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Despite public perception to the contrary, sudden death in young athletes is extremely rare. It most commonly occurs in male athletes, who have estimated death rates nearly five times greater than the rates of female athletes. “In athletes less than 35 years of age, this catastrophic event typically occurs during or shortly after training or competition,” reports Deborah Friedman, M.D., Chairperson, Department of Pediatrics at Saint Barnabas Medical Center and a board-certified pediatric cardiologist. “This suggests that intense physical exertion is a precipitating factor.” Dr. Friedman, along with Sabino Torre, M.D., Director of Interventional Cardiology at Saint Barnabas Medical Center, and a board-certified cardiologist, have developed an informative educational program on the detection of risk factors for and prevention of sudden cardiac death in young athletes. The program is designed for physicians, parents, school administrators, school nurses and youth sports coaches. A Rare but Tragic Event Young competitive athletes are generally perceived as the healthiest segment of our society, and their unexpected death can generate public debate on prevention of sudden cardiac death. Dr. Friedman reports that congenital cardiovascular disease, or more specifically, hypertrophic cardiomyopathy (a disease involving thickening of the heart muscle) is the leading cause of nontraumatic sudden athletic death. The most common sports associated with sudden death in competitive athletes in the United States are basketball and soccer. The largest available studies estimate the risk among high school and collegiate athletes to be between one per 100,000 and one per 300,000 each year. An estimated 50 to 100 cases occur in the United States annually. Screening: The Key to Prevention The best way to avoid tragic and fatal athlete events is through pre-athletic participation in cardiovascular screening, report Dr. Friedman and Dr. Torre. Current recommendations for cardiovascular screening include a careful history and physical examination, as well as the use of electrocardiograms (ECG). ECG can detect 95 percent of patients with hypertrophic cardiomyopathy (HCM). Such screening has been required of athletes in Italy for the past 25 years, and has been supported by the European Society of Cardiologists. A 17-year study in Venice, Italy found that mandatory screening greatly decreased the rate of sudden death in athletes from HCM. HCM is the most common cause of sudden cardiac death in young competitive athletes. Unfortunately, most athletes with HCM remain asymptomatic until the time of death and are difficult to identify on the basis of history or physical examination alone. In one study, only 21 percent of athletes who died from this condition had signs or symptoms of cardiovascular disease before their death. Symptoms of HCM may include chest pain, difficulty breathing, light-headedness, irregular heartbeats, and fatigue out of proportion to exertion. HCM is more often found in athletes with a family history of heart attack or sudden death in males 55 and under and females 65 and under. Athletes with a genetic predisposition to hypertrophic cardiomyopathy should undergo serial echocardiography every 12 to 18 months until age 18 because the condition may not be apparent until physical maturation is complete. Also at risk are those with a family history of cardiomyopathy, premature coronary artery disease, Marfan Syndrome, arrhythmia, Long QT Syndrome or Brugada Syndrome. Other Causes of Sudden Athlete Death
Another common cause of sudden cardiac death that may be detected is congenital coronary artery anomaly. The term refers to a wide range of congenital abnormalities involving the course and structure of coronary arteries. These abnormalities occur in less than one percent of the general population. Coronary artery anomalies are frequently found with other major congenital cardiac defects. Other less common causes of sudden death in athletes include:infections), arrhythmogenic right ventricular cardiomyopathy, aortic rupture as a result of Marfan Syndrome, and mitral valve prolapse. Rare cases of athlete death have also occurred from asthma, cerebral aneursym and sudden blunt chest trauma or “commotio cordis,” usually from the impact of a baseball. Chest trauma has also been reported during hockey, softball, lacrosse, karate, and other sports activities that use a hard projectile. Dr. Torre indicated that the spectrum of disease that causes sudden death in young athletes changes with age. As athletes reach their 30’s and beyond, atherosclerotic coronary artery disease plays a more significant role. The major risk factors for the development of atherosclerosis include high blood pressure, elevated cholesterol, diabetes, smoking and a family history of coronary artery disease. Because many of these conditions may go undetected, both Dr. Friedman and Dr. Torre advocate the use of automated external defibrillators (AED) and qualified users at sporting events and practices, as well as training in emergency protocols and CPR. NEW MEDICAL DIRECTOR OF THE PEDIATRIC INTENSIVE CARE UNIT AT SAINT BARNABAS
He received his medical degree (cum laude) from the University of Louisville School of Medicine and completed his pediatrics residency at Children’s Memorial Hospital, Northwestern University, Chicago, Illinois. Dr. Davis completed a Fellowship in Pediatric Critical Care at Children’s Hospital National Medical Center in Washington, D.C. He also completed his M.P.H. at Tulane University in New Orleans, LA . He has been named a Top Doctor New York Metro Area since 1999. For more information about Dr. Friedman and Dr. Torre’s education program on screening young athletes, please call (973) 322-5691. [ top ] |
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The sudden cardiac death of a young, competitive athlete is an unusual but tragic event that often leads to local and national headlines. The recent death of John Babbitt, a teenage basketball player from Chatham, New Jersey, highlights the importance of appropriate medical screening for young athletes. It was reported by The Star- Ledger that Babbitt, a popular 16-year old athlete, suffered a heart arrhythmia triggered by cardiomyopathy and that he collapsed while playing basketball at the school gym.
