Sudden cardiac arrests in youths

News-watchers were shocked to learn how a young robust 19 year-old Vishwanath, collapsed suddenly and died while playing football (soccer) recently in Bangalore. This happened at a time when soccer lovers were recovering from a similar incident in which the Bolton midfielder Fabrice Muamba, collapsed on the field from a sudden cardiac arrest (SCA) and had to be rushed to hospital.

The possibility that young, well-trained athletes at the high school, college, or professional level may die suddenly of heart disease seems incomprehensible. It is a dramatic and tragic event that devastates families and the community, especially as these young people seem to be the fittest in society.

SCA in young athletes triggered by vigorous activity occurs in 1 of 100,000 sportsmen annually. FIFA lists around 92 players who died while playing soccer, half of whom from SCA.YouTube contains an interesting video showingMiklosFeher slumpingsuddenly to the ground and dying, and another of Anthony van Loo who suffers a SCA but is revived by a timely thump on the chest by a coach.

The first recorded incident of sudden death of an athlete occurred in 490 BC when Phidippides, a young Greek messenger, ran 26.2 miles from Marathon to Athens, delivered the news of Greek victory and then collapsed and died. Today, the 2 sports that claim most lives from SCA are soccer and basketball.

Unlike people over 30 years of age in whom the cause is usually blockage of flow of blood by a clot or narrowing in the coronary, the causes in young athletes are:

1.   Abnormal thickening of heart muscles called hypertrophic cardiomyopathy, especially common in Afro-Americans, who indeed are more prone

2.   Developmental anomalies of coronary arteries, which can often arise from abnormal sites and may be prone to kinking

3.  Long QT syndrome (LQTS),an inherited heart rhythm disorder that can cause fast, chaotic heartbeats. The rapid heartbeats, caused by changes in the part of the heart that causes it to beat, may lead to fainting, which can be life threatening. In some cases, the heart's rhythm may be so erratic that it can cause sudden death. Young people with long QT syndrome have an increased risk of sudden death.

These shocking events and our growing understanding of the reasons behind SCA have generated considerable debate regarding our state of preparedness on the field. Developed countries have called for cardiac screening for all athletes undertaking vigorous sports. Anyone with a history of fainting or a family history of early cardiac events should undergo thorough evaluation.

We need to be better prepared at the venue. Coaches and players should be trained in resuscitation techniques. Anthony van Loo survived only because of timely action by his coach. It should also be mandatory to have hand-held defibrillators available on the field and people should be trained to use them. And the need for prompt transfer to ICU cannot be overstressed, if damage to the brain and other organs is to be prevented.

As published in HT City (Hindustan Times) dated 25 March, 2012.