Over 25 million youths participate in competitive sports each year and the benefits of exercise and team sports have been well-documented. What is less understood, however, is the risk to young athletes of a variety of rare but too often fatal preexisting medical conditions, usually associated with the heart.
Even though risk of Sudden Cardiac Arrest (SCA) appears low (1/200,000), the underlying conditions predisposing people to SCA are more prevalent (for example Michael’s heart anomaly is understood to affect as many as approximately 1 in 1000 people). While the reasons why some young people succumb to SCA are not fully understood, the incidence of SCA can be reduced, as discussed below, and should be viewed as a public health issue.
The majority of cases of sudden death in children and young adults are due to SCA, often occurring during sports. The conditions leading to SCA in children and young adults are different from those normally associated with SCA in older adults such as high blood pressure and coronary artery disease. That is, vigorous sports activities are believed to act as a trigger of cardiac arrest upon young people who have underlying (often undetected) cardiovascular diseases predisposing to life threatening ventricular arrhymias. Two of the most common of these silent conditions are hypertrophic cardiomyopathy (high profile cases have included Reggie Lewis and Hank Gathers) and congenital coronary artery anomalies (which Michael had).
SCA in young people can be due to hereditary or congenital conditions. In many cases, there are no apparent symptoms so pre-participation screening is the only way to detect if one of these life-threatening conditions exists. In cases where symptoms may be observable, typically upon further testing these are shown to be associated with non-life threatening conditions such as reflux and improper breathing. If any of these several warning signs are observed, the American Heart Association as endorsed by the American College of Cardiology Foundation has issued pre-participation screening recommendations to detect for heart anomalies in athletes. These symptoms include:
• Chest pain upon exertion
• Fatigue upon exertion
• Pre-syncope or syncope events
• Unexplained shortness of breath, especially with exercise
• Past detection of heart murmur
• Family history of premature death before age 50
The AHA Preparticipation Guidelines
If properly screened and detected, many instances of SCA could be prevented. In fact, in Italy where preparticipation screening of competitive athletes has been mandatory since 1982, the incidence of SCA has declined dramatically (See for example, Pelliccia A, Maron B. Preparticipation cardiovascular evaluation of the competitive athlete. American Journal of Cardiology 1995: 75, 827-829 / See also, Corrado, et al. Screening for hypertrophic cardiomyopathy in young athletes. New England Journal of Medicine 1998; 339: 364-369 / and Corrado et al. Cardiovacular pre-participation screening of young competitive athletes for prevention of sudden death. European Heart Journal 2005 26, 516-524)
Automatic external defibrillators (AEDs) have been effective in reviving children and adults who experience SCA. There are numerous legislative and voluntary initiatives to promote AEDs on ball fields as well as in other public places. It is crucial for those on the front lines: parents, coaches, school nurses, pediatricians, pediatric cardiologists, and pediatric pulmonologists to be made aware of these life-threatening conditions. That is why we are promoting the mission of this Foundation: lives can be saved through heightened knowledge and awareness and in turn better screening and detection.
(Disclaimer: The Foundation and its Directors are not medical professionals and nothing herein should be construed to constitute medical advice which only can be obtained by properly trained professionals.)