Education And Debate

ABC of Sports Medicine: Sudden death in sport

BMJ 1994; 309 doi: (Published 10 September 1994) Cite this as: BMJ 1994;309:657
  1. W S Hillis,
  2. P D McIntyre,
  3. J Maclean,
  4. J F Goodwin,
  5. W J McKenna

    Most sudden deaths in sport are caused by cardiovascular conditions. The cardiovascular benefits of exercise are well established, and epidemiology studies suggest that long term exercise programmes may reduce the risk of sudden death. Increasing leisure time and facilities promote sports participation at all ages. A few people are at risk of serious arrhythmia or sudden death with exercise. The cause of death varies with the age of participants; congenital structural abnormalities occur in younger age groups and coronary artery disease in older age groups. Identifying such abnormalities makes prevention possible.

    Sudden death in sport is uncommon, with an incidence of 2 cases per 100 000 subject years. Five in 100 000 athletes have a condition that might predispose them to serious cardiac problems, and of those at risk 10% (1 in 200 000) may die suddenly or unexpectedly. Considerable controversy exists about the cost effectiveness of screening all young people by examination before participation. Alternative views suggest targeting people with a family history of sudden death or premature coronary artery disease and educating all participants to see their doctors about even minor warning symptoms.

    Some of the cardiac causes of sudden death will be suggested by symptoms and signs on clinical examination. The importance of others may be established only by detailed cardiological investigations including electrocardiography, chest radiography, echocardiography, doppler cardiography, and, rarely, cardiac catheterisation. Exercise testing is of major value and 24-48 hour tape electrocardiographic recordings may be required. Potentially serious symptoms such as syncope, pre-syncope, palpitation, chest pain, and undue dyspnoea should stimulate taking a detailed clinical history, making a detailed examination, and referring for cardiological investigation if appropriate. A family history of cardiac abnormality would suggest a hereditary basis.

    Cardiac causes of sudden death

    Coronary artery disease

    Hypertrophic cardiomyopathy

    Idiopathic concentric left ventricular hypertrophy

    Congenital anomalies …

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