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 |
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 |
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 |
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 |
|
|
|
|
|
|
Recommended Equipment
- AED
- Emergency action plan
- Supplemental O2
- Nasal/oral airways
- Pocket mask
- Anti-perspirant
- Towel
- Scissors
- Razors
References
- Davies SW. Clinical presentation and diagnosis of coronary artery disease: stable angina. Br Med Bulletin. 2001;59(1):17-27.
- 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.
- 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.
- 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.