About 29% of Athletes Who Die of Sudden Cardiac Arrest Actually Experienced Red-Flag Symptoms
According to a new review published in CMAJ, 29 percent of athletes who died suddenly of cardiac arrest during activity experience red-flag symptoms beforehand.
While cardiac arrest and sudden death in athletes appear to be on the rise, the review concluded it is still a relatively rare occurrence.
The review looked at existing research in order to outline care and prevention of these incidents.
It seems like there are more and more cases of young, healthy people suffering cardiac arrest and sudden death during exercise. Is this really something to worry about—and what does it mean for your health at your next race?
According to a new review published in CMAJ that looked at existing research and guidelines to suggest care and prevention of these incidents, they actually remain rare occurrences, despite publicized cases of them happening: The rate of sudden cardiac arrest in athletes is just about 0.75 per 100,000 per year. It is also more likely that athletes will experience sudden cardiac arrest at rest and not during exercise, study author Paul Dorian, M.D., director of the division of cardiology at the University of Toronto, told Runner’s World.
Sudden cardiac arrest occurs when your heart unexpectedly stops beating—think of it as an electrical issue, while a heart attack, which usually happens when a clot blocks blood flow to the heart, is more a plumbing issue. About 90 percent of people who experience sudden cardiac arrest outside of a hospital die, according to the American Heart Association.
It is not exactly known what can trigger sudden cardiac arrest and why it happens when it happens, said Dorian. In general, most non-athletes and some athletes develop cardiac arrest due to a a blockage or a clot in an artery leading blood to the heart.
“In most situations, in non-athletes, cardiac arrest is triggered by a narrowing or blockage of an artery to the heart,” Dorian said. “In other words a ‘plumbing’ problem, which leads to an electrical problem—a cardiac arrest.”
In other athletes, though, a clot is not the triggering factor, and less is known about what is going on in the body that can cause it. In fact, in the review, authors listed “primary electrical disease with no specific cause identified” as the top cause of cardiac arrest in athletes under 35. (Other possibilities include a genetic condition called hypertrophic cardiomyopathy, where the heart walls thicken, or idiopathic left ventricular hypertrophy, an enlargement or thickening of your heart’s left pumping chamber.)
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That’s why it’s so important to identify who may be at risk of sudden cardiac arrest before it happens. And according to the review, there may be some red flags to watch for: One previous study found that of athletes who died suddenly from cardiac arrest during competition, 29 percent had previous symptoms.
Here are sudden cardiac arrest risk factors to watch for, said Dorian.
Unexpected shortness of breath during exercise
Chest tightness
Pressure, pain, or discomfort especially if it occurs during exercise or effort
Loss of consciousness, particularly during exercise
Severe and unexpected heart palpitations, or an unpleasant sensation of rapid heart beating when you do not expect it to be beating rapidly or so fast
Severe or sudden onset temporary dizziness, lightheadedness, or near fainting
If you experience any of these symptoms, especially during exercise, it should trigger a call to your doctor for a medical examination. Your doctor will ask questions about your medical and family history, and, if indicated, perform advanced tests such as electrocardiography and recommend any future exercise limitations.
While sudden cardiac arrest is serious and can be deadly, there is not solid evidence in favor of screening for abnormalities in healthy athletes—especially since false positives may be found that can cause patients anxiety but do not actually pose a health risk. Still, the researchers suggest doctors should routinely ask all athletes questions like, “Have you ever felt severely dizzy or faint, unexpectedly short of breath, or had chest pain during or immediately after exercise?” and “Do you have any first-degree relatives who died suddenly or had severe cardiac disease under age 60?” Depending on the answers to these questions, doctors may recommend further testing.
In order to further limit sudden cardiac deaths in athletes, researchers suggested that any public place with sporting events have AEDs—automated external defibrillators, which deliver an electric shock through the chest to the heart, potentially stopping an irregular heartbeat and allowing normal heart rhythm to resume—readily available for quick, lifesaving intervention. Typically, when AEDs are used, survival rates are high.
For example, in Japan during marathons, there are paramedics on bicycles with AEDs in backpacks riding up and down near the finish line, ready to provide immediate aid. In one study published in the New England Journal of Medicine, researchers found that 28 of 30 runners who experienced a sudden cardiac arrest were successfully resuscitated—a survival rate of 93 percent.
“If a cardiac arrest occurs, they can intervene very quickly,” Dorian said.
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