When a young athlete succumbs to sudden cardiac death (SCD), families and entire communities are shocked and bewildered: How can a young, active, strong person die of something usually associated with age and less-healthy lifestyles?
The vast majority of SCD cases happen to older adults who have underlying heart disease. According to John Perkins, M.D., an Emergency Department physician at Carilion Clinic and associate professor in the Department of Emergency Medicine at Virginia Tech Carilion School of Medicine (VTCSOM), only about 150 of the half-million annual cases of SCD happen to athletes under age 35.
“Sudden cardiac death in general is not a rare event, but sudden cardiac death in young athletes is really, really rare,” he said.
While small in number, each of those deaths is devastating, and a growing number of researchers and medical professionals believe that a revised screening process can help to prevent them in the future. Together with a team at VTCSOM, Dr. Perkins is conducting a study in partnership with Franklin County Public Schools that will add an electrocardiogram (EKG) test to the family history, personal history and physical examination currently recommended for student athletes by the American Heart Association.
In addition to the enhanced screening, the study will include a community outreach component that educates athletes and their families as well as school faculty and staff on what SCD is and how to respond when they see someone experience it.
What Is SCD?
SCD is the sudden, unexpected death from a cardiac cause, typically occurring within an hour of the onset of symptoms. SCD is characterized by an acute loss of consciousness.
According to Dr. Perkins, the causes of SCD vary by patient.
“In older adults, SCD is thought to be related to heart-related issues such as blockages,” he said. “In younger patients, congenital abnormalities—things that they were born with—are more likely to be at the root of it.”
Congenital abnormalities that may lead to SCD include:
- Hypertrophic cardiomyopathy (HCM). The most common cause of SCD in athletes, HCM thickens the heart muscle (myocardium), affecting its ability to pump blood.
- Structural abnormalities. If coronary arteries or the myocardium developed abnormally, connections and function can suffer, especially during exertion.
- Inflammation. Viruses and other illnesses can cause inflammation, which affects heart function.
- Heart rhythm disorders. Disorders such as long QT syndrome and Brugada syndrome can cause fast, erratic heartbeats.
These abnormalities do not always manifest symptoms preceding SCD. Often, the only discernible symptom that precedes SCD in young athletes is fainting, or syncope. While usually benign, syncope related to or caused by exertion should always be thoroughly investigated, including an EKG and a physician evaluation.
How to Respond to SCD
Just as the causes of SCD differ for older patients and young athletes, so too is the effectiveness of intervention by automated external defibrillators (AEDs).
AEDs are found in hospitals, businesses and schools. Combined with high-quality, chest compression-only cardiopulmonary resuscitation (CPR), AEDs can be effective in treating SCD.
“There are heart rhythms that the AED can’t shock, so the purpose of CPR is to circulate blood through the coronary arteries to get the patient to a heart rhythm that is shockable,” said Dr. Perkins.
A fast response is critical.
“The longer you delay CPR, the less blood is going through the coronary artery and the less likely you’re going to have a shockable rhythm,” explained Dr. Perkins.
Dr. Perkins believes that by teaching CPR and the use of AEDs, the outreach component of the Carilion study may affect many people far beyond the small number of student athletes at risk of SCD. The Carilion study will teach participants at Franklin County High School to use high-quality, chest compression-only CPR in conjunction with AED utilization.
“Student athletes are much more likely see somebody in the supermarket, in the drugstore, in the mall, collapse in an episode of sudden cardiac death,” he said. “Our real outreach is to educate athletes, faculty, staff, parents—anyone who shows up—about how to respond to it. Their actions in the next couple of minutes may determine whether that person lives or not.”