Risk of sudden cardiac death in athletes
- Antonio Pelliccia, MD
Antonio Pelliccia, MD
- Chief of Cardiology
- Institute of Sport Medicine and Science, Rome, Italy
- Mark S Link, MD
Mark S Link, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- UT Southwestern Medical Center
- Section Editors
- Peter J Zimetbaum, MD
Peter J Zimetbaum, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Harvard Medical School
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
Sudden cardiac death (SCD) associated with athletic activity is a rare but devastating event. Victims are usually young and apparently healthy, but many have underlying cardiovascular disease that is not diagnosed until after the event. As a result, there is great interest in detecting such abnormalities early, and then defining appropriate activity restrictions for affected individuals to minimize the risk of SCD.
The majority of SCD events in athletes are due to malignant arrhythmias, usually sustained ventricular tachycardia (VT) degenerating into ventricular fibrillation (VF), or primary VF itself. In the small number of susceptible individuals with certain underlying cardiac disorders, athletics can increase the likelihood of these events in two ways: prolonged physical training induces changes in cardiac structure (eg, chamber dilation, myocyte death, and fibrosis) that create arrhythmic substrate; and, the immediate physiologic demands of intense athletics can trigger malignant arrhythmias and SCD.
The potential for SCD associated with athletic activity generates two questions:
●How should individuals be evaluated prior to initiating athletic activity?
●What restrictions should be placed upon individuals with known cardiovascular disease?
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- BALANCE OF RISKS AND BENEFITS
- RECREATIONAL ATHLETES
- COMPETITIVE ATHLETES
- Incidence of sudden death
- Etiology of sudden death
- - Structural heart disease
- Young athletes
- Athletes aged 35 years or older
- - Absence of structural heart disease
- Structural abnormalities associated with SCD
- - Hypertrophic cardiomyopathy
- - Congenital coronary artery abnormalities
- - Arrhythmogenic (right) ventricular cardiomyopathy
- - Marfan syndrome
- - Myocarditis
- - Mitral valve prolapse
- - Congenital heart diseases
- Inherited arrhythmia syndromes
- - Congenital long QT syndrome
- - Brugada syndrome
- - Catecholaminergic polymorphic VT
- Coronary heart disease
- - Risk assessment
- Competitive athletes
- Recreational athletes
- SUMMARY AND RECOMMENDATIONS