Sudden Cardiac Death

Sudden cardiac death (SCD) is the number one cause of exercise related death in young athletes and is due to a cardiovascular disorder. Age is a very significant factor in regards to SCD in athletes.  For adults (individuals older than 35) coronary artery disease is the major cause of exercise related sudden cardiac death. For youth congenital cardiac conditions are the majority of causes for exercise related SCD.  In the United States SCD is seen in all sports but mostly in basketball and football due to higher participation levels.  Males are more likely to suffer from this condition as well as athletes of the African-American ethnicity.

 

How do you prevent sudden cardiac death?

  • Practice the emergency action plan (EAP) to ensure that all members of the medical staff is ready to appropriately act if this condition occurs.
  • Educating athletes, coaches, parents on recognition of signs/symptoms of coronary artery disease (CAD)
  • Equipping recreational facilities with an automated external defibrillator (AED) and staff is trained in cardiopulmonary resuscitation (CPR) and first aid.  The AEDs should be placed in locations such that wherever cardiac arrest occurs, the AED should be able to analyze heart rhythm within one minute of the collapse.
  • Gradual increase in activity, rather than sudden or strenuous onset
  • Avoid exercise in extreme weather: heat, cold, and high altitude
  • Educate athletes, coaches, parents on healthy nutritional habits
  • Include cardiac related examinations in the preparticipation exam (PPE) to screen for family history of heart diseases (see Table below)

 

Information to include in a preparticipation exam

Family History Physical Examination
Premature Sudden Death Heart murmur (supine / standing)
Heart disease in surviving relatives less than 50 years old Femoral artery pulses
Personal History Stigmata of Marfan Syndrome
Systemic hypertension Brachial Blood Pressure
Syncope Modes of testing
Fatigue Exercise Stress testing
Excessive / Unexplained exertional dyspnea   Exertional chest pain Risk stratification using left ventricular function assessment1

Adapted from: Maron BJ, Thompson PD, Puffer JC, McGrew CA, Strong WB, Douglas PS, Clark LT, Mitten MJ, Crawford MH, Atkins DL, Driscoll DJ, Epstein AE. Cardiovascular preparticipation screening of competitive athletes. A statement for health professionals from the Sudden Death Committee (clinical cardiology) and Congenital Cardiac Defects Committee (cardiovascular disease in the young), American Heart Association. Circulation. 1996;94(4):850-6.

Do You Know Your Risk of Sudden Cardiac Death?  Click Here to Find Out!

Look for these symptoms in athletes when cardiac arrest is suspected:

Men

Women

Chest pain, angina and/or ear or neck pain

Center chest pain, comes and goes

Severe headache

Lightheadedness

Excessive breathlessness

Shortness of breath with/without chest discomfort

Vague malaise

Uncomfortable pressure / Squeezing / Fullness

Dizziness/palpitations

Nausea / Vomiting

Increasing fatigue

Cold Sweat

Indigestion / Heartburn / Gastrointestinal symptoms

Pain / Discomfort one or both

arms / back / neck / jaw / stomach

Adapted from: Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA, Fulton JE, Gordon NF, Haskell WL, Link MS, Maron BJ, Mittleman MA, Pelliccia A, Wegner NK, Willich SN, Costa F. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation. 2007;115(17):2358-2368. 

 

How do you know if this is cardiac arrest?

Responsive

  • Monitor vitals: pulse rate/quality, breathing rate/quality, blood pressure, skin temp/color, pupils, secondary survey
  • Health history

S– Signs/symptoms

A– Allergies

M– Medications

P– Past health information

L– Last intake

E– Events leading up

Unresponsive

  • Assess Airway, Breathing, Circulation (ABC’s)
  • AED-rhythm assessment
  • Pace maker and medical alert bracelet
  • Ask questions to bystanders

What else could this be?

Cardiac

Other Vascular 

Respiratory

Gastrointestinal

Other

Angina

Aortic dissection

Pneumonia

Hiatus hernia

Kawasaki disease

Acute myocardial infarction

Discrete thoracic aortic aneurysm

Pulmonary embolism/infraction

Boerhaave’s syndrome

Chest wall syndromes, Tietze

Dyspnoea

Heat Illnesses

Viral pleurisy

Splenic infarct

Herpes Zoster

Arrhythmias, Cardiac failure

Inflammatory Conditions

Pneumothorax / Mediastinum Costosternal Syndrome

Oesophageal rupture/spasm

Psychogenic

Syndrome X

Exertional Sickling

Acute asthma

Peptic Ulcer

Syncope/Seizures

 

Adapted from: Thompson PD, Balady GJ, Chaitman BR, Clark LT, Levine BD, Myerburg RJ. Task force 6: coronary artery disease. J Am Coll Cardiol. 2005;45(8):1348-1353.

How do you treat an individual with cardiac arrest?

  • Activate emergency medical services (EMS)
  • Remove tight restrictive clothing
  • Attach AED
  • CPR- 30 compressions : 2 breaths
  • Supplemental O2

 

When can the individual return to activity?

  • Clearance from a cardiologist
Low Risk

High Risk

  • Participate in low-intensity dynamic and low-to moderate- intensity static competitive sports
  • Participate in low-intensity competitive sports only
  • Avoid intensely competitive situations
  • Restricted from moderate- and high –intensity sports
  • Aggressive treatment of atherosclerotic risk factors
  • Aggressive treatment of atherosclerotic risk factors

Adapted from: Thompson PD, Balady GJ, Chaitman BR, Clark LT, Levine BD, Myerburg RJ. Task force 6: coronary artery disease. J Am Coll Cardiol. 2005;45(8):1348-1353.

Recommended Equipment

  • AED
  • Emergency action plan
  • Supplemental O2
  • Nasal/oral airways
  • Pocket mask
  • Anti-perspirant
  • Towel
  • Scissors
  • Razors

 

References

  1. Davies SW. Clinical presentation and diagnosis of coronary artery disease: stable angina. Br Med Bulletin. 2001;59(1):17-27.
  2. Maron BJ, Thompson PD, Puffer JC, McGrew CA, Strong WB, Douglas PS, Clark LT, Mitten MJ, Crawford MH, Atkins DL, Driscoll DJ, Epstein AE. Cardiovascular preparticipation screening of competitive athletes. A statement for health professionals from the Sudden Death Committee (clinical cardiology) and Congenital Cardiac Defects Committee (cardiovascular disease in the young), American Heart Association. Circulation. 1996;94(4):850-6.
  3. Thompson PD, Balady GJ, Chaitman BR, Clark LT, Levine BD, Myerburg RJ. Task force 6: coronary artery disease. J Am Coll Cardiol. 2005;45(8):1348-1353.
  4. Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA, Fulton JE, Gordon NF, Haskell WL, Link MS, Maron BJ, Mittleman MA, Pelliccia A, Wegner NK, Willich SN, Costa F. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation. 2007;115(17):2358-2368.