Sudden death in athletes: not all is preventable

Morte súbita nos atletas: nem tudo é prevenível

Cardiology screening tests in athletes may not detect all problems. Other events result from the intensity of practice and other still are triggered by doping substances. In the end, collapsing on the field is not fatal only if there are defibrillators.

The symposium on “Sudden death in athletes: one step beyond” addressed ‘sudden cardiac death’ in athletes, a topic that receives plenty of media coverage because of its connection with mass sports.

Martin Maron, director of the Hypertrophic Cardiomyopathy Centre at Tufts Medical Center, in Boston, highlighted that the ECG is often regarded in the USA as too expensive for the results produced.

According to the speaker, there is no irrefutable proof that the electrocardiogram reduces the number of cases. He raised further the issue of false negatives, which lead to episodes like that of professional player Muamba – who suffered cardiac arrest on the field (English Premier League) and he only escaped death because there was a defibrillator – or false positives, which prevent healthy athletes from continuing the practice of sport. “In the USA, if an ECG to practice sport were mandatory, 75 million children under 18 years would have to do the test”.

His standpoint was, however, refuted by Domenico Corrado, associate professor in Cardiovascular Medicine and director of the Inherited Arrhythmogenic Cardiomyopathy Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, who is in favour of making this exam mandatory.

In his view, the ECG is sensitive enough to identify probable cases, as it can detect 2/3 of the causes of sudden death in young people. However, he underscored that one million athletes screened amounted to an investment of 36 million Euro, but the sudden death ratio in athletes and non athletes was reduced from 40 to four.

'Doping' substances were the topic addressed by the Greek speaker, Asterios Deligiannis, Director of the Thessaloniki Sports Medicine Division. Its use can cause sudden heart death, due to the structural changes inflicted on the heart muscle, which trigger arrhythmia and blood hypertension. This specialist highlighted further that genetic ‘doping’ is approaching.

Going too far

Australian cardiologist Andre La Gerche addressed physical exercise's capacity to induce cardiomyopathies or cardiac arrhythmias, and cited the World champion triathlete (1990), Greg Welch, who said in 2006: "Perhaps I pushed myself too hard..."

Luis Serratosa, former doctor at the clinical department of Real Madrid, followed in a similar vein, in his talk where he asked if too much exercise could be injurious to health. He gave the example of healthy athletes, who were asymptomatic during the tests, yet died on the field, while other symptomatic athletes enjoyed great sports careers, albeit submitted to frequent screening. He also concluded that former endurance athletes are less prone to suffering heart, oncological, endocrine, joint and muscle problems, inter allia.

The directors of the symposium, Pedro Granate, coordinator of the Centre for Sports Pathology at Hospital da Luz and professor Nuno Cardim, cardiologist at that Centre, also wanted to bring the outlook of sports stakeholders, so they invited to the congress two protagonists: Fernando Santos, manager of the Greek national team, and Nuno Gomes, former footballer for Benfica.

The coach discussed the training methodology, and addressed the need for tight collaboration with the medical departments in terms of monitoring and supporting players.

Nuno Gomes recalled the event with his fellow-player Miklos Fehér, who died on the field on 25 January 2004, during a match. He acknowledged that the death of the Hungarian footballer not only affected the team, but also raised awareness of the topic.