When sudden cardiac death strikes the young

Taiwanese-Canadian model and actor Godfrey Gao – seen here as Magnus Bane in the 2013 fantasy movie The Mortal Instruments: City Of Bones – recently died of sudden cardiac arrest during the filming of a reality show that puts its participants through various physical endurance activities. — Sony Pictures

The sudden, unexpected death of a young athlete is a tragedy unparalleled in sports.

Aside from the grief of friends and family members, shock waves reverberate as the community, institution, medical team and fans all cope with the death.

Instinctively, those involved wonder what might have prevented the death.

Every case of sudden death in a young athlete garners large amounts of media attention.

Indeed, such publicity may influence the public perception as to the frequency of these events, whether in athletes or young adults in general.

Sudden cardiac death is loosely defined as a non-traumatic, non-violent, unexpected death due to cardiac causes within one hour of the onset of symptoms.

The general public often equates sudden cardiac death to a heart attack.

However, while a heart attack can cause sudden cardiac death, they are not exactly the same.

A heart attack occurs when the bloodflow to the heart is suddenly reduced due to a blocked coronary artery from a ruptured plaque (build-up of cholesterol and other items) in a blood vessel.

Meanwhile, a sudden cardiac arrest is due to the sudden onset of rapid, erratic electrical rhythm in the heart from a pre-existing cardiac condition, causing the heart to quiver rapidly and uselessly, leading to death.

The majority of sudden cardiac death events in athletes are due to ventricular arrhythmias, usually from sustained ventricular tachycardia or ventricular fibrillation.

In individuals with certain cardiac disorders, athletics may increase the likelihood of ventricular tachycardia or ventricular fibrillation due to changes in their heart structure due to prolonged physical training or the body’s demands during intensive exercise.

A rare occurrenceCases of sudden cardiac death have been reported among both male and female athletes from all sports.

Although sudden cardiac death in athletes is rare, media coverage often makes it seem like it is more prevalent.

In the younger population, most sudden cardiac deaths occur while playing team sports such as football and basketball.

It occurs in about one in 100,000 to 300,000 athletes, and more often in males.

However, in a recent study of two decades of data on 11,168 youth football players in the United Kingdom, the risk of sudden cardiac death among the footballers was found to be much higher at seven in 100,000 players.

In older athletes (35 years and older), sudden cardiac deaths occur more often while running or jogging.

This occurs in about one in 15,000 joggers and one in 50,000 marathon runners.

Basically, there is a high probability that any intense athletic training is likely to increase the risk for sudden cardiac death (or disease progression) in trained athletes with an underlying heart problem, although it is not possible to quantify that risk at present.

Certainly, the vast majority of young athletes who die suddenly do so during athletic training or competition.

Regardless of whether a young person is a professional athlete or an amateur sports person, the impact of the untimely deaths is far reaching.

Act quickly

A cardiac screening usually includes an ECG to check your heart's rate, rhythm and structure. — AFP A cardiac screening usually includes an ECG to check your heart's rate, rhythm and structure. — AFP

The occurrence of sudden cardiac arrest in athletes is abrupt, and unfortunately, the player usually has no warning symptoms before the catastrophic event.

Thus, the arrhythmia is usually instantaneous, with seeming lack of any warning symptoms, occuring during or at the end of intense physical activity, with death quickly following.

Cardiac arrest is characterised by abrupt loss of consciousness, caused by a lack of adequate bloodflow to the brain.

This leads to sudden cardiac death in the absence of any medical intervention, although spontaneous reversions occur rarely.

There are no specific warning symptoms for predicting sudden cardiac death.

Signs such as heart rhythm abnormalities, heart ischaemia or heart failure, which present hours or minutes before cardiac arrest are more specific for heart diseases.

However, patients at risk for sudden cardiac death may have warning symptoms such as chest pain, shortness of breath, palpitations, weakness or fatigue, and a number of non-specific complaints.

Such symptoms can precede coronary events, particularly heart attack and sudden cardiac death.

To help save the life of a person experiencing a sudden cardiac arrest, the following needs to happen:

  • Calling an ambulance/medical help
  • Performing cardiopulmonary resuscitation (CPR) within the first 2 minutes
  • Using an automatic external defibrillator (AED) within the first two to four minutes
  • Providing early advanced life support within the first eight minutes), and
  • Providing late advanced life support.

The first four steps must have as short a time delay as possible to significantly increase survival rates.

CPR and the use of an AED must continue until the patient regains consciousness or is able to receive medical attention from healthcare professionals.

Screen yourself

Before you take up any sports, it is important that you see a cardiologist for a cardiac screening, especially if you have a family history of sudden cardiac death in young relatives and/or coronary risk factors such as smoking, diabetes, hypertension (high blood pressure) or hypercholesterolaemia (high cholesterol levels).

While it can be costly, a thorough heart screening can potentially save the lives of those who have a history of sudden deaths in the family, regardless of whether they have any symptoms and signs, or not.

Two of the more common screening tests are an electrocardiogram (ECG) and an echocardiogram.

For a more detailed examination of the heart in selected individuals, a cardiac MRI (magnetic resonance imaging) may be necessary.

Genetic testing may also be recommended in specific cases.

If you have any of the cardiac conditions listed above, it is important to speak to your doctor about how to reduce your risk of a sudden cardiac death and your suitability in performing sports.

Finally, increased education and awareness about sudden cardiac death, training in CPR and accessibility to AEDs, as well as treatment with an implantable cardioverter defibrillator (ICD), can help prevent sudden cardiac death in both athletes and non-athletes.

Datuk Dr Yap Yee Guan is a consultant interventional cardiologist and Dr Ooh Ping Yee is a consultant emergency physician. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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