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Sudden Cardiac Death in Athletes: Incidence, Causes and Prevention Strategies

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Textbook of Sports and Exercise Cardiology

Abstract

Sudden cardiac death (SCD) is the leading medical cause of death in athletes. Current reports on incidence are limited by methodological issues including difficulty with case identification and defining at-risk populations. There are, however, clearly higher risk groups including males, Afro-American/Caribbean athletes and certain sports such as men’s basketball, men’s football (soccer) and American football. In a young, athletic population, the overall risk of SCD is about 1 in 50,000 athlete-years (AY), although in high risk groups it may be as high as 1 in 5000 AY. The causes of SCD are also age-dependent with athletes <25 years of age dying most often from congenital, structural or electrical causes and those >25 dying from coronary artery disease. Structural causes of death include hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, dilated cardiomyopathy, coronary artery anomalies, and aortic rupture. Electrical causes of SCD include Long QT Syndrome, Brugada Syndrome, Catecholaminergic Polymorphic Ventricular Tachycardia, and Wolff-Parkinson-White Syndrome. Other causes of SCD include myocarditis. A ‘suspected cardiac death’ may be observed in those with a structurally and histologically normal heart; this is often referred as sudden arrhythmic death syndrome (SADS) or sudden unexplained death (SUD). Primary prevention includes screening for conditions that predispose to SCD and in young athletes via history and physical examination, with or without a 12-lead electrocardiogram (ECG). ECG is the most accurate way to detect athletes with occult cardiovascular conditions, however, there is debate over the practicality of implementation on a large scale and the benefits of early diagnosis. Development and practice of an emergency action plan (EAP) is critical for secondary prevention with an aim of defibrillation in less than 3 min after collapse.

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Change history

  • 01 May 2021

    The original version of this chapter is revised as follows,

    Initially the chapter was published with the co-author name as Eric Solberg.

    Now chapter 26 and List of contributors, Table of contents in the Front matter was updated with the Author’s full name as Erik Ekker Solberg.

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Author information

Authors and Affiliations

  1. Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Kimberly G. Harmon

  2. Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Kimberly G. Harmon

  3. Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar

    Mathew G. Wilson

Authors
  1. Kimberly G. Harmon
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  2. Mathew G. Wilson
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Corresponding author

Correspondence to Kimberly G. Harmon .

Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    Which athlete statistically has the highest risk of sudden cardiac death?

    1. (a)

      Caucasian female volleyball athlete

    2. (b)

      Afro-American/Caribbean female basketball athlete

    3. (c)

      Caucasian male football (soccer) athlete

    4. (d)

      Afro-American/Caribbean basketball athlete

  2. 2.

    What is the most common cause of sudden cardiac death in athletes over the age of 25?

    1. (a)

      Hypertrophic cardiomyopathy

    2. (b)

      Sudden arrhythmic death syndrome

    3. (c)

      Coronary artery disease

    4. (d)

      Coronary artery abnormalities

  3. 3.

    Which primary prevention screening strategy has the highest likelihood of discovering conditions which predispose to SCD in a young athlete?

    1. (a)

      History including extensive personal and family history

    2. (b)

      ECG

    3. (c)

      Echocardiogram

    4. (d)

      Physical examination

  4. 4.

    The single most important factor in surviving SCA is

    1. (a)

      Early CRP

    2. (b)

      Early defibrillation

    3. (c)

      Prompt arrival of emergency personnel

    4. (d)

      The underlying cause of the arrest (i.e. hypertrophic cardiomyopathy, coronary artery anomaly, etc.)

1.2 Answers

  1. 1.

    (d). The incidence of SCD is much higher in males, Afro-Americans/Caribbeans, and certain sports. Females are consistently demonstrated to be at lower risk for SCD. The highest risk sports include men’s basketball, men’s football (soccer) and American football. The highest demographic risk carries an Afro-American/Caribbean male basketball athlete.

  2. 2.

    (c). In athletes over 25 years, coronary artery disease is the primary cause of SCD. In athletes under 25 there are varying reports. More recent systematic reports suggest that SADS is the most common cause of death while earlier studies suggested HCM.

  3. 3.

    (b). Statistically ECG is much more likely to detect underlying cardiac conditions which predispose to SCD than history or physical examination. Although echocardiography has been suggested as a screening tool, it will not detect electrical causes of SCD, and will only detect some structural diseases often missing early or apical HCM.

  4. 4.

    (b). Early defibrillation is the primary determinant of survival from cardiac arrest, although early CPR also improves outcomes.

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Harmon, K.G., Wilson, M.G. (2020). Sudden Cardiac Death in Athletes: Incidence, Causes and Prevention Strategies. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_5

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