Question: As a coach, I worry about the possibility of one of my players dying suddenly during a practice or a game like the high-profile deaths of Reggie Lewis, Hank Gathers, Pete Maravich and Flo Hyman. Would you address the issue of what causes sudden death in young athletes? How big is the problem? Are there things that I should do to protect my athletes? Thank you.
Answer: Sudden death in highly trained, apparently healthy athletes is now officially called "sudden death syndrome." Luckily, the incidence of death is not very high, but it seems higher because of the amount of press associated with deaths in well-known, apparently healthy athletes.
According to an article in the June issue of Training & Conditioning, in men under 30 years of age, it is estimated that only one in 280,000 individuals dies suddenly every year. Compare this to one death per 4,000 hours of activity for adult joggers from the general population and one cardiac arrest for every 33,000 to 112,000 hours for patients in a cardiac rehabilitation program.
There are several causes of sudden death in young healthy athletes. The most common is called cardiomyopathy, of which there are two types, hypertropic and obstructive.
In hypertrophic cardiomyopathy, the cardiac muscle thickens, which is thought to increase the frequency of ventricular arrhythmia. Athletes with this problem may complain of cardiac palpitation or flutter and may pass out or collapse after a strenuous workout. This was probably the problem for both Reggie Lewis and Hank Gathers.
In obstructive cardiomyopathy, the heart muscle gets larger in several key places, which can obstruct blood flow during exercise. Both of these conditions can be discovered in cardiac examinations.
Another problem is an anomalous origin of the coronary artery, which can affect blood flow to the heart muscle during exercise. In some cases, the athlete has a single blood vessel instead of two, as was the case with Pete Maravich. More commonly, one of the two main coro-nary vessels originates from a different site than normal.
Some tall people have a genetic problem called Marfan's syndrome (nicknamed Abe Lincoln's disease). In these athletes, an abnormality of the connective tissue weakens the aorta (the main artery out of the heart) to a point that it ruptures (Flo Hyman's problem). An athlete whose arm span is greater than his or her height might be checked for this problem. Other cardiac problems include coronary artery disease, aortic stenosis, myocarditis, etc.
There are also several non-cardiac causes of sudden death. Alcohol, when combined with barbiturates, can be lethal; and by itself alcohol can cause cardiac arrhythmias. Amphetamines can also cause cardiac arrhythmias leading to sudden death, as can cocaine and other addictive drugs. Even erythropoietin, a drug used to stimulate red blood cell production so the athlete can carry more oxygen, can thicken the blood to the point that it becomes dangerous in terms of clotting during exercise.
Since it would not be cost effective to do cardiac tests for all athletes, the article suggested asking athletes the following questions: Has a physician ever said you have a heart murmur? Has anyone in your family under the age of 35 died suddenly? Have you had chest pain or discomfort? Have you fainted during exercise? Do you have a history of Marfan's in the family? If an athlete answers yes to any of these questions, further medical testing may be indicated.