Sudden Death in Athletes

1. See Also
   1. Arrhythmias in Athletes
   2. Sudden Cardiac Death
2. Epidemiology
   1. Less common than death from other medical conditions
      1. High School and College Athletes
         1. Sudden death Incidence: 1 in 200,000
      2. Adult Athletes
         1. Sudden death Incidence: 1 in 50,000
   2. Conditions predisposing to sudden death
      1. Incidence: 1 in 20,000 athletes
   3. Sudden death is 5 fold higher in young men than women
   4. Sudden death risk is increased with Sickle Cell Trait
      1. Relative Risk: 27 times risk of african american males
      2. Relative Risk: 40 times risk of caucasian males
3. Evaluation: Screening
   1. See Pre-participation History for cardiac red flags
4. Causes
   1. Age over 30-35 years
      1. Coronary Artery Disease (77% of cases)
   2. Age under 30 to 35 years (20% of causes non-cardiac)
      1. Hypertrophic Cardiomyopathy (50% of cases)
      2. Coronary Artery Abnormalities
      3. Marfan's Syndrome
      4. Congenital Heart Disease
      5. Myocarditis
      6. Drug Abuse
      7. Heart Valve defects
         1. Aortic Stenosis
         2. Mitral Valve Prolapse
         3. Ebstein's Anomaly of the Tricuspid Valve
      8. Arrhythmia
         1. Prolonged QT interval
         2. WPW Syndrome
         3. Third degree Atrioventricular Heart Block
         4. Arrhythmogenic Right Ventricular Dysplasia
         5. Brugada Syndrome
      9. Cardiac Concussion (Commotio cordis)
         1. Ventricular Fibrillation due to Blunt Chest Trauma
   3. Normal Athlete Findings
      1. See Athletic Heart Syndrome
5. Evaluation: Guidelines (26th Bethesda conference)
   1. Preparticipation Physical
      1. Careful History and Physical every 2 years
      2. No Regular Chest XRay, Electrocardiogram, or Labs
   2. Sinus Arrhythmia
      1. Arrhythmias
         1. Asymptomatic Sinus Bradycardia
         2. Asymptomatic Sinus arrhythmia
         3. Asymptomatic Sinus pause
      2. Episodes lasting less than 3 seconds and asymptomatic
         1. No further evaluation needed
      3. Symptomatic episodes
         1. Electrocardiogram
         2. Holter Monitor or Event Monitor
         3. Echocardiogram
         4. Exercise Stress Testing
   3. First Degree Atrioventricular Block
      1. Asymptomatic
         1. Electrocardiogram only
      2. Symptomatic or PR interval exceeds 0.3 seconds
         1. Holter Monitor or Event Monitor
         2. Echocardiogram
         3. Exercise Stress Testing
   4. Mobitz II Second Degree Atrioventricular Block
      1. Electrocardiogram
      2. Holter Monitor or Event Monitor
      3. Echocardiogram
      4. Exercise Stress Testing
   5. Atrial Fibrillation
      1. Electrocardiogram
      2. Holter Monitor or Event Monitor
      3. Echocardiogram