The truth about sudden cardiac death in young athletes

Fortunately, sudden death in young athletes is rare. Many cases are attributed to undiscovered abnormalities of the heart, prompting healthcare workers to use the term ‘sudden cardiac death’ (SCD) in such cases.

After an autopsy is performed on their loved ones, relatives often ask pathologists, “What went wrong?” and “Could this have been prevented?” While an autopsy is often sufficient to answer the first question, the answer to the second question is more complex, and often leaves parents understandably angry and confused.

The unfortunate truth is this: in many young patients with a symptomless underlying heart abnormality, the probability of spotting this abnormality on a routine medical examination is as likely as spotting a wolf in sheep clothing.

To better appreciate this analogy, here are some basic facts about the heart:

- Fundamentally, the structure of the heart is a collection of specialised muscles and blood vessels which is divided into different spaces called chambers.

- The muscles of the heart sequentially pump blood through the various chambers, and this blood eventually exits the heart, where it is eventually distributed around our entire body.

- This entire system relies on a set of coordinated electrical signals. These electrical signals are generated by the heart itself and orchestrate the pumping of the heart muscles.

- If any aspect of this system malfunctions, the heart can potentially fail to properly pump, which can lead to sudden death.

- Various tests exist that evaluate specific aspects of the system; an electrocardiogram (ECG or EKG) evaluates the electrical signals flowing through the heart, and an echocardiogram (ECHO) evaluates the structural integrity of the heart.

So, why is it so hard in many patients to detect abnormalities of the heart? Sadly, many patients will have normal findings on physical examination and no symptoms.

In some patients, signs and symptoms may be sporadic. In others, signs and symptoms will only manifest during strenuous activity. These factors contribute to the difficult nature of screening young, healthy athletes for a symptomless heart defect.

Although ECGs are used in addition to a physical examination to screen some young athletes, specialised tests like ECGs and ECHOs are relatively expensive and often require specialised personnel to perform and interpret the results. For these reasons, these tests are luxuries that many do not have access to.

An important part of preventing SCD in a child rests with parents and coaches. Be especially cautious about children who have a history of any of the following:

- Family history of SCD or heart problems

- Fainting

- Smoking or illicit drug use

- Underweight or overweight

- Recent or remote history of electrocution

- Chronic illness

Be actively involved in the medical examination process and be sure to alert the doctor if any of these concerns exist.

Parental vigilance may go a long way towards providing a clue that something may be wrong. In a young, healthy patient with no symptoms, this may be the trigger that prompts more sophisticated investigation, which may eventually save a life.

Dr Dayne Ashman is a medical doctor, and resident pathologist. Email: dpashman@hotmail.com and yourhealth@gleanerjm.com