The cardiac arrest death of Bears defensive end Gaines Adams may have you asking, “How can a young and fit professional athlete suddenly die of a heart-related condition?”
Sudden death in professional athletes is shocking. Professional athletes are particularly thought of as healthy having been the best at what they do since childhood and having the ability to withstand the rigors of training and making it to highest level of their sport. They are seemingly invincible.
In the U.S., the most common cause of sudden death in athletes is hypertrophic cardiomyopathy (HCM). This is often referred to as an “enlarged heart.” The pathology in this condition is an abnormal thickening of the heart muscle which can potentially lead to an electrical instability, referred to as cardiac arrest. When cardiac arrest occurs, if a normal rhythm is not restored promptly, death often occurs.
Hypertrophic cardiomyopathy can span the spectrum of asymptomatic to severely symptomatic. Some clues could be chest pain, shortness of breath, unexplained dizzy spells or passing out. A family history can also be important.
Screening for this condition can be difficult if there are no symptoms, family history or ECG abnormalities to suggest the diagnosis. An echocardiogram (heart ultrasound) can help to make the diagnosis. However, in large, tall individuals the enlarged heart may be a normal finding due to being a highly trained athlete or may just be normal for the individual’s size.
Other causes of sudden death in athletes include a weakened heart muscle leading to an enlarged heart that is weak, as opposed to thickened as in HCM. This can occur due to the effects of a virus, hypertension or drugs/toxins. Some athletes have premature coronary artery disease leading to a “heart attack,” or congenital abnormalities of the heart arteries. Other rare causes include primary abnormalities of the electrical system.
A cardiac arrest is often confused with a heart attack. A heart attack more accurately refers to a “myocardial infarction” This condition occurs when a coronary artery blocks, depriving the muscle of oxygen. If the artery is not opened quickly, the heart muscle supplied by that blocked artery dies. In some cases, this results in a cardiac arrest as well. It is possible to have a cardiac arrest without a heart attack and vice versa.
There are guidelines for screening younger non-professional athletes. Unfortunately, at the pre-collegiate level, mass screening with imaging (ECG, Echo, etc.) is not cost effective and not recommended. Each professional league has their own set of standards (NBA, NFL, etc.) I think it is imperative that any symptoms should not be ignored and all athletes must undergo a thorough physical prior to being cleared for competitive athletics.
Kousik Krishnan, MD, FACC, is a board-certified cardiac electrophysiologist, assistant professor of medicine, director of the Arrhythmia Device Clinic and associate director of the Electrophysiology Lab at Rush University Medical Center.