Cardiac Issues

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Sudden Cardiac Death:

Uncommon in Athletes

The sudden death of a young person is a tragedy no matter how it occurs. Sudden deaths in athletics have grabbed news headlines in the past few years. Reports of these young persons deaths are often portrayed as preventable if proper medical examinations were performed.

Sudden cardiac death occurs statistically in about 1 in 200,000 high school athletes per academic year. This number is actually smaller than the number of deaths suffered by adult male athletes, which is estimated at 1 in 15,000.

The majority of these adolescent deaths seem to be from hypertrophic cardiomyopathy (HCM). This is a genetic disease that affects the septum (wall) of the heart’s left ventricle. The arrow in the picture shows the left ventricular wall. HCM is relatively uncommon cardiac malformation in the general population, affecting approximately 1 in 500, or 0.2%.

No fewer than 75 names have been given to this condition over that past 40 years. This is ostensibly due to the fact that the wall thickening can occur in several different places. Many of the various names were based on one or two physicians’ minimal experience with the condition. HCM has now been adopted as the common name for broad disease spectrum.

The name itself means abnormal growth of cardiac muscle. The most common characteristic of HCM is a thickening of the left ventricular wall of the heart without an increase in size of the chamber.

The ventricular wall thickens impacts the normal flow of blood from the heart. The red arrow in this picture shows one type of wall thickening.

Not only is the chamber wall thickened, but the actual cells of the cardiac muscle are different. They appear to be laid down in a very chaotic manner. This disorganized appearance also affects the electrical activity of the heart.

The electrical impulses that make the heart beat do not travel normally within these chaotic cells. This may cause the heart to beat improperly.

Other signs and symptoms of HCM are difficult to list. The best test is to visualize the heart and determine if the characteristic wall thickening is present. There are still instances of false-positives with this type of testing.

Shortness of Breath: Since the ventricle does not move blood properly to the body, exercise capacity may decrease. This can manifest it self as shortness of breath and fatigue. But since this can be a side effect of exercise, this symptom alone is not indicative of HCM.

Chest Pain: Chest pain is a common symptom with HCM. It is usually exacerbated with activity and relieved with rest. Pain may persist during rest and even sleep. This pain may be due to deficient oxygen supply to the cardiac muscle. If chest pain is recurrent and reproducible, a physician should examine the athlete.

Palpitation: Palpitation is an uncomfortable awareness of the heart beat. In the case of HCM, palpitation may start suddenly, appear to be very rapid and may be associated with sweating and light-headedness. If this symptom is recurrent and reproducible, a physician should examine the athlete.

Light-Headedness & Blackout: HCM may cause an athlete to feel lightheaded or blackout during exercise sessions. This symptom may occur in combination with palpitations. Again, if both of these symptoms are recurrent and reproducible, a physician should examine the athlete.

Athlete & Family History: A complete medical history of the athlete and his/her immediate family is a must. Some examples of questions are:

• Have you had any brothers or sisters or other close relatives who died before the age of 30?

• Have you ever passed out during an exercise session?

• Do you ever experience repeated chest pain with exercise?

• Are you more short of breath during exercise than your friends?

• Can you keep up with your teammates during practice?

• Has there been a diagnosis of heart murmur?

• Has there been a diagnosis of heart disease? (There is an alarming increase in youth diagnosed heart disease.)

Try and avoid the word “ever” as this is a leading question and the adolescent may provide too many unimportant positive responses. Remember not to ask questions that lead to specific answers.

Since an enlarged heart is common in competitive athletes, it is imperative that physicians distinguish between the “athlete’s heart” and a person with HCM.

Mild HCM (thickening of the septum between 13 and 15 mm) can easily be confused with the “athlete’s heart.” Differential diagnosis should include a complete family history, patient history, echocardiogram (ultrasound picture of the heart) and electrocardiogram (test to measure the electrical activity of the heart).

Since wall thickness is not a valid way to differentiate between the two, cavity dimension should be measured. With “athlete’s heart” the cavity and wall will both increase in size. This measurement may be enough to distinguish between the two conditions.

If this fails, a deconditioning test may be used. The athlete is asked to not train for 3 to 6 months. At that time a repeat ultrasound is performed to compare the size of the heart walls and chambers pre– and post– conditioning. If the heart decreases in size, HCM is probably not a valid diagnosis.

Even the most thorough physical exam may not detect HCM. Athletic Trainers, coaches, parents, and athletes must be aware of the possible signs of this potentially fatal disease. If symptoms are present, a cardiologist should be consulted.

©2000 - 2006 David Edell

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Last Update for AthleticAdvisor.com: 06/04/2006 12:01:52 PM