Sudden Death in Athletes May Sometimes Be Prevented
May 1, 2000 -- When an athlete dies on the court or field, it usually turns
out that the player had a heart disorder that had gone undetected. But if a
doctor or coach knows what to look for, some common medical tests may be enough
to cut a potentially fatal problem off at the pass.
"The major causes of sudden death are mostly concealed cardiovascular
diseases that are very difficult to diagnose during life," Cristina Basso,
MD, PhD, tells WebMD.
So Basso and her colleagues at the University of Padua Medical School in
Italy, along with researchers from the Minneapolis Heart Institute Foundation
in Minnesota, studied two registries of information from the U.S. and Italy
about hundreds of young athletes who died suddenly during or after intense
exertion. Their hope was "to see if there were some signs during life to be
able to predict this event," Basso says.
Most sudden deaths are caused by a thickened, enlarged heart or by a
condition that disturbs the rhythm of the heart. A third condition occurs when
a coronary artery grows on the wrong side of the heart. All the conditions are
rare, and all are far from obvious.
This study, published in the Journal of the American College of
Cardiology, focused on the third condition -- known as a coronary artery
anomaly -- because it so often evades diagnosis in the medical screenings that
young athletes undergo before playing competitive sports.
Among the registries, the researchers identified 27 competitive athletes
between the ages of 9 and 32 whom autopsies found to have died because their
coronary arteries were on the wrong side of their hearts. Of the 27 athletes,
six were from Italy.
Most of the athletes were competing at the junior high or high school level;
three were professional, one was collegiate. Fifteen showed no previous signs
of problems and had undergone no cardiovascular testing. The remaining 12 had
undergone cardiovascular tests, including electrocardiograms (EKG) and exercise
stress tests. The test results were all normal.
But records indicated that 10 of the athletes previously had experienced
chest pains (angina) or dizziness or loss of consciousness (syncope). "We
found that sometimes there is the opportunity to suspect, at least, that
there's a malformation because some of these athletes had symptoms like chest
pain or syncope, particularly during effort," Basso tells WebMD.
Mahesh Amin, MD, a Florida cardiologist, explains that a lot of people,
relatively speaking, have anomalous coronary arteries. But when the coronary
grows between the pulmonary artery and the aorta, which it tends to do, that
may cause a problem -- especially for athletes. "When the young athlete is
exercising, both of [the arteries] dilate and squeeze the coronary artery going
between them, leading to a heart attack," Amin says.