Sudden death in young people, often due to hidden heart defects or overlooked heart abnormalities, is rare. Of the 360,000 sudden cardiac arrests that occur in the United States each year outside of hospitals, very few occur in young people and only some of those young people die of sudden cardiac arrest. When these tragic sudden cardiac deaths do occur, it’s often during physical activity, such as participating in an athletic event or strenuous exercise.
The causes of sudden cardiac death in young people vary, but most of the time deaths are due to heart abnormalities, such as unrecognized inherited heart disease (example, hypertrophic cardiomyopathy) and coronary artery abnormalities. Other causes include inherited heart rhythm disorders such as Long QT syndrome, Brugada syndrome, or other inherited cardiac “channelopathies”.
Additional etiologies include inflammation of the heart muscle (myocarditis), which can be caused by viruses and other illnesses. Sudden cardiac death can also occur as the result of a blunt blow to the chest, such as being hit by a baseball or hockey puck, at just the right time (commotion cordis). The blow to the chest can trigger ventricular fibrillation if the blow strikes at exactly the wrong time in the heart’s electrical cycle.
Don’t Ignore the Warning Signs
What can young athletes do to prevent a sudden cardiac event? In more than a third of these sudden cardiac deaths, there were warning signs that were not reported or taken seriously. In particular, symptoms that occur during exercise should always be taken seriously. Here are the typical warning signs:
- Fainting during physical activity;
- Dizziness or lightheadedness during physical activity;
- Chest pains or tightness, at rest or during exertion;
- Palpitations – skipping, irregular or extra beats during athletics;
- Being unable to keep up with peers due to shortness of breath or noted loss of exercise tolerance
Preventing Sudden Cardiac Death
A proper evaluation should find most, but not all, conditions that would cause sudden cardiac death in the athlete. Some diseases are difficult to uncover while others can be diagnosed following a normal guideline-based screening evaluation.
The required physical exam includes measurement of blood pressure, a careful listening examination of the heart, and palpation of the peripheral pulses. If there is concern for a condition associated with a higher risk of sudden cardiac death, further evaluation guided by the sports cardiologist would continue and frank discussions regarding the appropriate “exercise-prescription” would take place. These discussions would include the risk profile for ongoing competitive athletics.
About Dr. Jonathan Kim, MD
Dr. Kim is an Assistant Professor of Medicine at the Emory Heart and Vascular Center. He graduated from Vanderbilt University School of Medicine, Nashville, TN, and did his residency at Massachusetts General Hospital, Boston, MA. His specialties are Cardiology (Board certified since 2014) and Internal Medicine (Board certified since 2008) and his area of clinical expertise is sports cardiology. He has developed a new sports cardiology clinic at Emory-St. Joseph’s Hospital.