Understanding the Risks of Sudden Cardiac Death in Athletes and Delivering Effective Treatment.
Many football fans will remember the distressing scenes at Euro 2020 when Denmark’s Christian Eriksen collapsed on the pitch and went into cardiac arrest. The same can be said of the shock many spectators felt when Bronny James son of NBA superstar LeBron James suffered a cardiac arrest during basketball practice in 2023.
Athletes would appear to embody the aspiration of health that many would look up to. For elite athletes, their participation in regular exercise, training regimes and dietary monitoring by sports scientists, nutritionists and physiotherapists would lead to the assumption that death from a cardiac abnormality would be fairly remote.
With high-profile incidents of sudden cardiac arrest in sports athletes, attention has turned to understanding why these events are occurring.
What is Sudden Cardiac Death (SCD)?
SCD is defined as an ‘unexpected death from cardiac causes that occurs within one hour (or within 24 hours in unwitnessed cases) from the onset of an acute change in cardiovascular status in the absence of external causal factors.’
How Common is Sudden Cardiac Death?
The rates of SCD in Australians under 35 years are estimated at 1 in 30,000. The incidence rate of SCD in athletes across Europe and North America is estimated at 15,000 per year.
According to the Baker Institute, sudden cardiac death is 5 times more likely to affect men, and is one of the biggest killers for Australians under the age of 50 years.
Risks Factors for Sudden Cardiac Death in Athletes
Age: The incidences of SCD in athletes does increase with age. For older athletes (over 35-years), atherosclerotic coronary artery disease is the common cause. In a US study of 1247 SCD cases, 5% occurred during sports activities with a mean of 51 years age.
Younger athletes (under 35 years) are more likely to have SCD due to underlying congenital abnormality (anomalous coronary artery origin), primary arrythmia, channelopathy or cardiomyopathy).
Sex: Research into SCD have consistently shown that male athletes are more likely to have SCD than females. For example, a study of 1049 US college athletes (average age 19 years) who had SCD, only 11% occurred in females.
A large study of more than 110,000 athletes reported a SCD incidence rate of 1.1/100,000 in person years for female athletes, and 2.6/100,000 in person years for male athletes.
Cardiologists theorise a number of possibilities to explain why SCD occur in males more than females. These include the higher prevalence for myocardial fibrosis in males could contribute to fatal arrythmias, hormonal factors (oestrogen may be a protective factor in females) and sclerotic artery disease.
Ethnicity: Athletes of African descent have the highest risk due to predisposition to a cardiac condition known as hypertrophic cardiomyopathy (a thickening of the myocardial wall often due to sarcomeric protein mutation).
Sports Activity and Intensity: Researchers have noted that a higher risk for SCD occurs in high intensity athletes compared to recreational exercise. Within the US, basketball players have the highest incidences of SCD, whilst in Europe- football players rate highest.
How Are Athletes Screened for Sudden Cardiac Death?
Almost all pro-athletes complete numerous medical assessments throughout their competitive career which include cardiac assessments and measurements such as ECG’s, cardiac stress-tests and family history questionaries.
Consensus on what testing ought to occur for SCD remains variable across different sports codes and organisations. In the case of footballer Christian Erikson, he had had regular cardiac screening assessments across multiple domestic and international sporting clubs with no abnormal results detected prior to his cardiac arrest.
What is the Treatment for Sudden Cardiac Death?
The single most effective treatment for an athlete with SCD is defibrillation by an automated external defibrillator (AED) and effective cardio-pulmonary resuscitation (CPR).
Sports and athletics clubs from amateur to professional leagues ought to have an AED onsite and a person trained to deliver effective CPR.
Remember; for every one minute defibrillation is delayed, survival rates reduce by approximately 10%.
Real Men’s Health Takeaway
Knowing your family history for heart disease is important for knowing your overall cardiac risk score. All sports participants should learn how to access and use an AED.
Click the link to watch an AED video demonstration on how to use a defibrillator from the team at Victor Chang Cardiac Research Institute.
