The Athletic Heart: Sudden Cardiac Death in Athletes
By Ramin Manshadi, MD, FACC, FSCAI, FAHA, FACP
Sudden Cardiac Death (SCD) is a non-traumatic, nonviolent, unexpected death due to cardiac causes within one hour of the onset of symptoms. Though there is no official registry, research suggests between 200-300 high school athletes die of SCD each year.
What Happens During Sudden Cardiac Death?
Simply, these athletes die of arrhythmias.
A correctly functioning heart has electrical activity going from the top of the heart to the bottom, making the heart squeeze and pump correctly. An arrhythmia is when the entire electrical portion of the heart is firing all at once. The muscle cannot function. The pumping fails. You pass out since you’re not getting enough oxygen to the brain, and in time you die. The most obvious sign of an arrhythmia is blacking out due to lack of blood pressure.
CPR doesn’t really revive you. That can happen, but CPR really just keeps your heart pumping blood through your body by pressing down on the chest. This keeps you alive until paramedics or someone arrives to perform more intensive intervention (like with a defibrillator) to restore heart function. In fact, you should be aware that CPR isn’t even always successful. It really needs to be performed perfectly to keep a patient alive. That’s why staying practiced and updated on its ever-improving protocols is so vital. If you ever have the opportunity to learn or review your CPR skills – take it.
Fortunately, young athletes are generally very healthy. As soon as they’re down, if you shock them with a defibrillator, their heart rhythm can restore. They come back very fast and are just like they were before. It’s pretty astonishing.
Prevention as Solution
If we have a policy in place in which a competent physician evaluates all athletes before they start rigorous exercise activity, we can prevent many young athletes from abruptly collapsing and dying.
Others have already begun doing this. In Northeastern Italy, a simple EKG test has been added to the examination of all athletes. An EKG is a simple exam costing only around $30 or a little more. With this simple testing, they were able to cut down the risk of sudden cardiac death in their athletes by 85 percent!
We need to adopt using such a test in the United States as well. While there are more expensive tests one can do (like an echocardiogram), an EKG should be able to detect over 95 percent of those with the underlying conditions that could lead to sudden cardiac death.
Athletes should be aware of the possible warning signs of SCD, which include:
Feelings of passing out
Shortness of breath outside of the norm one would expect with exercise
If experiencing these symptoms, a cardiologist knowledgeable about SCD in athletes should evaluate the person.
The Solution on the Field
While prevention is key, something can also be done if an arrhythmia causes an athlete to collapse.
A terrific device called a defibrillator sends a therapeutic dose of electrical current into a person’s body to normalize heart function in various life-threatening situations. It’s what you’ve seen on TV and in movies, where paramedics place paddles on the patient’s chest in a hospital or, and the heart is “shocked” back into beating correctly.
In real life, if someone collapses and you get to him or her within five minutes and shock him or her out of arrhythmia, they will likely survive. But if it takes longer than five minutes to shock them in this manner, the likelihood of survival is almost zero. That’s why these devices need to be at athletic fields everywhere. The time it takes for someone to phone for help, for paramedics to arrive and get to the student, break out the equipment and use it – will most likely exceed those precious five minutes.
Portable Automatic Defibrillators
Fortunately, there are also portable “automatic” defibrillators. Even a person with little training can use one. You simply attach the leads to the chest, press the button, and it performs its own diagnosis and shock. So if someone collapses, you grab it and use it right away before paramedics even get there. If a portable automatic defibrillator is applied within the first minute, the survival rate is 90 percent. But if no such defibrillator is present, then survival drops to five percent, even with CPR. These defibrillators cost about $2000 each, but if one of these can save someone’s life, they’re worth many times that. It is imperative that high schools and colleges possess these life-saving tools.
A few years ago, The Sacramento Kings basketball organization realized the importance of schools having portable “automatic” defibrillators, and has been working to create a PSA (public service announcement) to raise awareness of sudden cardiac death in athletes. In fact, once the owners, Gavin and Joe Maloof, originally became aware of this project, they immediately got personally involved. Geoff Petrie, the General Manager, similarly offered to support the cause without hesitation. In addition, their media team has shown a genuine caring attitude in their assistance with this PSA community.
Athletics Offers Terrific Benefits
Athletics has benefits far beyond the exercise and fitness. It has the positive effect of socialization, competitiveness and teamwork, Plus the sense of achieving a goal. Every student-athlete should be involved in some sport. Not necessarily to become a pro and earn money, but to develop these values that will help in their future and daily work lives.
Being competitive, while also being a gentleman or gentlewoman as an athlete, is an example of what can help you to be successful in life.
It is important to relate this because while there are risks in everything, there are distinct benefits as well. It wouldn’t be beneficial for parent or student to shy away from participating in athletics because of anything that has been presented here.
It is important to relay health information like what has been described above, even if it makes some people uncomfortable. Perhaps that discomfort will motivate others to champion their own quest to enhance protections for our young athletes.
Knowledge is Powerful
Bottom line, athletes must simply be informed about their own body and how it functions, not just for their own sake, but for the sake of their team too. If you see a teammate experiencing a medical “event”, everyone else might stand around not knowing what happened (possibly thinking the fallen individual only had the wind knocked out of him). But you, with the knowledge presented here, may jump into action. Start CPR while yelling for someone to call 911, or summon the proper equipment to resuscitate someone. Perhaps an athlete’s life will be saved – simply because someone took the time to read this article.
Dr. Ramin Manshadi is a Board-Certified physician with the American Board of Interventional Cardiology, American Board of Cardiology, American Board of Internal Medicine and is Board-Eligible with the American Board of Nuclear Cardiology. He is an Associate Clinical Professor in the Department of Cardiology at UC Davis Medical Center. Dr. Manshadi was named a “2011 Top Cardiologist” by U.S. News & World Report. He is the author of The Wisdom of Heart Health: Attaining a Healthy and Robust Heart in Today’s Modern World. For more information, please visit, www.DrManshadi.com.