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Sudden death in young athletes

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Title: Sudden death in young athletes


1
Sudden death in young athletes
  • Rare event - actual rate uncertain
  • USA - retrospective analysis in High School and
    College athletes less than 1 100 000
    participants per year
  • Italy incidence 3 100 000 athletes less than
    35 years
  • Male/female ratio - 2-10 1
  • Men-higher prevalence of cardiac disease at the
    age12 - 35 years (probably phenotypic expression)
  • Men-higher participation rate in competitive
    sports (football, basketball, ice-hockey)

2
Causes of sudden death in athletes less than 35
years
  • Nonpenetrating strike to the chest wall
  • Commotio cordis (trigger of abrupt ventricular
    fibrillation in interval 15-30
    ms before T-wave peak on ECG)
  • Competitive sports increase likelihood of cardiac
    arrest
  • Most fatalities-in basketball, football,
    ice-hockey (USA), soccer, ice hockey (Europe)
  • Italy - young adults involved in sports - 25-fold
    greater risk of sudden death than their
    non-athletic counterparts

3
Causes of sudden death in athletes less than 35
years
  • Hypertrophic cardiomyopathy - more than 1/3 of
    cases
  • Cardiac congenital anomalies
  • arrhytmogenic right ventricle cardiomyopathy
  • premature atherosclerotic coronary artery disease
  • dilated cardiomyopathy
  • mitral valve prolaps
  • conduction system diseases -

    WPW-syndrome, prolonged QT - interval,
    Brugada syndrome, Lenégre disease, A-V block,
    sudden unexplained nocturnal death syndrome
    (SUNDS)
  • aortic rupture (bicuspid aortic valve, Marfan
    syndrome)

4
Causes of sudden death in athletes less than 35
years
  • Non-cardiac
  • exercise induced bronchoconstriction-BHR
  • cerebral aneurysma rupture
  • use of performance - enhancing drugs (deleterious
    health problems-heart attacks)
  • vigorous exercise (sudden death due to to
    undiagnosed heart disease)
  • London marathon runners 650 000 completed runs
    - 5 deaths, 6 resuscitations
    1 death per 80 000 runners

5
Extreme sport activities
  • decrease of heart function and its fatigue
  • Ashley - echocardiographic evaluation before and
    after a 480 km competition (running, swimming,
    bicycling) - lasting about 90 hours - 13
    decrease of cardiac contractility

6
Assessment of the risk for sudden death
in young poeple in competitive sports
AHA-1996, ESC-2005 Consensus Guidelanes
  • Family history

    of sudden death, heart disease before 50 years,
    cardiomyopathy, arrhythmias, Marfan syndrome
  • Athletes medical history
    chest pain,
    palpitations, syncope, tachycardia, dyspnoea,
    fatigue, heart murmur, hypertension
  • Physical examination
    heart
    murmurs, arrhythmias, femoral artery puls
    (coarctation of aorta), Marfan syndrome

7
  • Italy - addition of 12-lead ECG-identification of
    up to 60 of the potential lethal condition of
    sudden death
  • All investigations - marginal use in detecting
    heart disorders and preventing fatalities
  • Echocardiography tissue Doppler
    echocardiography differentiation pathologic
    from adaptational changes of the heart muscle
  • In 2 - 5 of sudden cardiac deaths cases - no
    definitive cause even after autopsy detected

8
Guidelines for management of athletes
with identified cardiovascular disease
are available
  • withdrawal of competitive sport activities
    -
    reduced risk of sudden death
  • suggestion to the type and degree of sport
    activity that can be done
    safely

9
Examples of sudden death in young athletes
  • Pheidipphides (490 BC)
  • A greek soldier and conditioned runner,
    Pheidippides ran from Marathon to Athens to
    announce military victory over Persia. He
    delivered his message, then collapsed and died.
  • Flo Hyman (1986)
  • Flo Hyman was captain of the 1984 US Womens
    Olympic volleyball team that won silver. She died
    aged 30 years of congenital heart disorder
    Marfans syndrome while playing a Japanese league
    game.
  • Daniel Yorath (1992)
  • A 15-year-old football player who had just been
    signed by the UK team Leeds United, Daniel Yorath
    died from hypertrophic cardiomyopathy while
    playing football with his father in the garden.

10
Examples of sudden death in young athletes
  • Reggie Lewis (1993)
  • Boston Celtics star and sixth captain Reggie
    Lewis was 27 year old when he died while shooting
    baskets at an off-seasons practice.
  • Sergei Grinkov (1995)
  • An Olympic gold medal skater, Sergei Grinkov
    collapsed
    and died from a heart attack at age 28 years
    while training at an ice rink in Lake Placid, NY,
    USA. An autopsy showed that he had arteries
    of a 70-year-old man, though had
    never mentioned any chest pain.

11
Case report
  • History
  • 16 years old athlete-attacks of tachycardia
    (220/min) during long distance running -
    faintness, disappearing immediately after
    stopping exercise
  • Physical examination
  • Signs of anemia on oral mucosa, lips,
    conjunctives
  • Systolic murmur 3/6 in praecordium, irradiating
    into carotides
  • Ergometry Rest Exercise
  • HR 97/min 240/min
  • BP 145/110 mmHg 200/110 mmHg

12
Klidové EKG tachykardie, jinak normální nález
13
Pri výkonu 90 W se zacaly objevovat ojedinelé
SVES.
14
Jejich pocet se v první minute výkonu 150 W
zvetil.
15
Ve 2. minute výkonu 150 W vznikl náhle záchvat SV
tachykardie (s frekvencí 240 tepu/min) a
vyetrovaný zacal pocitovat mdlobu.
16
V dobe uklidnování SV tachykardie opet náhle
vymizela.
17
Ve 3. minute uklidnování ji vidíme sinusový
rytmus s výraznou dechovou arytmií.
18
  • Laboratory results
    HB-79
    g/l Htc 0.25 Ery - 4,01 FW - 25/34
  • Cardiologic evaluation
    Echocardiography -
    hypertrophy and dilatation of left ventricle, a
    mild decrease of ejection fraction of left
    ventricle, interventricular septum thickeness at
    high normal limit
    (1.1 cm)

    Right and left heart catheterisation - normal
    pressure, normal flow values, no gradient even
    after Isuprel application
  • Treatment

    Ferronat p.os, no exercise until next control
    examination will be done

19
  • Follow up

    3 weeks after medical examination
    while playing football sudden syncope,
    resuscitation, defibrillation, sudden death.
  • Autopsy finding - Hypertrophic cardiomyopathy
    -interventricular septum thickeness -18 mm,
  • A thickenning of posterior left ventricle wall
    3 x 3 cm.

20
Výsledek pitvy mezikomorové septum 18 mm, na
zadní stene LK je ztlutení 3x3 cm, histologický
nález odpovídá hypertrofické kardiomyopatii.
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