Sudden Death in Athletes Prevention Program
Keith Mankowitz, MD – Director
The sudden death of a young athlete is a tragic event that has devastating effects on families and communities. These deaths are usually due to unsuspected heart disease. Many heart conditions are not detected by routine screening measures.
Here we outline the incidence and causes of sudden death in athletes under 35 years of age and discuss measures on how to prevent this devastating event. The information is intended as a guide for institutions who are involved with screening athletes under 35 years.
INCIDENCE, MECHANISM AND CARDIAC CAUSES OF DEATH
Incidence
There are approximately 75 deaths per year in athletes between 13-25 years. 89% occur in males, 64% occur in females. Most deaths occur during or immediately after exercise.
Mechanism of Death
Certain heart conditions react adversely to exercise. Exercise causes the heart to fibrillate, usually ventricular fibrillation and then stop. The athlete collapses suddenly and if not resuscitated immediately dies within minutes.
Cardiac Causes of Sudden Death
Hypertrophic cardiomyopathy: 36%
Coronary anomalies: 17%
Myocarditis: 6%
Arrhythmogenic Right Ventricular Dysplasia: 4%
Long QT Syndrome: 4%
CORONARY ANOMALIES
The above diagram depicts the normal 3 major coronary arteries which supply the heart with nutrition & oxygen.
Coronary anomalies occur when the arteries originate and/or course in an abnormal way.
The arrow points to the normal origin of the right coronary artery from the right side of the Aorta. If the left coronary artery originated from this site, it would have to course across the heart to reach its intended heart muscle. This abnormal course could result in compression of the artery between the Aorta and the Pulmonary artery during exertion resulting in chest pain, shortness of breath or sudden death.

Heart Anatomy
The diagnosis can only be made if an athlete with chest pain or shortness of breath undergoes a detailed Echocardiogram looking at the coronary arteries, a CAT Scan of the heart or a MRI of the heart.
PREVENTIVE MEASURES
Ensure that athletes with chest pain, shortness of breath, palpitations or passing out undergo a thorough medical evaluation. Train athletes with a graded program gradually building up their fitness level. Keep athletes well hydrated. Respond immediately to an athlete who has collapsed and be aware that the athlete may have suffered a cardiac arrest.
Train your staff to perform cardiac life support and have trained staff available at every practice and sporting event. Purchase a debrillator and ensure it is readily accessible.
Dr. Keith Mankowitz, the Director of the Sudden Death in Athletes Prevention Program at Washington University, is offering St Louis High Schools the following:
1) Advice on measures to prevent injury and death in athletes.
2) Review their current screening forms to ensure they comply with the American Heart Association guidelines.
3) Encourage coaches and sports personnel to be certified in cardiac resuscitation.
SOURCE: cardiology.wustl.edu
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