Sudden Deaths in Young Competitive Athletes

Abstract

Background-Sudden deaths in young competitive athletes are highly visible events with substantial impact on the physician and lay communities. However, the magnitude of this public health issue has become a source of controversy. Methods and Results-To estimate the absolute number of sudden deaths in US competitive athletes, we have assembled a large registry over a 27-year period using systematic identification and tracking strategies. , with an average of 66 deaths per year (range 50 to 76) over the last 6 years; 29% occurred in blacks, 54% in high school students, and 82% with physical exertion during competition/training, whereas only 11% occurred in females (although this increased with time; Pϭ0.023). The most common cardiovascular causes were hypertrophic cardiomyopathy (36%) and congenital coronary artery anomalies (17%). Conclusions-In this national registry, the absolute number of cardiovascular sudden deaths in young US athletes was somewhat higher than previous estimates but relatively low nevertheless, with a rate of Ͻ100 per year. These data are relevant to the current debate surrounding preparticipation screening programs with ECGs and also suggest the need for systematic and mandatory reporting of athlete sudden deaths to a national registry.

A Clinical Perspective on Sudden Cardiac Death

“…14 In professional athletes, a diagnosis is usually made in up to 65 % of cases and hypertrophic cardiomyopathy (HCM) is considered the main cause, at least in the United States, followed by arrhythmogenic right ventricular cardiomyopathy (ARVC, especially in the Veneto region of Italy), congenital coronary anomalies, genetic channelopathies, myocarditis, Wolff-Parkinson-White syndrome and Marfan syndrome, with blunt trauma, commotio cordis and heat stroke being less frequent causes. 19,49,50 There is evidence, however, that HCM may not be the major cause of SCD in athletes. 16,20 Autopsies in deceased NCAA athletes most often reveal a structurally normal heart (25 %), followed by coronary artery anomalies (11 %), myocarditis (9 %), ARVC (5 %) and aortic dissection (5 %), with HCM only demonstrated in 8 % of individuals.…”

Angioplastía primaria en infarto agudo al miocardio en arteria coronaria derecha con origen anómalo: Caso clínico

“…Se considera la MS como la principal manifestación clínica, característicamente en jóvenes y deportistas, donde la primera causa de MS es la miocardiopatía hipertrófica con 36%, seguida de las ACA hasta en 17% 6,7 . En casuísticas de necropsias con malformaciones cardiacas se describe la MS hasta en 60%, desencadenada por esfuerzo en la mitad de los casos (en su mayoría atletas) con sintomatología previa como síncope, palpitaciones y dolor torácico 8 .…”

“…Se han descrito diferentes prevalencias en registros de necropsias, series coronariográfi-cas y tomográficas en población seleccionada [3][4][5] . Clínicamente se asocia a muerte súbita (MS) en esfuerzo siendo su principal manifestación clínica, destacando su presentación en pacientes jóvenes y atletas 6,7 . Además pueden presentarse síntomas isquémicos e infarto agudo al miocardio (IAM) de manera anecdótica, existen pocos casos descritos de IAM en arteria coronaria anómala (ACA) que hayan sido tratados con angioplastía primaria (APP), y en nuestra literatura nacional no se conoce, lo que motiva este reporte.…”

Collapsed athlete – atraumatic

“…In a more recent case series by Maron et al [2], 1866 deaths of US competitive athletes were studied. Four hundred sixteen of these deaths were due to traumatic etiologies.…”