Sudden cardiac death in young athletes
The vast majority of heart attacks occur in older individuals who have coronary artery disease. But some young people, often athletes, are also at risk. Read this simple article from Time on the subject, then google "athletes cardiac death" and let us know some of the likely causes and solutions.
25 comments:
According to the website "www.rice.edu/~jenky/sports/sudden.death.html," the most common cause for sudden cardiac death in athletes is undetected hypertrophic cardiomyopathy, when one has "thin, compliant chest walls" making them "at risk of sudden ventricular tachycardia after a blow to the precordium." Also, some risk factors according to "http://www.merck.com/mmpe/sec07/ch082/ch082b.html" are smoking, higher cholesterol, elevated blood pressure, diabetes, as well as the family history of this problem.
Some solutions or preventative measures that can be taken are avoiding smoking, regular and continued exercise (but not sudden, or too vigorous).
http://www.aafp.org/afp/980600ap/oconnor.html
After reading the article and searching online for another evidence, I came upon a fact that says male athletes are more prone than female. Hypertrophic cardiomyopathy is usually the main cause and it is hard to detect during screening tests. The sports activity and the age of the athlete can be a factor. Young athletes were associated with congenital cardiovascular structural abnormalities. Also, congenital coronary anomalies and myocarditis are another cause for this tragic death. For now, the only thing that people can do is carefully see if there are any past histories or meticulously observing one's screening test
The website is
http://www.suddendeathathletes.org/about_sdia.asp#b
Some of the causes of sudden cardiac death in young athletes includes HCM(Hypertrophic cardiomyopathy), commotio cordis, coronary artery anomalies, LVH, myocarditis, and others. HCM is said to be the single most common cardiovascular cause of sudden death. It is relatively common in the general population; however different ages that suffer from sudden cardiac death might be due to different causes. Solutions to help deal with this situation includes regular exercise. The National Institute of Health recommends 30 minutes of moderate activity every day.
http://www.merck.com/mmpe/sec07/ch082/ch082b.html
This website states that male athletes that play football, basketball or soccer in Europe are at higher risk. It is estimated that 1/200,000 young healthy athletes die suddenly during exercise. This is caused by hypertrophic cardiomyopathy which is normally undetected. The impact of a baseball, hockey puck or impact of another player can cause death during a mycardial repolarization.
Immediate treatment is advanced cardiac life support which generally works less then 20%. For those that catch the symptoms before a collapse the treatment is management of the underlying condition. Athletes are usually screened for heart problems every year before the beginning of the season and this can sometimes prevent many unknown symptoms.
according to http://www.associatedcontent.com/article/3652/sudden_cardiac_death_in_athletes.html there are many causes causes of sudden cardiac death, including coronary artery disease, sickle cell trait, hyponatremia, and commotion cordis (sudden blow to chest/heart causing an arrhythmia), but the most common is Hypertrophic Cardiomyopathy, an enlargement of the left heart. it is common in younger athletes-less than 30 years old), "as one ages, there is an increasedlikelihood that sudden cardiac death is due to coronary artery disease and in those with dyslipidemia and a family history." also, thsi disease is hard to detect because there is usually a murmur in the heart and softens when one squats, however, in many instances the murmur is not heard so people do not know they have the disease.
http://www.freenet.tlh.fl.us/healthgazette/sudden.html
After reading the information on this website, I learned that most of the cases pertaining to sudden cardiac death deals with congenital problems. To name just a few, these deaths are caused by "Arrhythmogenic right ventricular dysplasia" a congenital heart conditions that causes "fibrosis of the heart muscle." This fibrosis causes the heart to carry out cardiac arrhythmias (abnormal heart beats) that can be deadly to young atheletes. Another problem called Hypertropic cardiomyopathy occurs when the muscles of the heart are thickened, making it harder for blood to leave the heart. There are no definite solutions to SCD in young atheletes, however regular exercise, jogging is the best way, along with a healthy diet that involves a low cholesteral count, can reduce the chances of SCD.
One of the best articles on the subject of sudden cardiac death in athletes was found in postgraduate medicine. It listed the common causes of sudden cardiac death in young adults:
Table 1. Causes of sudden cardiac death in young athletes
Most common
Hypertrophic cardiomyopathy
Idiopathic left ventricular hypertrophy
Congenital coronary artery anomalies
Less common
Ruptured aortic aneurysm
Myocarditis
Dilated cardiomyopathy
Arrhythmogenic right ventricular dysplasia
Aortic valve stenosis
Tunneled left anterior descending coronary artery
Atherosclerotic coronary artery disease
Rare
Wolff-Parkinson-White syndrome
Long QT syndrome
Mitral valve prolapse
Commotio cordis
Drugs
Unknown/other
Preparticipation exams have been the norm for a number of years for athletes prior to sports activities. There is debate whether all young adults should have extensive cardiac evaluations, but the expense would be difficult to justify. However, legal causes are leading schools to performing electrocardiograms and even echocardiographs on athletes engaging in vigorous sports.
http://www.postgradmed.com/issues/2000/10_00/drezner.shtml
Three years ago today, May 30 th ,we buried our wonderful son, Andrew Helgeson, who died May 25, 2005 at age 18 years old from Sudden Cardiac Arrest (SCA). Andrew was the epitome of health and the first warning was death. He never had amy pain or anything that would indicate a problem. He was a wonderful young man and had a full academic scholarship to college. He was to pick up his high school all scholar - athlete award for $4,500 the day he died. It is devastating to have a child die like this.
SCA is a real problem since no one knows the real numbers since there is no mandatory registry. It makes me sick when people say it is rare for a young and healthy person to die of SCA. Their numbers are way too low. Everyday we get articles of young people dying from SCA. A young person will die of a drowning or car accident or seizure or asthma attack and it is actually Sudden Cardiac Arrest and it really is SCA and their heart.
Our son was a kind and caring and wonderful young man and he deserved a long and healthy life. SCA should not be happening to our children. SCA happens everyday and no one talks about it.
To this day we do not know what happened to cause Andrew's fatal cardiac arrhythmia. All we know is that it was an electrical problem and maybe if we had had an AED (automatic external defibrillator) our Andrew would be alive today. Andrew deserved better and we feel all parents should be made aware of SCA in children. Some EMTS do not even know that SCA occurs in children and first responders do not know what to do. They and reporters should never assume that young people don’t die like this and it must be drugs and that is wrong and delays appropriate medical attention.
All children should be cardiac screened. They do it in Italy and Japan and our children are just as important. There is nothing worse than losing a child or watching your child die in front of you. Thousands of children die of SCA a year. We parents have been working hard to have laws passed to make sure that AEDS are in the schools and that people are AED and CPR trained. We had Andrew's Law passed in MD in 2006 that mandates AEDs be placed in high schools and at all school sponsored athletic events. We have tried to have them placed in elementary and middle schools also and it is so sad that money is more important than the safety of our children.
The truth is that AESs should be placed in all public areas for easy access.
Our family is devastated and crushed and we miss our Andrew with every breath and every heartbeat. Andrew was our SUN and this will never make any sense at all. Andrew was a star lacrosse player and the starting goalie for his high school.
The medical schools should start teaching about SCA in children. They have known about SCA in children since the 1950's and yet so little is done. Without broad awareness there is not demand for money to do research and little is going on. It is truly sad that so many doctors do not even know how to read an EKG correctly and yet we rely on them.
It is almost impossible to have news stories written. On May 22 nd Governor O'Malley signed a Good Samaritan Law that was inspired by Andrew that gives the person using an AED to helping a victim of SCA immunity from being sued. This will encourage people to give aid to a victim of SCA. This law will help save lives and nothing was even written in the Washington Post. We need awareness and screening and research so other children will stop dying.
you can read more about Andrew at
http://silverchips.mbhs.edu/inside.php?sid=5424
I hope that everyone that reads this will tell 10 people about Andrew and SCA in children and help bring awareness to this serious killer of our children. Please keep Andrew in your hearts and remember all the other children that have died of SCA. We have started the R. Andrew Helgeson Foundation in honor of Andrew. We are also affiliated with Parent Heart Watch which is a group of parents that have lost children by SCA. We all are trying to bring awareness of SCA in children and the importance of AEDS and cardiac screening in children.
We would encourage the news reporters to do an article about SCA in children and all the parents that have lost their children and everything we are all trying to do to keep others from losing loved ones and suffering as we do.
Thank you,
Rita Helgeson
Andrew's mother
RHFH@comcast.net
Rita & Richard Helgeson
"Andrew's Parents"
R. Andrew Helgeson Memorial Foundation
A 501(c)(3) Public Charity
http://www.swedish.org/15014.cfm
According to my site, Sudden Cardiac Arrest is mostly caused by an inherited condition called Hypertrophic Cardiomyopathy, where the left ventricle is abnormally thick. Other causes are attributed to conditions like myocartitis (inflammation of the heart muscle) and other various artery anomalies. Studies have shown that Sudden Cardiac Death amongst mostly occurs with basketball and football players
There aren't many medicinal solutions that could prevent sudden death. However there are preventative measures that can reveal problems that may be addressed. For instance, frequent checkups for athletes can be utilized to help search for warning signs. The site said at the very least schools and other facilities should have to provide portable EKGs in case something like this happens
Hypertrophic cardiomyopathy (HCM) is the main cause for Sudden Cardiac Death (SCD) in athletes. A study revealed that out of the 134 athletes that experienced SCD during the year 1985-1995, 90% were male, 44% were African American, and 68% were football or basketball players. Some conditions linked to Sudden Cardiac Death are HCM, Idiopathic left Ventricular Hypertrophy, Coronary Artery Anomalies, myocarditis, Marfan syndrome, and Electrophysiologic Abnormalities. HCM is an inherited defect where the patient’s heart is bigger than normal, specifically an enlarged left ventricle.Electrophysiologic Abnormalities include Wolff-Parkinson-White syndrome (WPW) and long QT syndrome (LQTS)which is displayed by extremely low heart rates. Sudden Cardiac Death can be prevented by visiting your doctor regularly especially if you have known risk factors that can lead to SCD. Making lifestyle changes which include: quitting smoking, exercising regularly, maintaining a low-fat diet, and managing your health conditions are all ways to reduce the risk factors that can prevent SCD.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=155532
http://www.clevelandclinic.org/heartcenter/pub/guide/disease/electric/scd.htm
http://findarticles.com/p/articles/mi_m0BJI/is_11_30/ai_63690783.
One of the main reasons for an athlete’s cardiac death is attributed to Hypertrophic obstructive cardiomyopathy, congenital aortic stenosis, coronary artery anomalies, and Wolff-Parkinson-White syndrome. These can be inherited ranging from young athletes to young adults. In order to prevent this, screening echocardiography and electrocardiography can pick up the rare high school athlete who is at risk for sudden cardiac death, and can reveal less worrisome but important abnormalities. It is definitely expensive, but it is worth it to look for any kind of symptoms. Thirty minutes of exercise a day is also pretty good too to prevent any of the said causes above.
I always thought that a heart of an athlete is at the greatest shape since they exercise so much. However it turns out that athletes have the highest risk of heart disease. Some of the causes that I came across are abnormalities of the heart, such as hypertrophic cardiomyopathy, a thickening of the heart muscle, or abnormal coronary arteries. Abnormal coronary arteries is when the right amount of oxygen is not being supplied to the heart muscle. These symptoms play a big role because during a game an athlete is doing aerobic training and needs sufficient amount of oxygen provided to their heart. Marfan Syndrome is another cause of sudden death in athletes. This is a disorder of the connective tissue that is the clip for blood vessels, valves, and other structures. It is easy to keep track of this disease for professional athletes that have the money to pay for big time health insurance. However for high school or non profit athletes the condition could get worse if not enough medical care is provided. Since athletes work out for a longer period than one hour each day, their body needs to be provided with more vitamins and minerals, and taking vitamin and eating healthy food is key for an athlete to be able to continue working out for longer periods. Also taking a sufficient amount of breaks during exercise is also a good way for the athletes to keep their heart in good shapes.
http://209.85.141.104/search?q=cache:ERX_4oQkFecJ:heart.kumu.org/exercise.html+prevent+heart+disease+in+athletes&hl=en&ct=clnk&cd=11&gl=us&client=firefox-a
http://www.hughston.com/hha/a_16_4_4.htm
There are some reasons as to why Ventricular Fibrillation takes place: there is the possibility that the blood vessels are too narrow and do not provide enough blood to the heart; for those athletes who suffer from sudden cardiac arrest, die because the "decreased blood flow irritates the heart muscle." As a result there is an irregular heartbeat, which can lead to death.
This can be prevented through examining children while they are young (before becoming major athletes), or even implantable cardiac defibrillators (a small electronic device placed in the chest to prevent cardiac arrest).
http://www.medicinenet.com/sudden_cardiac_death/page3.htm
Sudden death in young competitive athletes is due to many different cardiovascular diseases, but the most commonly known disease is HCM (hypertrophic cardiomyopathy). HCM has become a major disease amongst African Americas and even though it was first believed to be rare in the U.S. population, it has become more evident in young athletes. After studying the relationship of race to cardiovascular diseases causing sudden death in the national athletes; as well as comparing the findings with a representative multicenter hospital of patients with HCM, a lot has been uncovered. Of the 584 athlete deaths, 286 were due to cardiovascular diseases from the ages of 17 plus/minus 3 years. 156, which is also 55% were white and 120 (42%) were African American. 90% were male and 67% were either basketball or football players. Out of the 286 that died, about 102 of them were from HCM, which is about 36%. Another causes for this high proportion of deaths was anomalous coronary artery of wrong sinus origin and 37 of them (13%) died.
Of the athletes who died of HCM, 42 (41%) were white, but 56 (55%) were African American. But also in contrast, of 1,986 clinically identified HCM patients, only 158 (8%) were African American.
The conclusions that we arrive at are that HCM represented a common cause of sudden deaths in young and undiagnosed African American athletes. This shows that many HCM cases go unrecognized in the African American community and it underscores the need for enhanced clinical recognition of HCM. If more recognition was available, it would create more opportunities for preventative measures to be used in the high risk patients have with this disease. This information was found on http://content.onlinejacc.org/cgi/content/abstract/41/6/974
http://www.emedicine.com/med/topic276.htm
This website stated that death by cardiac arrest is only defined as sudden cardiac death (SCD) when the person is not in the hospital and has not been previously known to have heart problems.
There are 325,000 SCD's a year in the United states, which is more deaths than there are for lung cancer, breast cancer, or AIDS.
80% of SCD's occur in people with coronary artery disease. The incidences of SCD's being caused by hypertrophic myopathy (HCM) is obviously much smaller. According to the site, "The incidence of SCD in this population is 2-4% per year in adults and 4-6% per year in children and adolescents. HCM is the most common cause of SCD in people younger than 30 years."
In some people with HCM, arrhythmias occur, causing the SCD. Why it is that HCM causes arrhythmias is unclear. Interestingly enough, in those with HCM in whom SCD occurs, most of the SCD's occur during rest or under only mild exertion, though a significant amount of them occur during strenuous exercise.
I searched the web and found out that sudden cardiac death in young athletes is unexpected and nontraumatic. The athlete usually seems healthy no more than six hours before death. Most of the athletes who die from heart disease are not known to have heart disease. Sometimes these athletes have conditions that they have inherited since birth, which cause them to suffer cardiac athletes while participating in sports. Hypertrophic cardiomyopathy, ruptured aortic aneurysm, and commotio cordis are some of the causes of cardiac death in athletes. Unfortunately, some of these causes can not be detected through routine exams during sports.
http://www.kidsgrowth.com/resources/articledetail.cfm?id=1908
Basically hypertrophic cardiomyopathy (HCM) causes the heart muscle to thicken. When it is thick, it makes it harder for the organ to pump blood. Changes in heart muscle cells also causes rhythm problems that lead to sudden death without prior symptoms in most cases. People are questioning if screening for heart problems are worth it. The American heart association does not mandate screening because there are no data showing that screening saves lives. Although, it is not mandatory to screen, it is encouraged. EKGs and echocardiograms can detect heart problems in young athletes, but the reason why it is not mandatory is because heart tests can be expensive. The director of the Athletes’ heart program, Dr. Paul Thompson agrees to refrain for mandating expensive tests and hope the clinic will provide valuable information to medical students to see if they can properly detect problems. The idea of annual sports physical should be conducted with a good doctor if young athletes are concerned about their heart.
http://www.abcnews.go.com/Health/HeartDiseaseNews/story?id=4933037&page=1
Sudden cardiac death in young athletes is not as common as it is in older people. According to http://www.sportsci.org/jour/9804/tdn.html#pathology the real culprit behind sudden cardiac death is exercise itself. One of the common causes for the death are hypertrophic cardiomyopathy, which is when the heart muscle thickens abnormally which can interfere with the electrical system which can cause sudden death. Another common cause is a severe coronary disease which result from an inherited high level of cholersterol. Other less common causes that cause problem in the heart which lead to sudden death include aortic ruptures, coronary artery spasms, and aortic stenosis.
Exercise is not the cause for these heart problems but the reason why they are activated thus causing sudden death. The main reason many young people die is because they are not aware of their heart conditions. A physically fit person may seem perfectly healthy because symptoms are not visible to the naked eye. However if they are aware of their condition, they do not follow require fitness levels and strain their heart when exercising.
There are three main factors that trigger the cardiac arrest in an athelete with a heart condition. The first is the initial surge of blood to the heart. Second is the problem of the imbalance of oxygen required and oxygen supplied during excercise. The third is artery spasms. The first solution to avoiding cardiac arrest is to undergo cardiovascular screening before starting any type of excercise program. This will inform the athlete if it is safe to work out to extreme messures.
One of the likely factors involved in causing the cardiac deaths in athletes is Hypertrophic cardiomyopathy.
The American College of Cardiology studied the relationship of race to the amount of cardiovascular diseases causing sudden death in athletes and compared that with many patients in a hospital with hypertrophic cardiomyopathy.
Out of 584 deaths, 286 were due to cardiovascular disease in athletes aged 14-20. 156 were white and 120 were African American. Out of these 286 people, 102 deaths were due to hypertrophic cardiomyopathy and 37 of the athletes died of an anomalous coronary artery of wrong sinus origin. 56% of those with hypertrophic cardiomyopathy were Aftrican American.
These results lead me to believe that race is also a factor involved in hypertrophic cardiomyopathy.
The same study lead me to a possible sollution. Of the 1,986people tested in the hospital, 158 patients were African American. This is significantly smaller number than that of the undiagnosed African Americans.
Although it is impossible to know when an attack would happen, those that are in a supervised environment can be helped and lower their risk of dying from an attack.
The only solution that I can infer from this is for a person to get checked for various cardiac problems and, if they are diagnosed with one, then it is probably best for them to not be an athlete or work themselves too hard.
The worst case scenario solution for the problem is to always have an automatic external defibrillator around as well as have a person that knows how to use it. This solution has been implemented around the country and, in turn, has saved many athletes from sudden death.
http://content.onlinejacc.org/cgi/content/abstract/41/6/974
A Journal Report by the American Heart Association, "The Recommendations for Preparticipation Cardiovascular Screening of Competitive Athletes" states that a 12-point screening process can prevent sudden cardiac deatho among high school and
college students. The questions include personal and family medical history and a physical examination.
Personal history- Chest pain/discomfort upon exertion
Unexplained fainting or near-fainting, Excessive and unexplained fatigue associated with exercise, Heart murmur, High blood pressure
Family history- One or more relatives who died of heart disease (sudden/unexpected or otherwise) before age 50, Close relative under age 50 with disability from heart disease,
Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy in which the heart cavity or wall becomes enlarged, long QT syndrome which affects the heart’s electrical rhythm, Marfan syndrome in which the walls of the heart’s major arteries are weakened, or clinically important arrhythmias or heart rhythms.
Physical examination- Heart murmur, Femoral pulses to exclude narrowing of the aorta, Physical appearance of Marfan syndrome
Brachial artery blood pressure (taken in a sitting position)
If from any of these 12 steps there is a "yes", the athlete would need to have a cardiovascular examination.
The number of deaths a year is about 200,000 high school athletes. In the US, these deaths are usually among basketball and football athletes.
There has been debate about EKG's included in mass prescreening of competitive athletes; however, many factors stand in the way. First, the vast number of athletes in the US compared to Italy (a state which provides EKG for its athletes) stands as a dilemma. There are about 5 million competitive high school athletes, 500,000 collegiate, and 5,000 professional athletes. These numbers do not include the elementary and middle school athletes and athletes over the age of 30. Including these figures, the athlete population needing mass screenign may be about 10 million people per year. The cost of mass screening would cost $2 billion a year.
http://www.americanheart.org/presenter.jhtml?identifier=3046150
http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/dc/cen/card/gen/alert11142007.jsp
After reading this article, it is interesting to find out that these athletes who are boys in their midteens who play high-intensity sports, such as basketball and football are the ones that are most susceptible to sudden cardiac death. Several heart problems have been known to cause the sudden cardiac death and many of them are inherited. The most common cause is a disease known as hypertrophic cardiomyopathy. In this condition, the heart muscle is thicker than normal which can make it harder for the heart to pump. It can also affect the heart's electrical system and lead to dangerous heart rhythms. Sudden death often occurs because of a very fast or quivering heart rhythm that doesn't let the heart pump effectively which deprives the heart and brain of oxygen. Its very difficult to find out if one has the disease because if a person has inhertied the diesease they may seem normal but when the heart is overstressed with exercise, the symptoms can occur.
The best way to prevent sudden cardiac death is to go to the doctor and check one's personal history such as asking the patient if he or she had ever fainted, had chest pains or was extremely exhausted after exercise, or has a high murmur or blood pressure. More questions are asked regarding family history if the patient has any family members that had or died from a heart disease before the age of 50. The doctor can give one a physical exam that consists of listening to the heart for murmurs or other sounds, or checking the pulse at the wrist and groin to look for blood flow problems. Lastly, should the physician suspects a heart problem, the youth should have an EKG (electrocardiogram) before starting his or her sport. This test checks the electrical activity of the heart and can find many inherited heart problems. Other testing, such as an echocardiogram (ultrasound of the heart) or a stress test, might also be recommended.
http://www.time.com/time/health/article/0,8599,1618058,00.html
The risk of cardiac death is 6 times higher for athletes 35 and under. It is normally caused when there is a cardiac arrest, where the heart muscles thicken. In this article a athlete by the name of Davis Nwankwo, a basketball athlete had cardiac arrest. He had hypertrophic cardiomyopathy, which is the most common cause of cardiac death. But he was saved by his coach who had a AED, automatic external defibrillator. This device is portable and can stop cardiac arrhythmia. AED should be carried around athletes all the time. It has saved over 70 percent of people who had cardiac arrest.
http://www.webmd.com/heart-disease/guide/hypertropic-cardiomyopathy
HCM is associated with a thickening of the walls of the heart. This thickening causes stiffening and abnormal aortic and mitral valve function, affecting the normal blood flow through the heart. Because of these severe effects HCM can lead to sudden death if undetected as it has to many younger athletes who exert themselves in active sports. HCM has no symptoms and continually worsens as the heart continues to function abnormally.
In the cases of young athletes who suffer with HCM, I feel as if better precautions should be taken before hand. Examinations can reveal whether or not a person has this disease which might be more beneficial in preventing a sudden cardiac attack, like Davis Nwankwo, before someone plays a sport. Many other articles focused on AED and how to help when the problem arises but since anyone can have without symptom and it is such a severe disease better precautions should be taken before these students jump into a game.
Post a Comment