Sudden death in athletes continues to be one of the issues with the greatest social repercussions. Obviously, the unexpected death of a young athlete is traumatic. Everyone thinks that, at that age and with the competitive level they have, it is not possible that this type of situation can happen.
What are the causes of sudden death in young athletes?
Among the possible causes or etiologies of these sudden deaths, when we focus on young athletes, we would usually be faced with a heart disease, generally of congenital etiology. On the other hand, sudden death in an older athlete (over 35 years of age) is usually due to atherosclerotic coronary artery disease, i.e., a possible myocardial infarction.
If we focus on the causes of sudden death in young athletes, there is a wide variety of congenital heart diseases. Most of them are classified into structural and non-structural varieties.
Structural congenital heart diseases usually affect blood flow, both within the heart and outflow from the heart. Examples include hypertrophic obstructive cardiomyopathy, arrhythmogenic ventricular cardiomyopathy, and coronary artery anomalies.
Non-structural heart diseases involve defects in the heart’s electrical system, which can induce very unstable and dangerous ventricular arrhythmias. These include long QT syndrome, Brugada syndrome, Wolff-Parkinson-White syndrome and catecholaminergic polymorphic ventricular tachycardia. In addition, one must consider the cardiac effects induced by drugs, such as anabolic steroids and peptide hormones, which can induce structural changes in the heart and dangerous arrhythmias.
Are there any symptoms before sudden death occurs?
One of the great difficulties underlying these athletes, is that they may not give symptoms until they have the fatal event. Some may present non-specific dizziness, presyncopal situations or even lose consciousness (known as syncope or transient loss of consciousness). Others may present palpitations or chest discomfort, hence the importance of early detection to identify those diseases related to sudden cardiac death.
There is debate about the need to screen the sports population to identify these entities, which includes an exhaustive sports physical examination, an evaluation of personal and family history, a physical examination and an electrocardiogram, which can be a useful screening tool in asymptomatic and low-risk athletes; whereas higher-risk athletes, that is, those who come to our offices with symptoms or abnormal findings, may require more exhaustive tests.
Undoubtedly, this is a field where shared and consensual decision making between physicians, patients and the surrounding environment is necessary, so that in the case of finding a serious cardiac problem, a diagnosis can be made, with optimal treatment to avoid the most feared complication in the world of sports cardiology, i.e., sudden death.