Someone in the prime of their life -- a professional sports star, teen athlete, marathon runner, or other seemingly healthy person -- isn't supposed to collapse and die from heart disease. But it occasionally happens, making sudden cardiac arrest front-page news.
The rare nature of sudden cardiac arrest among the young is precisely what makes it so attention-grabbing. According to the Cleveland Clinic, sudden cardiac death kills 1 in 100,000 to 1 in 300,000 athletes under age 35, more often males.
Among the most publicized cases: U.S. Olympic volleyball player Flo Hyman in 1986; college basketball player Hank Gathers in 1990; and professional basketball players Pete Maravich in 1988 and Reggie Lewis in 1993.
People wonder if anything could have been done to prevent such an event. They wonder who's at risk, and whether anyone can survive sudden cardiac arrest.
Fortunately, the answer is yes, says Christine E. Lawless, MD, MBA, a cardiologist and sports medicine doctor in Chicago. She is the co-chair of the American College of Cardiology's sports and exercise council, and a consulting cardiologist for Major League Soccer.
"We're trying to get folks to recognize that the person can come back from [cardiac] arrest if you get there within a minute," Lawless says. With immediate use of an automated external defibrillator, people have a chance to live...
Causes of Sudden Cardiac Arrest
You probably know that high blood pressure, high cholesterol, diabetes, and other problems can lead to heart disease in older people. But you may not know about the rare heart disorders that can cause sudden cardiac arrest in young people.
"The underlying conditions in young people are very different from the underlying conditions in somebody who is 50 or 60 years old," Lawless says. "In the younger people, we're looking for inherited diseases of the myocardium [the heart's muscular tissue], of the electrical system, and then of course, congenital [heart] diseases."
The No. 1 culprit: hypertrophic cardiomyopathy (HCM), a disorder marked by abnormal thickening of the heart muscle. "Their heart is thick," Lawless says. "The inner layers of the heart maybe are not getting enough blood supply with exercise."
But remember, HCM is rare. It has been estimated to affect only 0.05% to 0.2% of the population.
Congenital abnormalities of the coronary arteries pose another risk for sudden cardiac arrest. The arteries may be positioned improperly -- or, as in basketball star Pete Maravich's case, a person may be born with only one coronary artery, instead of the usual two.
Other conditions that can trigger sudden cardiac arrest include an inherited electrical disorder of the heart called long QT syndrome; an inflammatory heart condition called acute myocarditis; and Marfan syndrome, which led to Flo Hyman's cardiac arrest...
Some athletes die after being struck in the chest, a trauma called commotio cordis.
"When the chest is hit at the vulnerable period of the cardiac cycle, the heart goes into this terrible rhythm, the ventricular fibrillation," Lawless says. The window of time is miniscule, she says. "It's got to happen within forty-thousandths of a second."
Screening for Sudden Cardiac Arrest Risk
Sudden cardiac arrest occurs without previous symptoms in some cases.
But sometimes, there are red flags. For example, Reggie Lewis fainted during a basketball game a few months before his death.
The American Heart Association recommends a 12-step screening for high school and college athletes. It includes a careful family and medical history and a physical exam. The assessment asks about chest pain on exertion, unexplained fainting, a family history of premature death from heart disease, and other relevant issues. The physical exam includes a check for heart murmurs, pulses, blood pressure, and physical signs of Marfan syndrome...
The AHA guidelines don't include a routine electrocardiogram (EKG) or echocardiogram (ultrasound evaluation of the heart). The use of these tests to screen athletes prior to participation is controversial and adds significant cost. Opponents argue that there isn't enough evidence to support their effectiveness in screening, that these tests aren't cost-effective, and that they can lead to further unwarranted testing. They may also produce misleading results that bar many athletes unnecessarily. "The fact that they'll be left out is a very real problem," Lawless says.
But not everyone is waiting for these tests to get the official green light. In Maryland, Johns Hopkins offers a screening program for student athletes, aged 14 to 18. In addition to a medical questionnaire and physical exam, it includes an electrocardiogram to check the heart's electrical rhythm and to screen for long QT syndrome, and an echocardiogram to assess heart size and shape, pumping function, heart muscle thickness, and condition of the heart valves.
What to Do
- Make sure your teen athlete gets the recommended AHA screening.
- Pay serious attention to any symptoms.
- Push for access to automated external defibrillators.