Sudden Cardiac Death in Athletes

AED Use

-244 NCAA institutions surveyed -43 cases of AED being used @ 41 institutions -35 were SCA episodes -77% (27/35) Older non-students (spectators, coaches, referees) -14% (5 cases) SCA athletes -One non-intercollegiate athletes -*None of the intercollegiate athletes were successfully recussitated

Marfan Syndrome Comorbidities

-Arachnodactyly -Chest wall deformity -Scoliosis -High arched palate -Acromegaly -Joint hypermobility -Increased arm span relative to height -Myopia -Retinal detachment

Aortic Stenosis

-Decreased Aorta size -Reduction in pump efficiency - can result in ventricular arrhythmia and cardiac death

Types of Diagnostic Tests

-EKG/ECG -Stress test -Echocardiogram -Holter monitor

Anomolies S/Sx & Tx

-Echocardiogram or Cardioangiography -Beta-blockers, surgical resection -Remove from competitive sports

EAP

-Every school with athletic events must have a written and structured EAP. -The EAP should be coordinated with EMS, public safety, first responders, and school administrators -Specific to each venue EAP needs to be reviewed and practiced annually

HCM S/Sx

-Fatigue -Dyspnea -Syncope / Near Syncope

Cardiac Abnormalities Statistics

-HCM = 25% -Coronary Artery Anomalies = 14% -Commotio Cordis = 20% -Remaining: myocarditis, marfan syndrome, vavlular heart disease, cardiomyopathy, CAD -Unknown = 2%

HCM Autosomal dominant disorder

-If you carry the gene - your offspring have a 50% chance of getting the congenital defect The septum of muscle tissue that separates the ventricles is hypertrophied - causes a disruption in ventricular output in systole and never have complete ventricular relaxation in dyastole -Left ventricular outflow obstruction -Predisposes athletes to ventricular arrhythmias

HCM Dx & Tx

-PE presents a murmur that decreases in intensity in the supine position -Chest X-ray and Electrocardiography are o.k. -Gold standard is 2-D echo (approx $900) -Beta Blockers are used as treatment

AHA Recommendations ('07)

-Pre-participation Screening -Focus on personal and family hx -Does not see cost effectiveness attached to PPE EKG or echocardiogram

Marfan Syndrome RTP

-Removal from participation in sports that risk collision -No family history of SCD, no MVP, or aortic root dilation -IA IIA sports (archery, diving, bowling, etc.) - otherwise IA

Sudden Death Incidence

-Sudden death before age 35 is typically a congenital cardiovascular disorder -Sudden death after age 35 is associated with atherosclerotic disease

Coronary Artery Anomolies

-Tunneling of the coronary arteries -Usually the left anterior descending artery -1/3rd are symptomatic -Sx: c/o early fatigue, chest pain or dizziness w/exercise

Sudden Cardiac Death

A non-traumatic, nonviolent, unexpected event resulting from sudden cardiac arrest within six hours of a previously witnessed state of normal health -Sudden cardiac arrest is the leading cause of death in young athletes1

80%

As many as __________ of patients with SCD are asymptomatic until sudden cardiac arrest occurs

Commotio Cordis

Blunt force to chest causes a disruption in the electrical activity -Concussion of the heart -Arrhythmia from blow to chest -Most common in baseball -Since 1998 - 150 athletes

Management & Prevention

Components: -Early activation of EMS, early CPR, early defibrillation, rapid transition to adv cardiac life support (ACLS) SCA suspected in ALL collapsed unresponsive athletes AED should be applied ASAP for rhythm analysis CPR while waiting for AED and after shock ALWAYS assume SCA if collapse occurs after player is struck in chest

Incidence of Sudden Death

Difficult to estimate true incidence of defect -Rare -7.5 per million per year for males -1.3 per million per year for females -Male > female by five fold -OVERALL 1 and 3 in 100,000

Hypertrophic Cardiomyopathy

HCM is a disease of the myocardium in which a portion is hypertrophied (thickened) with an unknown cause -Disruption of muscle cell alignment

Marfan Syndrome

Hereditary connective tissue disease -Present in 1 in 20,000 -Progressive dilation of the aortic root that can cause aortic dissection or rupture -Results in weakened aortic arch, mitral valve prolapse or regurgitation -The elasticity of the heart tissue is diminished and allows for the aorta to increase to such a great size

PPE

History -Family hx of premature death -Family hx of heart disease in close relative (<50yr) -Personal hx of heart murmur -Personal hx of systemic hypertension -Personal hx of excessive fatigability -Personal hx of syncope, dyspnea, chest pain, particularly if present with exertion Physical Exam -Blood pressure while seated -Heart sounds in supine and standing position §Listen for: clicks & extra heart sounds -Signs of Marfans Syndrome

Myocardial Ischemia

In this case the Left Main Artery makes an acute angle off of the aorta as it crossing above the pulmonary artery resulting in diminished blood flow to the Left anterior descending artery.

Myocarditis

Inflammation of the heart muscle -Acute viral infection most often caused by Coxsackie B virus (over 50%) -Sx: exercise intolerance, signs of congestive heart failure, tachycardia, abnormal heart sounds -Sudden death due to ventricular arrhythmia

AMA Consensus Statetment ('96)

Pre-Participation Exam' -Should be mandatory for all secondary and college athletes -Should include a history and physical examination -Should be conducted by a health care worker -Should be done every two years in HS (hx in interim

HCM Participation

Removal from all competitive sports, except: -Low-intensity: -Golf -Bowling -Billiards

Syncope

fainting