As you may recall, I recently wrote a blog post on Sudden Cardiac Deaths in Young Athletes. In that article, I walked you through the history of marathoning, the (potential) increased risks for young athletes, and the particular case of Ryan Shay. We left off with the question:
Are athletes in fact at increased risk for sudden cardiac death?
Although sudden cardiac death is the leading medical cause of death in athletes, it is rare. Most athletes do not “drop dead” while competing in their sport.
As you can see, the risk of sudden cardiac death is much lower in young athletes than it is in the general population. Does this mean we shouldn’t worry about the impact of heavy exercise on our hearts? Not entirely, but it’s not as big a concern as some may think.
The fact of the matter is, the risk of sudden cardiac death increases greatly (around double) when a person is exercising.
Generally speaking, the exercise does not cause the condition; the condition is aggravated by the exercise.
A case of sudden cardiac death in an athlete is almost always linked with a pre-existing cardiac condition that was unknown and that was most likely asymptomatic until the added stress of hard exercise, training, and competing was introduced.
The cause of Ryan Shay’s sudden cardiac death was determined to be cardiac hypertrophy (enlarged heart) with patchy fibrosis (scarring). The cause of the scarring was unknown, but was felt to be old damage, which possibly could have been due to a viral infection in the past.
Looking back at myself: as much as it pains me to say so, I am considered an “older athlete” (35 and up). My age increases my risk as compared to the young athletes in the study, but the risk is still based on underlying cardiovascular disorders.
A 20-year-old athlete who dies of sudden cardiac death most likely had an underlying congenital or inherited heart defect that has been present since birth.
The reason my risk is a bit higher than the 20-year-old is due to the added risk for coronary artery disease (CAD), which increases with age. A 20-year-old has a very low risk of CAD; a healthy 38-year-old like myself still has low risk for CAD, but it is higher than that of the 20-year-old.
Cardiac screening including family history, personal history, physical exam, and resting electrocardiogram screening may identify some of those at risk in young athletes.
Important things to look out for in family and personal medical history:
- Has there been any family history of unexplained and unexpected sudden death in a young person?
- Have you ever had episodes of fainting or have you had seizures?
As an underwriter, I would be concerned about the underlying condition and the effect of intense exercise on the potentially damaged/diseased heart.
If the family history and personal history are unremarkable, there are no symptoms, and no abnormal cardiac tests, the odds of an underlying heart condition are low.
Of course, someone could have an unknown underlying condition, but if it truly is unknown and asymptomatic, no amount of digging during underwriting will find it.
So… are athletes at increased risk for sudden cardiac death?
I’m going to say no… unless they have heart defects, abnormalities, or damage.
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