Transcript 3. Sudden death in young athletes

Sudden death in young athletes
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Rare event - actual rate uncertain
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USA - retrospective analysis in High School and College
athletes – less than 1 : 100 000 participants per year
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Italy – incidence 3 : 100 000 athletes less than 35 years
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Male/female ratio - 2-10 : 1
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Men-higher prevalence of cardiac disease at the age12 35 years (probably phenotypic expression)
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Men-higher participation rate in competitive sports
(football, basketball, ice-hockey)
Causes of sudden death in athletes
less than 35 years
Nonpenetrating strike to the chest wall
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Commotio cordis (trigger of abrupt ventricular fibrillation
in interval 15-30 ms before T-wave peak on ECG)
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Competitive sports increase likelihood of cardiac arrest
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Most fatalities-in basketball, football, ice-hockey (USA),
soccer, ice hockey (Europe)
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Italy - young adults involved in sports - 25-fold greater risk
of sudden death than their non-athletic counterparts
Causes of sudden death in athletes
less than 35 years
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Hypertrophic cardiomyopathy - more than 1/3 of cases
Cardiac congenital anomalies
 arrhytmogenic right ventricle cardiomyopathy
 premature atherosclerotic coronary artery disease
 dilated cardiomyopathy
 mitral valve prolaps
 conduction system diseases WPW-syndrome, prolonged QT - interval, Brugada
syndrome, Lenégre disease, A-V block, sudden
unexplained nocturnal death syndrome (SUNDS)
 aortic rupture (bicuspid aortic valve, Marfan syndrome)
Causes of sudden death in athletes
less than 35 years
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Non-cardiac
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exercise induced bronchoconstriction-BHR

cerebral aneurysma rupture

use of performance - enhancing drugs (deleterious
health problems-heart attacks)
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vigorous exercise (sudden death due to to
undiagnosed heart disease)
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London marathon runners – 650 000 completed runs
- 5 deaths, 6 resuscitations – 1 death per 80 000
runners
Extreme sport activities
 decrease
 Ashley
of heart function and its fatigue
- echocardiographic evaluation before and
after a 480 km competition (running, swimming,
bicycling) - lasting about 90 hours - 13 % decrease
of cardiac contractility
Assessment of the risk for sudden death
in young poeple in competitive sports
AHA-1996, ESC-2005 Consensus Guidelanes
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Family history:
of sudden death, heart disease before 50 years,
cardiomyopathy, arrhythmias, Marfan syndrome
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Athletes medical history:
chest pain, palpitations, syncope, tachycardia, dyspnoea,
fatigue, heart murmur, hypertension
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Physical examination:
heart murmurs, arrhythmias, femoral artery puls
(coarctation of aorta), Marfan syndrome
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Italy - addition of 12-lead ECG-identification of up to
60% of the potential lethal condition of sudden death
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All investigations - marginal use in detecting heart
disorders and preventing fatalities
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Echocardiography + tissue Doppler echocardiography
– differentiation pathologic from adaptational changes of the
heart muscle
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In 2 - 5% of sudden cardiac deaths cases - no definitive
cause even after autopsy detected
Guidelines for management of athletes
with identified cardiovascular disease
are available
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withdrawal of competitive sport activities
- reduced risk of sudden death
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suggestion to the type and degree of sport activity
that can be done safely
Examples of sudden death in young athletes
Pheidipphides (490 BC)
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A greek soldier and conditioned runner, Pheidippides ran from Marathon
to Athens to announce military victory over Persia. He delivered his
message, then collapsed and died.
Flo Hyman (1986)
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Flo Hyman was captain of the 1984 US Women´s Olympic volleyball
team that won silver. She died aged 30 years of congenital heart
disorder Marfan´s syndrome while playing a Japanese league game.
Daniel Yorath (1992)
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A 15-year-old football player who had just been signed by the UK team
Leeds United, Daniel Yorath died from hypertrophic cardiomyopathy
while playing football with his father in the garden.
Examples of sudden death in young athletes
Reggie Lewis (1993)
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Boston Celtic´s star and sixth captain Reggie Lewis was 27 year old
when he died while shooting baskets at an off-seasons practice.
Sergei Grinkov (1995)
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An Olympic gold medal skater, Sergei Grinkov collapsed
and died from a heart attack at age 28 years while training at an ice rink
in Lake Placid, NY, USA. An autopsy showed that he had arteries
of a 70-year-old man, though had never mentioned any chest pain.
Case report
History
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16 years old athlete-attacks of tachycardia (220/min) during
long distance running - faintness, disappearing immediately
after stopping exercise
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Physical examination
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Signs of anemia on oral mucosa, lips, conjunctives
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Systolic murmur 3/6 in praecordium, irradiating into carotides
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Ergometry:
HR
BP
Rest
97/min
Exercise
240/min
145/110 mmHg 200/110 mmHg
Klidové EKG – tachykardie, jinak normální nález
Při výkonu 90 W se začaly objevovat ojedinělé SVES.
Jejich počet se v první minutě výkonu 150 W zvětšil.
Ve 2. minutě výkonu 150 W vznikl náhle záchvat
SV tachykardie (s frekvencí 240 tepů/min) a
vyšetřovaný začal pociťovat mdlobu.
V době uklidňování SV tachykardie opět náhle vymizela.
Ve 3. minutě uklidňování již vidíme sinusový rytmus s
výraznou dechovou arytmií.
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Laboratory results
HB-79 g/l; Htc – 0.25; Ery - 4,01; FW - 25/34
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Cardiologic evaluation
Echocardiography - hypertrophy and dilatation of left
ventricle, a mild decrease of ejection fraction of left ventricle,
interventricular septum thickeness at high normal limit
(1.1 cm)
Right and left heart catheterisation - normal pressure, normal
flow values, no gradient even after Isuprel application
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Treatment
Ferronat p.os, no exercise until next control examination
will be done
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Follow up
3 weeks after medical examination while playing football
sudden syncope, resuscitation, defibrillation, sudden death.
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Autopsy finding - Hypertrophic cardiomyopathy interventricular septum thickeness -18 mm,
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A thickenning of posterior left ventricle wall – 3 x 3 cm.
Výsledek pitvy: mezikomorové septum 18 mm, na zadní stěně LK je
ztluštění 3x3 cm, histologický nález odpovídá hypertrofické
kardiomyopatii.