Below is an excerpt from Heart 411, The Only Guide to Heart Health You'll Ever Need by Marc Gillinov, M.D., staff cardiac surgeon at Cleveland Clinic, and Steven Nissen, M.D., Chairman of the Department of Cardiovascular Medicine at Cleveland Clinic.
In the second week of January 2010, Americans were stunned when two competitive athletes in peak condition, Chicago Bears defensive end Gaines Adams, age 26, and Southern Indiana center Jeron Lewis, 21, died with no warning. They joined a tragic list that includes Flo Hyman (Olympic volleyball), Hank Gathers (NCAA basketball), Pete Maravich (NBA) and Korey Stringer (NFL). All were world-class athletes who died suddenly of heart disease.
These events are not as rare as you might think. Hundreds of other athletes have suffered similar fates. Each year in the U.S., 200 to 300 young athletes suffer sudden cardiac death. Basketball and football players account for most of the deaths in the U.S., while soccer is the more common predisposing sport in Europe. Men and boys are affected nine times as often as women and girls, and African Americans are affected five times as frequently as Caucasians.
Newscasters highlight the emotional impact of these events, the lives and careers cut short. There is usually little discussion of the causes, and only recently have the media focused on their prevention. The fact is, we know why these tragedies occur, and for the most part we can determine in advance who is at risk.
First, let's talk about the causes. When middle-aged and older people die during or after exertion, the cause is usually a heart attack triggered by coronary heart disease that has developed over a lifetime. Such is not the case with competitive athletes. Athletes who experience sudden cardiac death usually have an underlying heart condition that has been present since birth, a problem that we ought to be able to identify beforehand. In peak physical condition, these athletes train and play hard, exposing their hearts to extraordinary stresses. These stresses can aggravate unsuspected heart abnormalities, creating risks that might not occur in others with the same abnormality who perform less strenuous exercise. When a young athlete dies, the immediate cause is usually an abnormal heart rhythm, brought on by the combination of a structural heart problem and intense physical activity. An exception to this rule is the athlete with Marfan syndrome. In patients with this condition (Flo Hyman had it, and Abraham Lincoln probably did, too), sudden death is caused by rupture of an aortic aneurysm.
In the U.S., the most common underlying condition that causes sudden death in athletes is hypertrophic obstructive cardiomyopathy. People with this condition have overgrowth of part of the heart muscle, and the heart rhythm tends to be unstable. It is not rare—about one in five hundred people has it. It is so common, and so dangerous, that the NFL recently announced that it will start screening players for this condition.
Sudden Cardiac Death in Athletes
We all agree that any individual known to have one of these conditions needs a cardiac workup before participating in strenuous sports. The key question is: Why don't we identify young athletes with these problems before they die?
While high school and college athletes in the U.S. are screened by a perfunctory history and physical examination, we believe they should also be screened for hypertrophic obstructive cardiomyopathy by having an annual electrocardiogram test (EKG). An EKG tests the electrical activity of the heart and can check for any heart diseases or conditions like high blood pressure.
In other countries, like Italy, all competitive athletes 12 to 35 years old must participate in a mandatory national screening program and undergo a detailed history and physical examination, as well as an annual EKG. If any abnormality turns up on these tests, they undergo further examination, which frequently includes an echocardiogram, which is an ultrasound of the heart that allows medical professionals to see how a heart is beating and pumping blood.
Since more rigorous screening was instituted, sudden deaths in athletes have dropped by nearly 90% in Italy. After adopting the Italian protocol, Dutch doctors found that for every 143 athletes screened, doctors identified one athlete who had a potentially lethal heart problem. They could actually count the lives saved.
It is also important to pay attention to warning signs in athletes. Twenty percent of young athletes who die experience symptoms during the week before the tragedy. Common complaints are chest pain, feeling faint, indigestion or heartburn, increasing fatigue, and profound shortness of breath. If any of these occurs, especially if it represents a change, don't write off the symptoms as the result of a tough workout. Investigate. Save a life.
We recommend that all competitive athletes of high school age or older should invest a couple of hours in a detailed personal and family history, a physical examination and an EKG. At a minimum, search your family history for specific warning signs or red flags. If you have a young athlete in the family or are a competitive athlete yourself, fill out this checklist; you'll likely be able to determine if any of these factors apply. If any of them do, a visit to the cardiologist is imperative.
Screening Athletes for Heart Disease
Family History
Any early heart disease in family (in a relative less than 50 years old)?
Any sudden cardiac death or sudden death of unknown cause?
Any family members with hypertrophic cardiomyopathy, Marfan syndrome or other inherited heart disease?
Personal History
Have you ever experienced any of the following:
Heart murmur
High blood pressure
Fainting spells
Chest pain with exercise
Excessive shortness of breath with exercise
Unusual fatigue
