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Competitive athletes not over-represented in sudden cardiac death

May 20, 2005

Sudden cardiac death among young people is uncommon but is not decreasing. Three times more men than women are affected, and competitive athletes are not over-represented. This is shown a dissertation written by Aase Wisten, Ume'å University, to be publicly defended in the auditorium at Sunderby Hospital on May 25.

It is difficult to single out the typical patient at risk of sudden cardiac death, even though symptoms and EKG changes are common. Around ten different heart diagnoses can lead to sudden cardiac death. In certain heart diseases it may be vital to cut down on training and competitive activities, while others show no connection between increased risk of sudden cardiac death and physical activity. Correct diagnosis is crucial to avoid preventable deaths. A basic examination with EKG should be done if symptoms include fainting, chest pain, and heart palpitation, as well as unspecific symptoms like pronounced fatigue following an infection. A more extensive examination should be performed in cases of altered EKG, severe symptoms, or hereditary proneness to sudden cardiac death.

Competitive athletes were not over-represented in the group that died suddenly, but those involved in athletic competition did die more often in the course of physical activity and more often had various types of structural heart disorders.

Bereaved relatives often experienced a lack of support and information in connection with the deaths. It is important to be understanding and to provide clear information and a person to turn to for further questions. Many relatives would have liked to have had access to the type of crisis-management team that is deployed when several people die, in connection with accidents, for instance.

For the years 1992-1999 there were 181 cases of sudden cardiac death in the ages of 15-35 in the database at the Swedish National Board of Forensic Medicine. In some cases the autopsy revealed morbid changes in the heart, such as hardening of the coronary arteries or heart muscle diseases involving changes in the muscle walls of the heart. In about 20% the heart had no morbid changes. One explanation for cardiac arrest in these cases may be the occurrence of various types of electrical disturbances, even though the heart muscle appeared to be fully healthy. Such disturbances may be congenital, but they may also be acquired, following a heart muscle infection, for example.

Half of all EKGs available showed changes while the others were fully normal. Most EKGs were for men and had been taken many years before death, in connection with military service. When more than one EKG was available, it was possible to detect changes in the EKG curve over time in half of the cases, possibly indicating a morbid process in the heart.

The most common symptoms leading to consultation of a doctor were fainting, chest pain, and palpitation, but there were also unspecific symptoms, like pronounced fatigue following an infection. It was common for the symptom not to have been seen as related to heart disease, neither by the individual nor by health-care providers. Roughly one fourth had had no known symptoms. Some few individuals had had a heart disorder diagnosed several years before death, and a few others were currently under examination. In one case of six there was a known hereditary propensity for sudden heart failure or for heart disease that could lead to it.

Male victims of sudden cardiac death were not distinguishable from a control group of the same age in terms of levels of physical activity and participation in competitive sports. Women evinced a lower level of physical activity and also a higher BMI (body mass index = weight/(height x height)) than the control group. The group with atherosclerosis of the heart included many smokers and overweight individuals.

On Wednesday, May 25, Aase Visten, Department of Public Health and Clinical Medicine, Ume'å University and the Medical Division, Sunderby Hospital, Lule'å, will publicly defend her thesis titled Sudden Cardiac Death Among the Young in Sweden 1992-1999: From Epidemiology to Support of the Bereaved. The defense will take place at 10:00 a.m. in the auditorium at Sunderby Hospital, Lule'å. The external examiner will be Professor Johan Herlitz, Cardiovascular Department, Sahlgrenska University Hospital, Gothenburg.

Vetenskapsrådet (The Swedish Research Council)