Athletes: Risk of sudden cardiac death
- 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 can be young and apparently healthy, and while many of these deaths are unexplained, a substantial number harbor underlying undiagnosed cardiovascular disease. As a result, there is great interest in early identification of at-risk individuals for whom appropriate activity restrictions can be implemented to minimize the risk of SCD.
The majority of SCD events in athletes are due to malignant arrhythmias, usually sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). In individuals with certain cardiac disorders (eg, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, etc), athletics may increase the likelihood of VT/VF in two ways:
●In certain susceptible individuals (ie, with inherited arrhythmogenic cardiomyopathy), prolonged physical training may induce changes in cardiac structure (eg, interstitial fibrosis, disruption of normal myocardial architecture, dilation of right and left ventricle) that may create pathologic arrhythmogenic substrate.
●The immediate physiologic demands of intense athletics (eg, hemodynamic overload, catecholamine release, electrolyte imbalance) may trigger malignant arrhythmias in susceptible individuals with underlying cardiac abnormalities.
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- COMPETITIVE VERSUS RECREATIONAL ATHLETICS
- INCIDENCE OF SCD
- ETIOLOGY OF SUDDEN DEATH
- Structural heart disease
- - Athletes <35 years of age
- - Athletes ≥35 years of age
- Primary electrical disease
- STRUCTURAL ABNORMALITIES ASSOCIATED WITH SCD
- Hypertrophic cardiomyopathy
- Congenital coronary artery abnormalities
- Arrhythmogenic (right and/or left) ventricular cardiomyopathy
- Marfan syndrome
- Congenital heart diseases
- INHERITED ARRHYTHMIA SYNDROMES
- Congenital long QT syndrome
- Brugada syndrome
- Catecholaminergic polymorphic ventricular tachycardia
- Short QT syndrome
- Early repolarization syndrome
- CORONARY ARTERY DISEASE
- Risk assessment
- SUMMARY AND RECOMMENDATIONS