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sudden death in competitive sports

Etiology: 1) unrecognized hypertrophic cardiomyopathy 2) congenital coronary artery anomalies - anomalous coronary arteries [3] 3) subclinical viral myocarditis 4) Marfan's syndrome 5) right ventricular dysplasia 6) blunt chest trauma 7) premature coronary artery disease (rare) 8) non cardiac causes (14%) [3] 9) idiopathic (35%) [3] 10) vigorous exercise heightens risk of cardiac arrest [2] a) activation of the sympathetic nervous system b) promotion of plaque rupture Epidemiology: 1) 7/1,000,000 for men 2) 1/1,000,000 for women 3) twice as high in college men as in high school men 4) 0.76 per 100,000 athlete-years [8], 50% mortality - 20% of cardiac arrest in persons age 12-45 years occur during competitive sports [8] - 2 deaths over 6 years during competitive sports attributed to hypertrophic cardiomyopathy [8] - none due to arrhythmogenic right ventricular cardiomyopathy Management: - screening may save lives [4], or may not [5] - at most, 3 of 74 competitive athletes who died could have been identified as being at high risk during preparticipation screening [8] - athletes with pacemakers & ICD may be considered for high- intensity sports; risk for sudden death may be low [6] - athletes with long-QT syndrome may be considered for competitive sports; risk for sudden death may be low [6]

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athletics

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sudden unexpected death

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 18. American College of Physicians, Philadelphia 1998, 2018.
  2. Journal Watch 20(24):192, 2000 - Albert CM, Mittleman MA, Chae CU et al Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med. 2000 Nov 9;343(19):1355-61. PMID: 11070099 Free Article
  3. Journal Watch 25(3):23, 2005 - Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med. 2004 Dec 7;141(11):829-34. Summary for patients in: Ann Intern Med. 2004 Dec 7;141(11):I26. PMID: 15583223
  4. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006, 296:1593 PMID: 17018804 http://jama.ama-assn.org/cgi/content/full/296/13/1593 - Thompson PD & Levine BD Protecting athletes from sudden cardiac death JAMA 2006, 296:1648 PMID: 17018808 http://jama.ama-assn.org/cgi/content/full/296/13/1593
  5. Steinvil A et al. Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death: Proven fact or wishful thinking? J Am Coll Cardiol 2011 Mar 15; 57:1291. PMID: 21392644
  6. Maron BJ, Zipes DP, Kovacs RJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015 Oct 27. pii: S0735-1097(15)06548-1 PMID: 26542655 - Maron BJ, Zipes DP, Kovacs RJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations. A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015 Oct 27. pii: S0735-1097(15)06548-1 PMID: 26542655 http://circ.ahajournals.org/content/early/2015/11/02/CIR.0000000000000236
  7. Maron BJ. Sudden death in young athletes. N Engl J Med. 2003 Sep 11;349(11):1064-75. Review. PMID: 12968091
  8. Landry CH, Allan KS, Connelly KA et al Sudden Cardiac Arrest during Participation in Competitive Sports. N Engl J Med 2017; 377:1943-1953. November 16, 2017 PMID: 29141175 http://www.nejm.org/doi/full/10.1056/NEJMoa1615710
  9. Maron BJ, Levine BD, Washington RL et al Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 2: Preparticipation Screening for Cardiovascular Disease in Competitive Athletes: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015 Dec 1;66(21):2356-2361.Epub 2015 Nov 2. PMID: 26542659 Free Article - Maron BJ, Udelson JE, Bonow RO et al Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015 Dec 1;66(21):2362-2371. Epub 2015 Nov 2. PMID: 26542657 Free Article - Ackerman MJ, Zipes DP, Kovacs RJ, Maron BJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 10: The Cardiac Channelopathies: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015 Dec 1;66(21):2424-2428. Epub 2015 Nov 2. PMID: 26542662 Free Article - Link MS, Estes NAM 3rd, Maron BJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 13: Commotio Cordis: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015 Dec 1;66(21):2439-2443. Epub 2015 Nov 2. PMID: 26542669 Free Article