Sudden cardiac death (SCD) occurs rarely in athletes, but when it does happen, it often affects us with shock and disbelief.

Cause:

Most cases of SCD are related to undetected cardiovascular disease. In the younger population, SCD is often due to congenital heart defects, while in older athletes (35 years and older), the cause is more often related to coronary artery disease.

Prevalence:

Although SCD in athletes is rare, media coverage often makes it seem like it is more prevalent. In the younger population, most SCD occurs while playing team sports; in about one in 100,000 to one in 300,000 athletes, and more often in males. In older athletes (35 years and older), SCD occurs more often while running or jogging – in about one in 15,000 joggers and one in 50,000 marathon runners.

Screening:

The American Heart Association recommends cardiovascular screening for high school and collegiate athletes, which should include a complete and careful evaluation of the athlete’s personal and family history and a physical exam. Screening should be repeated every two years, and a history should be obtained every year.

Men aged 40 and older and women aged 50 and older should also have an exercise stress test and receive education about cardiac risk factors and symptoms.

If heart problems are identified or suspected, the athlete should be referred to a cardiologist for further evaluation and treatment guidelines before

Implantable cardioverter-defibrillator (ICD):

For patients who have a great risk for SCD, an ICD may be inserted as a preventive treatment. An ICD is a small machine similar to a pacemaker that is designed to correct arrhythmias. It detects and then corrects a fast heart rate.

The ICD constantly monitors the heart rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy (a small, but powerful shock) to the heart muscle to cause the heart to beat in a normal rhythm again. The ICD also records the data of each episode, which can be viewed by the doctor through a third part of the system that is kept at the hospital.

The ICD may be used in patients who have survived sudden cardiac arrest and need their heart rhythms constantly monitored. It may also be combined with a pacemaker to treat other underlying irregular heart rhythms.

Interventional procedures or surgery:

For patients with coronary artery disease, an interventional procedure such as angioplasty (blood vessel repair) or bypass surgery may be needed to improve blood flow to the heart muscle and reduce the risk of SCD. For patients with other conditions, such as hypertrophic cardiomyopathy or congenital heart defects, an interventional procedure or surgery may be needed to correct the problem. Other procedures may be used to treat abnormal heart rhythms, including electrical cardioversion and catheter ablation.

When a heart attack occurs in the left ventricle (left lower pumping chamber of the heart), a scar forms. The scarred tissue may increase the risk of ventricular tachycardia. The electrophysiologist (doctor specializing in electrical disorders of the heart) can determine the exact area causing the arrhythmia. The electrophysiologist, working with your surgeon, may combine ablation (the use of high-energy electrical energy to “disconnect” abnormal electrical pathways within the heart) with left ventricular reconstruction surgery (surgical removal of the infarcted or dead area of heart tissue).

Educate your family members:

If you are at risk for SCD, talk to your family members so they understand your condition and the importance of seeking immediate care in the event of an emergency. Family members and friends of those at risk for SCD should know how to perform CPR.

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