News media occasionally present us with tragic cases of famous young athletes dying suddenly during sports activity. Theses cases commonly provoke discussions on how to prevent such dreadful incidents. Then, in a few days, everybody seems to have forgotten about it, until next time… NIL
Sudden death in young athletes, associated with athletic activity, is a rare but well-known disorder. Most of these cases do not receive any media coverage. However, family and friends are left in deep shock. Many questions are left unanswered. How could this happen? Did we miss any warning signs? Could we have done something to prevent this from happening?
The majority of sudden cardiac death incidents in athletes are caused by disturbances in heart rhythm (ventricular tachycardia or ventricular fibrillation), leading to loss of blood circulation. Immediate treatment is aimed at restoring normal heart rhythm, usually by electric shocks given by so-called defibrillators.
The most common cause of disturbances in heart rhythm leading to sudden death in young athletes is underlying heart disease. Often, the disease is not diagnosed until after the event. As a result, there is great interest in detecting such disorders early, in order to be able to define appropriate treatment and activity restrictions for the individual.
The most common underlying cause of sudden death in young athletes is so-called hypertrophic cardiomyopathy. This is a disorder which sometimes runs in families. However, in many cases there is no family history at all. In this disease, the muscle of the left ventricle of the heart becomes abnormally thick. Young people with this disorder commonly have no symptoms at all. There are a number of other underlying heart diseases that may lead to sudden death. Most of them are rare. Some may be temporary, such as viral infections of the heart muscle. Some may be congenital.
The only way to prevent sudden cardiac death in young athletes is to find the underlying heart disease before it leads to collapse and sudden death. This is a huge challenge, because some of these diseases are difficult to detect. The responsibility is within the medical community and among sports regulatory authorities. An important questions is whether regular screening of young athletes, by health professionals, can reduce the risk of sudden death.
There are two important questions we have to ask about screening for heart disease in young athletes. The first one involves how screening should be performed and what methods should be used. The second addresses what restrictions should be placed on athletes who turn out to have heart disease.