A good review with an abstract of new findings concerning “sudden cardiac death” occurring to athletes was published early June 2006 in the “Deutsche Ärzteblatt”. The term “sudden cardiac death“ describes an unexpected loss of consciousness leading to death within an hour conditional on a cardiovascular system dysfunction. Regularly, reports are published of runners or other athletes dying suddenly; a study published 2005 in the USA proved meanwhile, that marathon runners suffer rarer of sudden cardiac death during the race compared to the non sportive population. The sudden cardiac death in the general population has an incident rate of approximately one or two deaths per 1000 people per annum.

Sudden deaths in sports, especially for apparently healthy young athletes, are almost always caused by an organic cardiac disorder and not caused by their sport. In the age of 35 and over, the coronary vessels disorder (calcification of the coronary vessels) is most prominent.

Facilitating factors for the occurrence of a sudden death in sports:

-    Pre-existing heart disorder, especially anomalies of the heart.
-    Age over 40; with a peak between 40 and 50 years
-    Restart of a sportive activity, especially after a longer break, with abrupt and very intense onset.

For younger athletes the following disorders are etiologic:

-    Change of the myocardium, e.g. through a genetically caused hyperplasia (hypertrophy obstructive cardiomyopathy – HOCM);
-    Paroxysmal occurring cardiac dysrythmia (the so called preexcitation syndrome like the WPW-Syndrome;
-    Through external influences caused cardiac dysrythmia (e.g. through certain antibiotics or allergens), drugs, heat, cold, pollution;
-    Myocarditis, which is considerably rarer than considered so far (by viruses or – even rarer by borrelia);
-    Blunt chest trauma (not to be encountered in running).

Diagnostics:

Juvenile athletes with Collapse or Syncope have always to be diagnosed very thoroughly. The examination of competitive athletes as well as amateurs or older athletes is based on an interview, clinical findings and apparative diagnostics. Especially the question whether there are reports of unclear loss of consciousness gets particular importance.

Alarming symptoms may be:

-    abnormal heartbeat combined with arrhythmia or tachycardia;
-    Vertigo while running, status of collapse
-    Pain or feelings of constriction in the chest or shoulder;
-    Cauterisation behind episternum (breast bone) way up to the throat (neck), also feelings of pressure in the cervical region;
-    Obstruction, feeling of repletion or pain in the upper abdomen, nausea, a feeling of indisposition;
-    Dyspnoea (air hunger) at rest or low physical strain.


Obligatory part of the apparative diagnostics is an electrocardiogram (ECG) at rest, an exercise electrocardiogram; and an ultrasonic cardiography (echocardiography) is desirable.


Electrocardiogram at rest and exercise electrocardiogram require adequate knowledge to detect especially paroxysmal arrhythmia. Exercise induced variations in ECG must be verified in differential diagnosis. The exercise electrocardiogram has to be carried out and interpreted according to the guidelines. Most common mistake during exercise electrocardiogram is the insufficient level of stress to the athlete. For some top-level athletes with coronary heart disorder we encounter coronary insufficiency solely beyond 250 watts. Please note that a regular exercise electrocardiogram does not provide a 100 percent safety for the exclusion of a coronary heart disorder.

An ultrasonic cardiography has to be carried out at suspicion of HOCM or valvular defect. Not every cardiologist is familiar with sports related variations of the heart and not every sports physician with the specific cardiac problems. The cooperation of the “cardiological versed sports physician” or “the cardiologist skilled in sports medicine” is therefore essential at specific problems.

References:
Löllgen, Herbert; Gerke, Roger: Steinberg, Thomas: Der cardiale Zwischenfall im Sport. Dtsch. Ärzteblatt 2006; 103(23): A 1617-22

Kleinmann, Dieter: Laufnebenwirkungen. Vom Ermüdungsbruch zum plötzlichen Herztod: Was können Sie dagegen tun? Deutscher Ärzteverlag Köln, 2009. 2nd edtion revised.
ISBN 978 3 7691 0592 6. 16,5 x 23,8 cm; paperback.
XII + 372 pages with 99 illustrations in 130 specifications and 56 tables.
D € 39,95 / A € 41,10.