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Sudden Cardiac Death in Athletes


Robert S. McKelvie

, MD, PhD, Western University

Reviewed/Revised Sep 2022
Topic Resources

An estimated 1 to 3 per 100,000 apparently healthy young athletes develop an abrupt-onset heart rhythm abnormality Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more Overview of Abnormal Heart Rhythms and die suddenly during exercise. Males are affected up to 10 times more often than females. Basketball and football players in the United States and soccer players in Europe may be at highest risk.

Causes of Sudden Cardiac Death in Athletes

Young athletes

In young athletes, most sudden cardiac death occurs in people who have no abnormality of the heart structure. When there is an abnormality of heart structure, the most common one is abnormal thickening of the heart muscle (hypertrophic cardiomyopathy Hypertrophic Cardiomyopathy Hypertrophic cardiomyopathy includes a group of heart disorders in which the walls of the ventricles (the 2 lower chambers of the heart) thicken (hypertrophy) and become stiff. Most cases of... read more Hypertrophic Cardiomyopathy ).

Abnormalities of the coronary arteries (coronary artery disease Overview of Coronary Artery Disease (CAD) Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-rich blood. The coronary... read more Overview of Coronary Artery Disease (CAD) ), especially when one of the arteries takes an abnormal path through, rather than on top of, the heart muscle, may also cause sudden death in athletes when the compression cuts off blood flow to the heart during exercise.

Rarely, young, thin athletes may also have sudden heart rhythm disturbances if they experience a strong blow to the area directly over the heart (commotio cordis Commotio cordis Blunt injury to the heart is a blow to the chest that bruises the heart muscle, tears (ruptures) the heart's walls, or damages a heart valve. People may feel that their heart is pounding or... read more ) even when they have no heart disorder. The blow often involves a fast-moving projectile such as a baseball, hockey puck, or lacrosse ball or impact with another player.

Older athletes

Symptoms of Sudden Cardiac Death in Athletes

Some athletes have warning signs such as fainting or shortness of breath. Often, however, athletes do not recognize or report these symptoms, and the first sign is that the person suddenly stops breathing and collapses.

Screening for Risk of Sudden Cardiac Death in Athletes

  • Screening before exercise participation

People are commonly screened by their doctor before starting an exercise program Starting an Exercise Program People should consult their doctor before beginning competitive sports or an exercise program. Doctors ask about known medical disorders in the person and family members and about symptoms the... read more . Doctors screen people who have medical disorders and also those who do not think they have any medical disorders. People without known medical disorders should typically be checked because some serious disorders do not cause problems until people exercise. People in the United States are reevaluated every 2 years (if high school age) or every 4 years (if college age or older). In Europe, screening is repeated every 2 years no matter what the athlete's age.

Doctors always ask people questions and do a physical examination, but they do testing only when the person's age and reported symptoms are cause for concern. Questions focus on three areas:

  • Symptoms such as chest pain or discomfort, fainting or near-fainting, fatigue, and difficulty breathing, particularly when these symptoms occur during vigorous exercise

  • Family history, particularly any history of family members who fainted or died during exercise, or who died suddenly before about age 50

  • Use of certain prescription, performance enhancing, and illegal drugs

The physical examination focuses on listening to the heart with a stethoscope for heart murmurs that indicate a possible heart disorder and measuring blood pressure with the person lying down and again while the person is standing.

For younger people, doctors typically do not do any tests unless something abnormal is identified in the person's history or is found during the physical examination. Routine use of electrocardiography (ECG) screening of young athletes is not considered practical in the United States. However, if findings suggest a heart problem, doctors typically do ECG Electrocardiography Electrocardiography (ECG) is a quick, simple, painless medical test that measures the heart’s electrical impulses. During an ECG, the heart's electrical impulses are measured, amplified, and... read more Electrocardiography , echocardiography Echocardiography and Other Ultrasound Procedures Ultrasonography is a type of medical imaging that uses high-frequency (ultrasound) waves to produce a moving image of internal organs and other tissues. Echocardiography is ultrasonography of... read more Echocardiography and Other Ultrasound Procedures , or both.

If a heart disorder is found, the person may need to stop participating in competitive sports and undergo further testing. Some people with severe heart disease, such as hypertrophic cardiomyopathy Hypertrophic Cardiomyopathy Hypertrophic cardiomyopathy includes a group of heart disorders in which the walls of the ventricles (the 2 lower chambers of the heart) thicken (hypertrophy) and become stiff. Most cases of... read more Hypertrophic Cardiomyopathy , should not participate in competitive sports. However, most people with heart disease may participate in noncompetitive sports. Increased activity is directly related to better health outcomes such as a decrease in "bad" cholesterol levels (low-density lipoproteins), prevention of high blood pressure, and reduction of body fat. Regular exercise is routinely included in care plans for people with most forms of heart disease (cardiac rehabilitation Rehabilitation for Heart Disorders Cardiac rehabilitation is useful for some people who have had a recent heart attack, have heart failure or coronary artery disease that has recently developed or suddenly worsened, or had heart... read more ).

Did You Know...

  • Even people with heart disease can usually participate in some physical activity.

Treatment of Sudden Cardiac Death in Athletes

  • Resuscitation

If people stop breathing and collapse, immediate treatment is with

Resuscitation is continued in the emergency department. If the person survives, doctors treat the condition that caused the abnormal rhythm. Sometimes doctors place an implantable cardioverter-defibrillator Implantable Cardioverter-Defibrillator (ICD) There are many causes of abnormal heart rhythms (arrhythmias). Some arrhythmias are harmless and do not need treatment. Sometimes arrhythmias stop on their own or with changes in lifestyle,... read more , which continually monitors the person's heart rhythm and delivers a shock to return the rhythm to normal if needed.

Automated External Defibrillator: Jump-Starting the Heart

An automated external defibrillator (AED) is a device that can detect and correct a type of abnormal heart rhythm called ventricular fibrillation. Ventricular fibrillation causes cardiac arrest.

AEDs are easy to use. The American Red Cross and other organizations provide training sessions on the use of AEDs. Most training sessions take only a few hours; but it is possible to use an AED even if you have never participated in a training course. Different AEDs have somewhat different instructions for use. The instructions are written on the AED, and most modern AEDs also use voice prompts to direct the user in each step. AEDs are available in many public gathering places, such as stadiums, airports, and concert halls. People who are told by their doctor that they are likely to develop ventricular fibrillation but who do not have an implanted defibrillator may want to purchase an AED for home use by family members, who should be trained in its use.

Automated External Defibrillator: Jump-Starting the Heart

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

  • Nick of Time Foundation: This organization works to increase survival of sudden cardiac arrest with awareness, "hands-only" CPR training, advocacy for having defibrillators in all public places, and access to screening for young athletes.

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