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Sudden cardiac death

Preventing sports-related fatalities.

By Celine Blancas-Evidente, M.D.

FEBRUARY 2013

We’ve seen it on the news—fit athletes on top of their game suddenly collapsing and dying during a sports event. How could this happen when everyone knows for a fact that sports and vigorous activities help keep our body healthy, particularly the heart?

Exercise and active participation in sports are considered part of an ideal, healthy lifestyle. It’s a tragedy to see a young athlete die from a sudden and unexpected cause during sports. The event is often abrupt, non-traumatic and non-violent. Although this is a rare occurrence, it has caused concern and much fear.


Sudden cardiac death

Louella Gonzalez-Santos, M.D., a preventive cardiologist from Cardinal Santos Medical Center in San Juan City defines sudden cardiac death (SCD) or sudden cardiac arrest (SCA) as death from a cardiac cause within a short time period in a person who may or may not have had a pre-existing heart disease. What is significant about SCD is that the time and mode of death are unexpected and rapid. This is caused by a disturbance in the electrical system that controls the beating of the heart. When this arrhythmia or irregular beating occurs, it can result in the complete stopping of the heart, resulting in sudden death. Specifically, sport-related SCD has been further defined as non-traumatic death during or within an hour after moderate- to high-intensity exercise in a competitive athlete involved in physically demanding sports and participating in competitions.


Early warning signs

According to Dr. Gonzalez-Santos, the problem with SCD is that persons at risk may not manifest with early symptoms. This makes it a silent killer. Symptoms that should be medically worked up in physically active young individuals include: dizziness, shortness of breath, palpitations, fainting, weakness, and fatigue or chest pain especially while exercising. Other warning signs include fainting or syncope, seizure during physical activity or from emotional excitement or distress. As athletes are used to exerting themselves physically, these symptoms may be misinterpreted as exhaustion.

Some clues may identify a person to be at risk of sudden cardiac arrest. Often, the presence of warning signs, a history of heart problems requiring medication, or family history of death due to sudden cardiac arrest at a young age should prompt the individual to consult their doctor.


Matters of the heart

There are several causes of SCD, the most common being coronary artery disease or a blockage in one of the arteries providing blood supply to the muscle of the heart. In adolescents or young adults who are active in sports, SCD causes may include:

• Hypertrophic cardiomyopathy (HCM). The heart muscle becomes abnormally thick. This makes it more difficult for the heart to pump blood. HCM often goes undetected and is the most common cause of heart-related sudden death in young adults under 35.

• Congenital coronary artery abnormalities. Abnormal connections of the heart arteries may lead to inadequate blood flow to the heart.

• Long QT syndrome. Getting its name from an electrocardiogram (ECG) finding, this is an inherited disorder of the heart rhythm causing fast and irregular heartbeats.

• Commotio cordis. This is a rare condition that occurs as a result of a blunt blow to the chest. A type of irregular heartbeat can be triggered if the blow strikes the chest at exactly the wrong time in the heart’s electrical rhythm.


According to Dr. Gonzalez-Santos, training and exercise can bring about various changes in normal heart tissue. During intense physical training, the oxygen consumption of the muscles increases significantly and the heart is required to increase its output to meet the body’s demands. Over time, aerobic training results in increased cardiac output and increased heart rate during exercise, with decreased heart rate at rest. Competitive stress can also enhance changes that may trigger irregularities in how the heart functions, especially if a pre-existing abnormally exists.


First aid

After getting over the initial surprise and shock of seeing an athlete collapse, the on-field response is crucial to prevent death. An emergency medical team should be present. An immediate assessment of the respirations and pulse should be done. If these are not detected, cardio-pulmonary resuscitation (CPR) should be started until help arrives. Defibrillation equipment should be readily available to detect as well as treat fatal arrhythmia. According to the American Heart Association, defibrillation is “a process in which an electronic device gives an electric shock to the heart”. It “helps re-establish normal contraction rhythms in a heart having dangerous arrhythmia or in cardiac arrest.”

Even when CPR is started right away, however, the chances for successful resuscitation are minimal. The best strategy for preventing these events is still identification of susceptible individuals before such a fatal event.

 

Learn how to use screening tools to prevent the occurrence of SCD in the February issue of HealthToday, out now in bookstores and newsstands.











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