Abstract
Sudden cardiac death (SCD) during sports activities accounts for a small but significant proportion of all SCD, with recent studies consistently reporting around 5% of overall SCD occurring during sporting activity. The emphasis on young competitive athletes as opposed to recreational sports participants is discordant with the relative magnitudes of the respective problems, which was recently highlighted by several recent population-based studies. There is a crucial need to focus attention on this large at-risk population of subjects. Although coronary artery disease represents the vast majority of underlying mechanisms in recreational middle age cases, cardiomyopathies and inherited electrical disorders remain significant among the youngest. Strategies to reduce SCD burden related to sports should incorporate targeted screening, public education and consideration of warming symptoms, improving rates of bystander CPR and early AED use.
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1.1 Questions
- 1.
A 45-year-old male with diagnosed coronary artery disease recently underwent coronary angiography and stenting. He is presently asymptomatic. He seeks your advice regarding playing recreational tennis in the evenings, as he is worried after reading about instances of people dying suddenly while playing. Would you advise him to play sports?
- 2.
The owner of a fitness center chain contacts you for advice as there was a recent case of a person having a sudden cardiac arrest while exercising in one of his facilities. He asks you to suggest some measures which would be useful to prevent such events in the future. What are some practically useful measures which you can suggest?
1.2 Answers
- 1.
Yes. While there is a transient small risk of SCD associated with vigorous physical activity, this should not overshadow the fact that regular exercise/sports have irrefutable cardiovascular benefits. Therefore, a blanket prohibition of sports in this case is not warranted. However, a thorough discussion and patient education is mandatory, with advice to gradually build up the activity level and to pay attention to any warning symptoms during exercise which can often precede an SCD event.
- 2.
Strategies to prevent sports related SCD include targeted screening of individuals, public education and better AED access. Some practical measures which the fitness chain owner can implement could include arranging educational talks by experts for participants in the centers, focusing on cardiovascular prevention, early evaluation of any potential symptoms and also stressing the importance of early response in case of a witnessed cardiac arrest. Training in CPR can be arranged for interested volunteers and lastly AEDs can be made available in all centers. These strategies should help reduce instances of SCD during exercise and improve rates of bystander CPR and early AED use, two key determinants of survival after SCD.
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Jouven, X., Narayanan, K., Marijon, E. (2020). Incidence and Causes of Sudden Cardiac Death in Recreational Athletes. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_30
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