Intended for healthcare professionals

Clinical Review

Sudden cardiac death in athletes

BMJ 2015; 350 doi: (Published 18 March 2015) Cite this as: BMJ 2015;350:h1218
  1. Christopher Semsarian, professor123,
  2. Joanna Sweeting, PhD student12,
  3. Michael J Ackerman, doctor4
  1. 1Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, NSW, 2042, Australia
  2. 2Sydney Medical School, University of Sydney, Sydney, NSW, Australia
  3. 3Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  4. 4Departments of Medicine, Pediatrics, and Molecular Pharmacology and Experimental Therapeutics, Divisions of Cardiovascular Diseases and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
  1. Correspondence to: C Semsarian c.semsarian{at}

The bottom line

  • Sudden cardiac death in athletes aged less than 35 years is most commonly caused by an underlying genetic heart disorder, such as hypertrophic cardiomyopathy; however, up to half of all sudden cardiac deaths may be associated with a structurally normal heart at postmortem examination and are referred to as autopsy negative sudden unexplained deaths

  • Systematic and intense physical training can lead to changes in the heart; however, these are not always detrimental

  • Pathological changes to the heart caused by exercise may mimic characteristics of genetic heart diseases—for example, hypertrophy and fibrosis

  • There is much debate worldwide regarding the implementation and extent of preparticipation screening for athletes, with the main issue being the balance between lives saved; athletes tested; psychological, ethical, and legal issues; and the economic cost

  • Increased education and awareness about sudden cardiac death, training in cardiopulmonary resuscitation, and accessibility to automated external defibrillators can help prevent sudden cardiac death in athletes, as well as non-athletes

Sudden cardiac death is defined as an unexpected death, occurring usually within one hour from onset of symptoms in cases where the death is witnessed and in unwitnessed cases within 24 hours of the individual last being seen alive and well.1 Sudden cardiac death in athletes is the leading cause of medical death in this subgroup, with an estimated incidence of 1 in 50 000 to 1 in 80 000 athletes per year, although a wide range has been reported, from 1 in 3000 in some subpopulations to 1 in 1 000 000.2 Males, black or African Americans, and basketball players seem to be at a higher risk than other subgroups.2

Sources and selection criteria

We searched PubMed and the Cochrane Database of Systematic Reviews using the search terms “sudden cardiac death” and “athletes”. To ensure that we represented a diversity of opinion worldwide, particularly on preparticipation screening, …

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