Sudden Cardiac Deaths of Young Athletes

Francisco J. Diaz, MD FCAP
February 26, 2017
Francisco J. Diaz MD, FCAP

The sudden death of young athletes while practicing a sport or a recreational activity is a rare phenomenon but one that requires attention from coaches, families and school administrators. In the United States, approximately 100 young athletes die every year. That number may not appear large enough as compared to the overall cardiovascular deaths that are in the vicinity of 300,000 per year. However, sudden cardiac deaths may be preventable with relatively low tech and inexpensive screening tools. The most common cause of sudden cardiac death in young athletes is a condition known as hypertrophic cardiomyopathy which represents close to 40% of deaths in this category.

What is Hypertrophic Cardiomyopathy?

Hypertrophic Cardiomyopathy is a congenital condition where the muscle fibers of the heart are arranged in a pattern that prevents the electrical impulses of the heart to flow normally and the heart muscle is increased in thickness. The young athlete usually had no prior symptoms and collapses during a game or a practice. The average age is 17 years old. This condition is congenital and tends to run in families, hence the importance of screening prospective athletes with an EKG because abnormalities on the heart rhythm can be detected and the young athlete can be monitored and treated as well as his/her family members. The most common sports where individuals with hypertrophic cardiomyopathy suddenly collapse are basketball and football. The author examined a twelve-year-old girl that collapsed while in cheerleading practice. The autopsy showed no findings, but due to the sudden nature of her death, genetic testing was suggested to the family. The results were surprising. Her two siblings, her mother, and her grandmother had a heart rhythm condition known as Long Q-T syndrome. Long Q-T syndrome is a heart rhythm condition that can cause fast and chaotic heartbeats and in some cases sudden deaths. This condition is not curable but it can be controlled with medication. In the case that we just described, unfortunately a young woman died, however, her whole family is currently on successful treatment. As a forensic pathologist, we see these types of deaths from time to time and the most important message is that a lot of these deaths may be preventable with an EKG before the athlete starts in any given sport, which will detect abnormalities in the rhythm of the heart. This simple and inexpensive tool proves very valuable in detecting pre-existing cardiac condition that otherwise the athlete and the family may not be aware. The mMajority of athletes with the conditions described and others, usually do not exhibit noticeable symptoms and that is why it is difficult to know which young person may be predispose to a sudden collapse. There is a cause of sudden cardiac death that is not related to irregular rhythm of the heart or increased thickness of the heart muscle but it is the direct result of trauma to the chest plate causing sudden death due to the disruption of the electrical cycle of the heart. This condition is known as “Commotion cordis”, which means commotion of the heart. It occurs when the chest plate sustains an impact causing a disruption of the electrical impulses of the heart. It occurs more frequently as a result of a baseball impacting the chest plate. Prevention is by wearing the right protective gear.

References:

Hastings JL, Levine BD (March 2012). "Syncope in the athletic patient". Prog Cardiovasc Dis. 54 (5): 438–44

Raju H, Alberg C, Sagoo GS, Burton H, Behr ER (Nov 21, 2011). "Inherited cardiomyopathies". BMJ. 343

Maron, BJ; Estes, NAM III (March 2010). "Commotio cordis". New England Journal of Medicine. 362 (10): 917–927