors of treatment are directed to the underlying disease.

[8], [9], [10], [11], [12], [13]

Screening

Before participating in the competition, athletes usually undergo screening to identify the risk. Screening screening of all children, adolescents and young people (aged college students) includes medical and family history, as well as physical examination (including measurement of blood pressure and auscultation, when the patient lies on his back and is standing). A burdened family history, symptoms of hypertrophic cardiomyopathy or Marfan syndrome - indications for further examination. Diagnosis of any pathological condition can become a prohibition to exercise. Athletes with a presyncopal condition or syncope should be examined for coronary artery anomalies. It is necessary to explain the inadmissibility of using illegal and increasing the working capacity of drugs. Anamnesis and examination have neither sensitivity nor specificity; often false-negative and false-positive results occur, because the prevalence of heart disorders among apparently healthy people is very low. Using screening ECG or echocardiography would improve the detection of diseases, but would lead to a large number of false positive diagnoses in a large population.