12 January 2021 Author : Hélder Dores Sudden death in athletes is a tragic and paradoxical event, due to the multiple health benefits that are known to be associated with regular physical exercise. Although infrequent, it has a huge impact on athletes, family, and friends, namely due the media coverage of these cases. Most cases of sudden death occur during or immediately after exercise and are due to heart disease : In young athletes, the main causes are hereditary heart diseases, namely cardiomyopathies and primary arrhythmic disorders; In veteran athletes (over 35 years old), atherosclerotic coronary disease is responsible for about two thirds of cases. Due to the predisposition of these diseases to the occurrence of severe arrhythmias during exercise, which can cause cardiorespiratory arrest, an early diagnosis is essential . Some external factors can be cause of sudden death, even in athletes without previous heart disease. Among these, doping and exercise in extreme environmental conditions stand out. Main causes of sudden death in athletes Structural heart disease Hypertrophic cardiomyopathy Arrhythmogenic cardiomyopathy Dilated cardiomyopathy Anomalous coronary origin Marfan syndrome Prolapse of the mitral valve Arrhythmic diseases Long QT syndrome Brugada syndrome Wolf-Parkinson-White syndrome Catecholaminergic polymorphic ventricular tachycardia Acquired diseases Atherosclerotic coronary disease Myocarditis Thoracic trauma (commotio cordis) Abuse of stimulating substances (doping) Electrolytic disorders Extreme environmental conditions, such as heat stroke or hypothermia Prevention of sudden cardiac death The prevention of sudden death is mainly based on two strategies: Specialized pre-competitive assessment; Sports practice in areas with emergency support, including defibrillation capacity. Pre-competitive medical evaluation in athletes Although the risk is never 'zero' and some heart diseases are difficult to diagnose, most cardiac causes of sudden death can be detected in medical assessments , which must be performed before physical exercise begins and regularly. In asymptomatic athletes , pre-competitive assessment should include a consultation with an experienced physician in sports medicine or sports cardiology, with a detailed medical history (personal and family), physical exam, and electrocardiogram. Whenever changes are identified in this initial assessment, additional tests may be required. For some specific sports, such as extreme exercise, the assessment may include exams other than those mentioned. In veteran athletes , due to the relevance of coronary heart disease, the assessment should be focused on cardiovascular risk stratification and include laboratory tests, exercise testing and other tests if the risk is high. In athletes with symptoms induced by exercise , namely chest pain, loss of consciousness, palpitations, tachycardia, excess tiredness for the effort made or shortness of breath, the evaluation needs to be more detailed. Competitive sport and leisure sport It should be emphasized that this evaluation is not be limited to professional or competition athletes, who usually already carry out regular evaluations. Regardless of the level of exercise , and also for recreational or leisure sports, it is essential to carry out an assessment before beginning the practice of exercise , for risk stratification and advice. In this broad population, there are groups that deserve special attention , such as: Sedentary; Physically active who intend to exercise with high intensity or volume; With cardiovascular risk factors; With previous cardiovascular events; Symptomatic. Heart disease and physical exercise The diagnosis of cardiac pathology does not, per se , contraindicate the practice of all types of exercise. Depending on the disease and its severity, the practice of physical exercise will require an individualized prescription , following international recommendations of sports cardiology. In short, sudden death in athletes is an alarming reality, but many cases can be prevented with a differentiated and specific medical assessment for the age group and type of exercise , so that athletes have a safe practice and can benefit from its effects to health. Meet the cardiology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
