Sudden Cardiac Death in the Young Athlete

Tue, 1/5/10 - 2:22pm
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Author(s):

Peter T. Burke, MD, Hazim Al-Ameri, MD, Christian Machado, MD, FACCP, FAHA
Providence Heart Institute, Providence Hospital
Southfield, Michigan

A. E. Housman’s celebrated literary work, “To an Athlete Dying Young,” romanticizes the premature death of a young athlete. The poem reveals the concept that those dying at the peak of one’s glory or youth are actually quite lucky. This horrifying and ill-fated phenomenon in apparently healthy, young athletes is often the result of sudden cardiac death (SCD). The sobering reality, however, is that young athletes are dying from SCD with a frequency that is much higher than originally thought.1-6 Regrettably, there is obviously nothing “lucky” about dying at the peak of one’s youth.

This past fall, Detroit, Michigan was witness to SCD in two young athletes during the city’s annual marathon. These occurred just months after the Baltimore marathon claimed the life of a 23-year-old runner. The surrounding community was shocked and devastated with the news that the two young, well-conditioned runners, both under the age of 36, had collapsed within a couple miles of one another. The Wayne County medical examiner's office listed cardiac dysrhythmia as the cause of death.

The concept that young, healthy individuals who epitomize invulnerability could be subject to potential lethal cardiovascular disease and subsequent sudden death is not only counterintuitive, but quite disturbing. Accordingly, we need to increase awareness within the community to the causes of SCD, provide comprehensive and cost-effective screening strategies to the population at risk, and provide easier access to resuscitation equipment at all athletic venues.7-9

Incidence, Prevalence and Distribution of SCD

SCD is defined as death due to any cardiac disease within 1 hour after the onset of symptoms.10 SCD may be due to arrhythmic causes (e.g., ventricular fibrillation [VF], ventricular tachycardia [VT], or asystole) or non-arrhythmic causes (e.g., pulmonary embolus or rupture of the sinus of Valsalva).

The true prevalence of SCD is difficult to determine, as a significant percentage of cases are underreported.1-9 Relying on media reporting may also grossly underestimate the true incidence, since lower profile, non-elite athlete cases are more likely to be overlooked or unrecognized by the public and press. Estimates for runners range from 1 in 15,000 joggers and 1 in 50,000 marathon runners, representing 1 death per 50,000 to 375,000 man-hours of exercise.11

Sudden death is more common in male athletes, approximately 9 to 1, probably because young women have lower rates of participation in certain sports.1,12 This also may be explained by the disproportionate rate of recognition of hypertrophic cardiomyopathy (HCM) in women.13 One of the largest demographic studies of SCD in athletes demonstrated an equal distribution among different ethnic groups.14 When SCD in athletes is categorized according to etiology, HCM occurs more commonly in males than females and in African-American athletes than in Caucasian athletes, whereas aortic valve stenosis and arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs with more prevalence in Caucasian athletes.1,14-15

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