Title: Sudden death in young athletes
1Sudden 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)
2Causes 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
3Causes 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)
4Causes 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
5Extreme 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
6Assessment 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
8Guidelines 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
9Examples 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.
10Examples 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.
11Case 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
12Klidové EKG tachykardie, jinak normální nález
13Pri výkonu 90 W se zacaly objevovat ojedinelé
SVES.
14Jejich pocet se v první minute výkonu 150 W
zvetil.
15Ve 2. minute výkonu 150 W vznikl náhle záchvat SV
tachykardie (s frekvencí 240 tepu/min) a
vyetrovaný zacal pocitovat mdlobu.
16V dobe uklidnování SV tachykardie opet náhle
vymizela.
17Ve 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.
20Výsledek pitvy mezikomorové septum 18 mm, na
zadní stene LK je ztlutení 3x3 cm, histologický
nález odpovídá hypertrofické kardiomyopatii.