Preventing Sudden Cardiac Arrest in Young Athletes

When Allan Chaney was 20 years old, he was a healthy young man on a basketball scholarship at Virginia Tech University. “One morning I did a workout, and at the end I started to have rapid heartbeats,” he recalls. “I was breathing really fast, and I couldn’t stop it. I thought I must be just tired, but when I tried to take a deep breath, I couldn’t.” Chaney passed out, and although he felt fine when he regained consciousness, the coach brought him to the hospital. He was diagnosed with myocarditis, an inflammation of the middle layer of the heart wall caused by a viral infection.

Undiagnosed myocarditis is just one of the conditions that can cause sudden cardiac arrest, also called sudden cardiac death, among young athletes. About half the time young athletes die from cardiac events it’s due to hypertrophic obstructive cardiomyopathy. This genetic abnormality causes an area of the heart to become two to three times thicker than usual, making it difficult for blood to pump past the thick point. 

Chaney told his story at a symposium on sudden cardiac arrest in young athletes hosted by the Duke Heart Center last spring. “Sudden cardiac arrest is an uncommon event in athletes, but it is very tragic when it happens, particularly when the athlete is a young person,” says Mahesh Patel, MD, a Duke cardiologist and co-organizer of the symposium. “Most cases of sudden cardiac arrest in athletes are due to pre-existing, undiagnosed heart disease. It is a poorly understood field overall. We’ve been working to bring greater awareness to physicians and the broader community about this issue.”

The incidence of death in teen athletes due to sudden cardiac arrest is twice as high as death due to trauma. And while it is still rare - up to 50 percent of those who die never knew they had heart disease - In countries such as Italy, teenage athletes are routinely screened with an electrocardiogram (EKG) to detect underlying abnormalities. In the United States, however, EKG screening is not routinely recommended. “It’s a controversial topic,” Dr. Patel says.   “There is a temptation to do routine EKG screening as a means of reducing rates of sudden cardiac arrest in athletes. But there is no strong evidence that indicates that screening EKGs can reduce sudden cardiac death among young athletes.

“The most important thing young athletes can do is to be very aware of their family history and pay close attention to any cardiovascular symptoms such as chest pain and shortness of breath,” Dr. Patel adds. “Also, a thorough health history and physical exam prior to engaging in rigorous physical exercise is important.”

The American Heart Association recommends that competitive athletes undergo a 12-item standardized history and physical questionnaire that the organization has developed. EKGs can identify preexisting heart disease in teens who have a family history of early cardiac death. Genetic testing is used for select individuals with HCM and those who have a family history.

Automated external defibrillators are portable machines that can diagnose and treat cardiac arrhythmias. Making these machines accessible and available at sporting events is one step sports organizations can take to prevent sudden cardiac death in young athletes. “It’s also important for coaches and athletes to learn bystander CPR,” Dr. Patel says. “Performing CPR can make a major difference in survival rates among those who do experience cardiac events.” Learn the steps of hands-only CPR.

Fortunately for Chaney, he received treatment for myocarditis. He was fitted with a wireless, implantable defibrillator, which regulates the rhythms of his heart. His health improved, and he was even able to go on to play basketball for High Point University when he enrolled there as a master’s student in nonprofit management. Chaney is continuing efforts to build a nonprofit that helps heart patients purchase defibrillators. “I am lucky to have gotten a second chance,” Chaney says. “I just want to help others as much as I can.

A 14-point screening process could help reduce sudden cardiac death in high school and college competitive athletes, according to an American Heart Association scientific statement. The screening includes the following 14 questions—a “yes” to any might warrant further medical evaluation. To learn more, talk to your doctor.

Personal History

• Chest pain/discomfort upon exertion
• Unexplained fainting or near-fainting
• Excessive and unexplained fatigue associated with exercise
• Heart murmur
• High blood pressure

Family History

• One or more relatives who died of heart disease (sudden/unexpected or otherwise) before age 50
• Close relative younger than 50 with disability from heart disease
• Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy in which the heart cavity or wall becomes enlarged, long QT syndrome (which affects the heart’s electrical rhythm), Marfan syndrome (in which the walls of the heart’s major arteries are weakened), or clinically important arrhythmias or heart rhythms

Physical Exam

• Heart murmur
• Femoral pulses to exclude narrowing of the aorta
• Physical appearance of Marfan syndrome
• Brachial artery blood pressure (taken in a sitting position)
• If individual has been restricted from participation in sports in the past
• If individual has had prior testing for the heart, ordered by a health care provider

Source: American Heart Association