Sudden Cardiac Death in Young Athletes

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Sudden Cardiac Death in Young Athletes

• Yann Ping Pan, MD
• Ruey-Kang Chang, MD, MPH

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What do they have in common?

• Hank Gathers (1967-1990)
• Reggie Lewis (1965-1993)
• Flo Hyman (1954-1986)
• Sergei Grinkov (1967-1995)
• Pete Maravich (1947-1988)

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Athlete SCD why is it important

• Family physicians see a lot of athletes for
  sports related issues
• Family physicians are involved in school health
  and pre-participation examinations
• It is important to know the clinical
  characteristics of SCD and identify athletes who
  are at risk
• It is important to know the current
  recommendations for pre-participation examinations

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What do we know about SCD in Athletes?

• 12-15 million young (lt30 years) competitive
  athletes in the US
• Estimated incidence of sudden cardiac death at
  2.1 per 100 000 athletes per year
• Estimated 200 athletes in the US die per year of
  sudden cardiac death
• Sudden death of the young athletes is mostly
  unexpected, dramatic, tragic and carries huge
  emotional impact on the society

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Epidemiology Based on Autopsy Series
Sudden Cardiac Death of Athletes

• Age--
• 9 in middle school
• 62 in high school
• 22 in college
• 7 in professional
• Sex90 male, 10 female
• Caucasians at highest risk

Maron BJ et al, JAMA 1996 276 199 - 203
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Sports engaged in at the time of sudden death
Sudden Cardiac Death of Athletes
Maron BJ et al, JAMA 1996 276 199 - 203
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Causes of Sudden Cardiac Deaths in Young Athletes
Sudden Cardiac Death of Athletes
Maron BJ et al, JAMA 1996 276 199 - 203
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Research Questions

• What are the epidemiologic characteristics of
  athlete SCD from the an active surveillance,
  population-based sample?
• What are the major causes for athlete SCD from
  the an active surveillance, population-based
  sample?

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Objectives

• To evaluate an active surveillance system of
  athlete SCD from a population-based sample using
  Google Internet search engine
• To compare the active surveillance of athlete SCD
  by Google with reported athlete SCD data using
  autopsy or passive report systems

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Methods

• Advanced Google Internet search was conducted
  once a week (every Friday) from April 2007 to
  March 2008
• Combinations of keywords were used athlete,
  player, practice, game, collapse, pass out, die,
  gym class, etc.
• Only US athletes died in a game or practice or
  immediately after, occurred in the US
• Age 11 to 30 years, death between 4/07 to 3/08
• Exclusions known cardiac history, trauma, non-US
  athletes, died in sleep or at home, possible
  drugs or alcohol,

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Methods

• First 200 Google search results are carefully
  examined
• For cases that fulfill inclusion criteria, the
  web pages are printed/saved
• All demographic data, history and circumstances
  (CPR, use of AED), are recorded and compiled for
  analysis
• Autopsy results are searched 1 month to 12 months
  later to determine the cause of death

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Results

• Total of 74 athletes died in April 2007 to March
  2008 in a game or during or after practice
  (comotio cordis are excluded)
• 25 athletes died in a game (34), and 49 died in
  or after practice (66) consistent with the
  literature or 12
• Most common sports are basketball and football
  consistent with the literature

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Results
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Sudden Cardiac Death of Athletes
FM 13
Female
Male
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Race and Ethnicity
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Sports Associated with SCD
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Sudden Cardiac Death of Athletes
Maron BJ et al, JAMA 1996 276 199 - 203
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Causes of SCD
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Maron BJ et al, JAMA 1996 276 199 - 203
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Conclusion

• Excluding comotio cordis, there are 74 SCD of
  young athletes in the US in 2007-2008
• 1/3 SCD occurs in a game, 2/3 in practice
• Including gym class death, there are more females
  than previously described
• Blacks may be at higher risk, ore studies needed
• Basketball and football are common sports
  associated with SCD
• HOCM/LVH accounts for almost 50, coronary
  anomaly and arrhythmia are next common causes

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Sudden Cardiac Death of Athletes
Circulation 20071151643-1655
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Endorsement of AHA Guidelines

• American Academy of Family Physicians
• American Academy of Pediatrics
• American College of Cardiology
• American College of Sports Medicine
• American Medical Society for Sports Medicine
• American Orthopaedic Society for Sports Medicine
• American Osteopathic Academy of Sports Medicine

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European Guidelines for PPE

• In 2005, The European Society of Cardiology
  issued official recommendation for PPE, including
  12-lead ECG

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Coronary Artery Anomaly
Sudden Cardiac Death of Athletes
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Coronary Artery Anomaly
Sudden Cardiac Death of Athletes

• With increased stroke volume during exercise
  ascending aorta expands and the take-off angle is
  further exaggerated
• LMCA may also be compressed against root of
  pulmonary trunk during exercise
• ECG is likely normal
• Very difficult to screen or diagnose even with
  echocardiogram
• Treatment Surgery for coronary reimplantation

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Commotio Cordis
Sudden Cardiac Death of Athletes

• Sudden disturbance of heart rhythm as the result
  of a blunt, non-penetrating impact to the
  precordial region
• Impact occurring within a specific 10-20
  millisecond portion of the cardiac cycle in the
  ascending phase of the T wave, when the
  ventricular myocardium is repolarizing, moving
  from systole to diastole
• Most effective preventions are
• Chest shield
• Automatic External Defibrillator (AED)

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Sudden Cardiac Death of Athletes
J Am Coll Cardiol 20085219906
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Sudden Cardiac Death of Athletes