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Sudden Cardiac Arrest in Young Athletes
The sudden death of a child is a catastrophe that has devastating social and emotional impacts on both families and the community. Young athletes risk sudden cardiac death due to previously undiagnosed congenital heart disease; acquired conditions such as myocarditis; or accidents such as Commotio Cordis.
Congenital (from birth) heart disease often goes undiagnosed in children because it rarely produces symptoms. Often, the first sign of these diseases is the sudden collapse during athletic activity. Exercise and athletic activity significantly increase the risk for sudden cardiac death in predisposed individuals.
Screening for conditions that place an athlete at risk starts with a careful medical history, with an emphasis on family members with known congenital heart disease or early or unexpected death; personal history of passing out (syncope), chest pain, or shortness of breath; and salient issues regarding ethnic background. For example, Michael Monteleone was diagnosed after his death with Right Ventricular Cardiomyopathy, a disease known to have a high prevalence in individuals from Northern Italy (with an autosomal dominant genetic transmission, meaning 50% chance of passing it on). The physical exam should include an emphasis on equality of pulses in arms and legs; irregular heart rhythm; cardiac murmurs; and physical stigmata of congenital disease such as Marfan's. The American College of Cardiology recently updated its guidelines for Athletic Participation of persons with congenital heart disease and for screening programs. They continue to suggest proceeding with cardiac testing such as EKG and echocardiogram only based on concerns raised by the history and physical exam; they feel that the cost as well as the high incidence of false positive findings in the very heterogeneous US population would not make more routine use of diagnostic testing an effective strategy.
The most common congenital cardiac conditions predisposing young athletes to sudden cardiac death include Hypertrophic Cardiomyopathy; Right Ventricular Cardiomyopathy (also known as RV Dysplasia or ARVD); Long QT Syndrome; Marfan's Disease; and Congenital Coronary Anomalies.
Myocarditis (inflammation of the heart, usually caused by a viral infection) is the most common acquired cardiac condition that may lead to sudden death in athletes.
Commotio Cordis (cardiac concussion) is a sudden disruption in the heart's electrical system caused by a blunt trauma. It is most commonly associated with baseball, softball, hockey, and lacrosse.
The use of performance enhancing drugs, especially stimulants of all types, also significantly increases the risk of sudden death.
Prompt defibrillation is the only realistic hope for survival from cardiac arrest. The chances of successful resuscitation decrease about 10% for every minute that goes by without defibrillation. With on-site AEDs, survival can be increased from 5% to as high as 50%. That is why the American Heart Association gives on-site AEDs a prominent role in the Emergency Response Plan for Schools.
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