They are produced every year in Spain Nearly 30,000 sudden deaths, According to data from the Spanish Society of Cardiology. There are different types of sudden death, although they all occur without any apparent cause. As Miguel Enrique del Valle, president of the Spanish Society of Sports Medicine and Medicine, told CuÃdatePlus Professor at the Faculty of Medicine of the University of Oviedo, ,Sudden death It is that which appears unexpectedly from a natural cause, not painfully or violently.”
sudden cardiac death This includes sudden, non-traumatic and unexpected cardiac arrest which occurs within a period of approximately 6 hours after the onset of symptoms– And this sudden death of athlete “That happens during a competition or training or when symptoms arise.” Death appears during or an hour after sports practice†.
The latter is the most common cause of unexpected death of an athlete. During a competition or training, “it can affect any type of game,” the expert says. It is secondary to heart disease, Usually secondary to coronary artery sclerosis of congenital etiology (in young people) or in older athletes.
In many cases it is difficult to doubt that an athlete is at risk of sudden death. About 90% of them “occur in people who have some form of cardiac anomaly.” already present And that clinical symptoms are not present in most people.
Pre-symptoms of sudden death
In young people it can occur without the presence of premonitory symptoms, so there are few signs that would lead one to suspect risk. The only way to detect at-risk athletes is to screen with medical examinations and other tests.The sports medicine expert reports, “Although there are many causes that can lead to sudden death, it is difficult to address them all,” although it is true that in some cases “there may be indicators in which family history should be taken into account.” Must be placed in. “€.
Which needs to be stopped to some extent, sudden death pay attention to unusual symptoms, And, as experts point out, Before sudden cardiac death appears,
- Chest pain (angina pectoris)
To - unconsciousness
To - Dyspnea (difficulty in breathing) on exertion.
To - heartbeat
To - lose consciousness.
To - arterial hypertension
To - Arrhythmia.
In the absence of symptoms, ECG changes should be evaluated (branch conduction problems, atrioventricular block, arrhythmias, channelopathy, hypertrophy…).
It is very important to look at family history (Family history of MS or heart disease) or personal.
Furthermore, del Valle says, Age should be taken into account: “The annual incidence of sudden death in people under 35 is estimated to be 1/160,000, compared to 1/18,000/year in people over 35.”
Illnesses, competitive sports, and sudden death
It is true that there are diseases that can be considered risk factors for sudden death and must be controlled or, in some cases, This may even be a good enough reason not to practice certain sports, Especially the most demanding ones. Although there are no conclusive studies on whether sports are more or less prone, “it is clear that the sports with the highest risk are the most demanding sports, that is.” those that require greater intensity or are of longer duration†.
According to their statistics, the sports most involved in sudden death cases areFootball, cycling and athletics (running), possibly because they are most prevalent in Spain.
besides this also It is important to note which cardiovascular diseases may be risk factors In sudden death. Thus, as del Valle reports, in young athletes (Below 30-35 years of age)They highlight:
- Hypertrophic cardiomyopathy (according to some data the most common cause of sudden death in athletes)
To - Arrhythmogenic right ventricular dysplasia (very common in Europe)
To - Abnormal origin of coronary arteries
To - mitral valve prolapse
To - brugada syndrome
To - Wolff–Parkinson–White (WPW) syndrome.
To - Congenital Long QT Syndrome
To - Marfan syndrome
To - Myocarditis.
Most of these diseases “Are they genetic or inborn And they can affect the heart muscle (cardiopathies) or the electrical conduction of the heart (channelopathies),” he highlighted.
In people above 30-35 years of ageThe most common causes of sudden death that should be taken into account are:
- coronary artery disease
To - Myocarditis or long QT syndrome.
even sudden death It may appear from other causes that are not related to cardiovascular problems such as “heat stroke, ruptured aneurysm or stroke.”, Thus, the expert reports, “Stress resulting from sports with a high emotional component involving extreme environmental changes (temperature, altitude, etc.) may increase myocardial O2 demand and the risk of sudden death in susceptible athletes.”
When should sports be banned?
In general, according to Del Valle’s report, “There is a long list of cardiovascular diseases whose existence represents a complete contraindication to the practice of sports.”†. In some cases, he comments, “sports with low static and dynamic stress are allowed and also cardiopulmonary pathologies with temporal differences.”
According to sports therapists, “In most cases, competitive sports are discouraged after being diagnosed with a cardiac disorder that can cause sudden death.†. Of course, as he explains, “The current criteria for not allowing sports practice due to the risk of sudden death take into account the athlete, not the disease, so they should be differentiated.”
To do this, “the risks and potential benefits involved in training and participation in competitive sports as well as the various treatment options” must be evaluated, and the athlete and his or her environment must be “clear about the risks associated with the practice.” ” Sports ethics in each case.
it’s clear that Some diseases require the athlete to leave professional sports, But with regard to some pathologies “we lack studies of sufficient quality that could guarantee safety with the practice of high-intensity sports.” so your advice “Be cautious when allowing the practice of competitive sports.”
In any case, athletes with these pathologies “must entrust themselves to an expert cardiologist to apply the appropriate treatment because with this, Many athletes can return to high level sports†.
It should be clarified that, regardless of the specific treatment in each case, “non-competitive physical exercise of moderate intensity is beneficial for most patients at risk of sudden death.”
Tests that athletes should take
Since many heart conditions cause sudden death in athletes Do not present warning symptoms, It is very important to proactively prevent high-risk cardiovascular diseases by early diagnosis.
This means, above all, “carrying out medical-sports testing for the early detection of conditions at high risk of sudden death (cardiac screening).”
However some medical societies believe that a questionnaire such as the PAR-Q (Physical Activity Readiness Questionnaire) may be sufficient to investigate this problem. The Spanish Society of Sports Medicine (SEMED) or the Spanish Society of Cardiology believe that sports medicine recognition plays a fundamental role in the prevention of sudden death.
Del Valle explains, in this recognition, “in addition to the family and personal history (clinical history), a physical examination should include auscultation and a 12-lead ECG at rest.” Depending on the circumstances, “a monitoring stress test and echocardiography will also need to be performed. In some cases, special tests are required, such as applying a Holter ECG for 24 hours or cardiac magnetic resonance.
As a general rule this should be done,
- In physical/sports participants without a history of MS, a sports medicine examination with a 12-lead ECG will be required, but if they have a family history of MS, a stress test will be added.
To - In federal athletes who already have high demands, a sports medical examination should be carried out with ECG and stress test, for those over 35 years of age, as well as in people under 35 with a history (and this includes a Echocardiogram will also be included).
To - In high-level athletes, MRI + ECG + stress testing will be universally mandatory and an echocardiogram will be recommended.
As Del Valle reports, ”Echocardiogram offers high sensitivity by detecting certain cardiac structural changes that may not be noticed with physical examination and ECG. Some channelopathies present with normal ECG and a stress test or medicinal test must be performed to uncover them.
However, there are diseases that are not evident in these tests or that emerge acutely after these examinations, such as myocarditis or acute myocardial infarction, and which may not be identified.
Can sudden death be prevented?
As mentioned, sudden death is very difficult to detect and prevent, but not impossible. In prevention, the following factors should be taken into account:
- Identification and specific prevention of pathologies at risk for sudden death in athletes.
To - Assess for risk symptoms such as loss of consciousness or unusual dizziness, chest pain, palpitations, feeling unusually tired.
To - Avoid hazardous environmental conditions.
To - Avoid the use of anabolic steroids, peptide hormones and stimulants that can lead to the appearance of acquired heart disease in athletes.
To - Teaching and dissemination of cardiopulmonary resuscitation (CPR) techniques.
To - Generalization of the use of automatic defibrillators (AEDs) in sports centers and all types of competitions.
To - In most cases a checkup every 2 years is considered sufficient, although sometimes (high competition, change in clinical status or new symptoms…) the frequency of these follow-ups should be increased.
We must not forget this to avoid sudden cardiac death.”We should always have automated external defibrillators in stadiums And sports centers where, in addition to the presence of personnel trained in basic cardiopulmonary resuscitation, a sports activity is carried out.