THE ARTICLE
Typically, undiagnosed heart ailments are the cause of sudden deaths among athletes. However, when a person of middle age suddenly dies due to heart problems, he or she is very likely to have heart disease, the kind of which we read so much about. This kind of heart disease, known also as coronary artery disease, is due to plaque buildup in the blood vessels, which eventually blocks blood flow to the heart. But when a young athlete dies and a heart problem is suspected, the condition is more likely hypertrophic cardiomyopathy, an inherited condition. Hypertrophic cardiomyopathy involves a thickening of the heart muscle tissue, which can disrupt the natural rhythm of the heart.
It seems odd that regular exercise, which is suppose to protect the heart from heart disease, could lead to the sudden emergence of these conditions during sporting matches or strenuous exercise. However, during an exercise session itself, our risk of a heart attack and even death is briefly increased, according to Euan Ashley, an assistant professor of cardiology at the Stanford School of Medicine. Ashley, who directs the Stanford Hypertrophic Cardiomyopathy Center, says, “However, the long-term benefits of regular exercise far outweigh the short-term increase in risk of death, so there’s no excuse for not exercising.” It’s not unlike the risk of death from flying, which is extremely low but is highly tragic when it occurs. It is important to do everything possible to diagnose hidden heart conditions and prevent these youthful tragedies whenever possible.
How to achieve a reduction in sudden death among athletes is a subject of some controversy. Some believe that screening for hidden heart problems during high school and college is the answer, but current practices of taking medical histories will only identify 20% of those with underlying problems that could lead to cardiac arrest. Jonathan Drezner, a primary-care sports medicine doctor in the University of Washington's Department of Family Medicine and author of a recent article on the topic in the British Journal of Sports Medicine says, “Adding a 12-lead electrocardio gram which monitors electrical activity in the heart could bring that figure up to 70 or 75%”. Many professional athletes in England are already required to have an ECG screening, and there is growing support for it to be required in younger athletes. When Italy launched a nationwide screening program for its young athletes in the 1980s, the rate of sudden death in that country dropped by 89 percent, according to an article published in the journal Sports Health.
However, the use ECGs is not without controversy. For example, it is not clear how many deaths could be prevented through ECG, since the actual incidence of sudden death due to cardiac arrest isn’t known. Current estimates range from 1 in 50,000 to 1 in 200,000. Another problem is that ECG testing often reveals enlargement of heart muscle in athletes, which requires no medical treatment whatsoever. As many as 40% of elite athletes who are also African Americans show ECG abnormalities of this kind. The only way to know if the enlargement is a dangerous thickening is to stop training and see if the heart returns to a normal thickness, something most athletes are unwilling to do.
Because of these issues, the American Heart Association currently does not recommend routine pre-competition ECG screening for all young athletes. They advocate further research to determine the actual prevalence of sudden death due to cardiac arrest, and training of physicians to be able to interpret the test appropriately. A current program at Stanford University is testing a voluntary athlete-screening program to assess effectiveness and cost issues.
What can you as an athlete do to decrease your risk of sudden death during exercise? Most people, especially those in middle age and those who are new to exercise, can benefit from screening for risk factors such as high blood pressure and cholesterol. Be sure you are familiar with your family history and whether any of your close relatives died of heart conditions at a young age. You may also want to ask if your gym maintains an automated external defibrillator or AED. A study also done by Jonathan Drezner showed a 64 percent survival rate among people who suffered cardiac arrest during exercise on high school campuses, when an AED was available. Without the AED, the survival rate is just 5 to 10 percent.
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