Sudden cardiac death while exercising

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Classification according to ICD-10
I46.1 Sudden cardiac death, as described
ICD-10 online (WHO version 2019)

The Sudden cardiac death during sports (Syn .: Sudden Sporttod, Sudden cardiac death in athletes) is triggered through sport sudden cardiac death (SCD). It does not represent a clinical picture of its own. Sport is assumed to be the triggering factor in PHT up to one hour after physical exertion.

distribution

The incidence of PHT during sport is given as 0.5 to 2 per 100,000 athletes, men are affected significantly more often than women. In France, for example, between one and two thousand athletes die each year from this cause of death. In Germany around 900 athletes die each year from cardiac death; a nationwide register for the more precise recording of sudden cardiac death during sport was initiated in 2012. Sports with the most common cardiac deaths are triathlon (1.5 / 100,000), basketball, American football (USA), soccer, and running (0.8 / 100,000). Young athletes are 2.5 times more likely to suffer sudden cardiac death than non-athletes.

Possible causes

As in general with sudden cardiac death, three components of structural heart disease , arrhythmia mechanism and temporary trigger must come together. The trigger in sudden sports death is physical strain. The heart diseases only differ in their distribution. Most common among competitive athletes is hypertrophic cardiomyopathy (46% including suspected cases), followed by the actually rare congenital coronary anomalies (17%) as well as myocarditis (7%) and arrhythmogenic right ventricular cardiomyopathy (ARVCM) with (4%). The older the patient, the more common coronary artery disease is the underlying disease. In some regions of Italy, ARVCM is the most common cause in young athletes, probably due to genetic accumulation.

doping

A connection between sudden cardiac death and doping has been suspected for decades . Virtually all known doping agents can damage the heart. In particular, anabolic steroids and artificially added growth hormones can lead to pathological changes in the heart. It is usually difficult to prove that doping is responsible for sudden cardiac death. On the one hand, agents that may have been used are often not (no longer) detectable in the athlete's blood at the time of death, for example if the agents were taken during a training phase without doping controls. On the other hand, in some cases no autopsies are performed at all, or a specialist is not called in who could determine changes in the heart muscle and cells typical of doping. There are currently no reliable statistics or long-term studies on the subject.

Prevention

In a statement, the Swiss Society for Sports Medicine recommends a basic examination with resting ECG as well as annual sports medicine examinations for all active athletes . Which includes:

Cardiovascular history

Clinical examination

  • Thorough cardiovascular status ( auscultation / palpation / blood pressure measurement)
  • Search for evidence of connective tissue disorder (Marfan's syndrome)

Others

  • Resting electrocardiogram (when starting a competition)
  • Serum cholesterol (over 35s)

In the case of a positive medical history, pathological heart or vascular noises, indications of arrhythmia or a pathological resting ECG, referral for further specialist clarification is recommended. Routine exercise ECGs or Doppler echocardiographic examinations are not justified.

The Swiss Society for Sports Medicine also recommends a slow increase in exposure, as sudden unaccustomed exposure increases the risk of PHT. It is also recommended to refrain from physical activity if you have a febrile infection. Unusual symptoms (e.g. unexplained chest pain, dizziness, impaired consciousness) or malaise during exercise should be viewed as warning signal (s).

In November 2010, the French foundation Cœur et Artères (“Heart and Arteries”) set up a fund to finance research in this field and named it after Marc-Vivien Foé .

Related phenomena

According to one opinion, there is also an increased risk of (mostly non-fatal) heart attacks and cardiac arrhythmias for spectators who watch an exciting football broadcast (e.g. penalty shoot-out) in the stadium or in front of the television. However, other studies could not show any connection between cardiac events in viewers of football matches in Germany and Italy.

literature

  • Wilfried Kindermann, Axel Urhausen : Sudden cardiac death while exercising . Federal Institute for Sport Science, Cologne 2000, ISBN 3-89001-131-4 , p. 1–55 ( online [PDF] brochure for active participants and supervisors).
  • B. Marti: Sudden cardiac death while exercising: meaningful preventive medical checkups . In: Swiss magazine for sports medicine . tape 46 , no. 2 , 1998, p. 83–85 ( sgsm.ch [PDF] with attachment: checklists for non-medically trained sports directors and adapted questionnaires according to Ades as guidelines for the anamnesis ).
  • Sports Medicine: Sudden Cardiac Death Registry. In: Deutsches Ärzteblatt. Vol. 109, issue 18, May 4, 2012.

Individual evidence

  1. ↑ a b c d Wilfried Kindermann : Sudden cardiac death during sport . In: German magazine for sports medicine . tape 56 , no. 4 , 2005, p. 106–107 ( zeitschrift-sportmedizin.de ( memento from February 23, 2014 in the Internet Archive ) [PDF]). Sudden cardiac death while exercising ( memento of the original dated February 23, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / www.zeitschrift-sportmedizin.de
  2. ↑ Article in France Football ( Memento of November 22, 2010 in the Internet Archive ) of November 21, 2010.
  3. ↑ When jogging becomes life-threatening. In: Hamburger Abendblatt. 2002.
  4. ^ Online register of the Saarland University for cases of sudden death
  5. ↑ How big is the risk of cardiac death in a triathlon? In: Doctors newspaper . March 30, 2009.
  6. ↑ D. Corradoal et al .: Does sports activity enhance the risk of sudden death in adolescents and young adults? In: Journal of the American College of Cardiology . tape 42 , no. 11 , December 3, 2003, p. 1959-1963 , PMID 14662259 .
  7. ↑ Mewis, Riessen, Spyridopoulos (ed.): Cardiology compact - Everything for ward and specialist examination . 2nd Edition. Thieme, Stuttgart / New York 2006, ISBN 3-13-130742-0 , pp. 408 ( books.google.de ).
  8. ^ Spiegel Online : Sudden cardiac death in sport - "Competitive sport is dangerous for the heart" , accessed on May 8, 2012.
  9. ↑ ARD Radio Feature: Doping in Football ( Memento from August 16, 2010 in the Internet Archive ) (PDF).
  10. ↑ Spomedial: Sudden cardiac death and doping ( Memento from July 22, 2012 in the web archive archive.today )
  11. ↑ B. Marti, B. Villiger, M. Hintermann, R. Lerch: Sudden cardiac death in sport: sensible preventive examinations . In: Swiss magazine for sports medicine . tape 46 , no. 2 , 1998, p. 83-85 ( sgsm.ch [PDF]).
  12. ^ Swiss Society for Sports Medicine , accessed on April 15, 2012.
  13. ↑ Article ( Memento of November 22, 2010 in the Internet Archive ) at France Football. November 21, 2010.
  14. ↑ Heart attack on penalties. In: Stern. January 31, 2008 and kick-off for the heart attack. In: Süddeutsche Zeitung. January 31, 2008. (The original papers are: Douglas Carroll et al .: Admissions for myocardial infarction and World Cup football: database survey. In: British Medical Journal. Vol. 325.2002, pp. 1439–1442 and: Ute Wilbert-Lampen et al .: Cardiovascular Events during World Cup Soccer. In: New England Journal of Medicine. Vol. 358.2008, pp. 475–483)
  15. ↑ D. Niederseer, CW Thaler, A. Egger, MC Niederseer, M. Plöderl, J. Niebauer: Watching soccer is not associated with an increase in cardiac events. In: Int J Cardiol. 2013 Dec 10; 170 (2), pp. 189-194. doi: 10.1016 / j.ijcard.2013.10.066 . Epub 2013 Oct 25.
  16. ↑ F. Barone Adesi, L. Vizzini, F. Merletti, L. Richiardi: It is just a game: lack of association between watching football matches and the risk of acute cardiovascular events. In: Int J Epidemiol. 2010 Aug; 39 (4), pp. 1006-1013. doi: 10.1093 / ije / dyq007 . Epub 2010 Mar 7.