Sudden death in sportsmen

Every year about 200,000 people die a sudden related death In the United States during or just after sports. In the Netherlands, the number is estimated to be between 150 to 200 people, in Belgium between 150 and 300. Not the sport itself is the cause but mostly a hidden heart disease is to blame. In athletes over the age of 35 usually an aneurysm or a heart attack is the cause, but in younger athletes that cause is unlikely. Young athletes often have congenital heart diseases, of which they were unaware.

After a brief introduction on the problem of sudden death, we will give an overview of notable cases of sudden death in athletes since the year 2000 that we encountered during our research.

When an athlete gets heart problems during or after sports, there is usually a reaction of disbelief. Surely this can not happen to a healthy, well-trained person! Regular sports do not make human beings immune to cardiovascular disease. A sports medical examination, steady and structured training and being aware of signs of cardiovascular disease can prevent a lot of suffering.

Some facts:

• Cardiac and cardiovascular disorders are often the cause of sudden death during sports.
• Sudden death in well trained athletes is seven times higher during sports than at rest.
• In not well trained athletes over 35 years old, that chance is even 57 times higher.
• Sudden death in sports is three times more likely in men than in women and occurs usually without symptoms.
• Possible symptoms are palpitations, chest pain, irregular breathing, dizziness or syncope during exercise.

Causes of sudden death in sports:

• The most common cause of sudden death is a hypertrophic obstructive cardiomyopathy (26.4%), a genetically induced excessive thickening of the heart muscle that can lead to ventricular fibrillation. During ventricular fibrillation more than 400 chaotic electrical discharges per minute pass through the heart chambers causing the blood flow to stop.
• Commotio Cordis (19.9%), a rare disturbance of the electrical system of the heart due to a punch on the chest, leading to sudden cardiac arrest, appears to be the second most common cause.
• Anomalies of the coronary arteries (13.7%) can consist of abnormally located coronaries or coronary arteries having a sharp angular twist that slows down the blood flow.
• Left ventricular hypertrophy (7.5%), a significant thickening of the myocardium of the left ventricle.
• Myocarditis (5.2%), an inflammation of the heart muscle.
• A ruptured aortic aneurysm due to Marfan's syndrome (3.2%). People with this condition are usually tall and slim. It is a hereditary condition of the connective tissue.
• Arithmogenic right ventricular cardiomyopathy (2.8%), a hereditary heart disease caused by genetic defects of parts of the heart muscle.
• A tunneled coronary artery or myocardial bridge (2.8%) where the coronary artery tunnels through the myocardium instead of resting on top of it.
• Aortic valve stenosis or a narrowing of the aortic valve (2.6%) which causes the left ventricle to generate higher pressure to get the blood in the aorta . Due to this pressure load, there is usually a left ventricular hypertrophy.
• Atherosclerotic coronary artery disease (2.6%)
• Long QT syndrome
• Brugada syndrome
• Wolff-Parkinson-White syndrome
• Arteriosclerosis, congenital abnormalities, high blood pressure, cholesterol, smoking and viral infections.