Sudden Cardiac Death
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- Elisabeth Ward
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1 Sudden Cardiac Death
2 Exercise and Risk SCD and AMI 6-17 times more likely to occur during physical activity Still very low risk overall SCD overall occurs around once per 1.5 million episodes of vigorous exertion in men and once per 36.5 million hours of vigorous exertion in women
3 Exercise and Risk About one death per 396,000 hours of jogging One death per 2,897,057 person-hours at a YMCA More than 10 million marathon and ½ marathon participants reviewed and found a rate of 1/184,000 runners with cardiac arrest and 1/296,000 suffered a SCD
4 Physical Activity Still has a Risk Onset study Twice the risk of of an AMI during vigorous activity than at rest for those that exercise 1hr 5 days a week The inactive group had an AMI rate 50 times higher than the exercise group at vigorous exercise
5 Physical Activity Onset study also showed that the in regular exercisers the rate of CVD events decreased by 50% for 24 hour during and after the vigorous exercise
6 ACSM Preparticipation Health Screening Removed CVD risk factor screening 65 million US adults have hypertension 71 million US adults have high LDL Estimated 600,000 die each year from heart disease in total and only a small fraction die from exercise-associated SCD or AMI
7 ACSM Preparticipation Health Screening Asymptomatic healthy exercising Cleared to continue, see PCP if symptoms begin Asymptomatic with history of CVD, DM, or renal disease exercising Clearance good for 12 months if no change in disease or exercise intensity
8 ACSM Preparticipation Health Screening Asymptomatic healthy inactive Cleared for light intensity and slow progression without need of medical clearance unless symptoms present. Asymptomatic with known CVD, DM, or renal disease or having symptoms suggestive of a disease process should seek medical clearance prior to any exercise intensity program
9 Divergent Etiology Over 35 y/o majority of cases are CAD Under 35 y/o usual etiology of SCD is structural.
10 Figure 1 Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review. Harmon, Kimberly; Asif, Irfan; Maleszewski, Joseph; Owens, David; MD, MS; Prutkin, Jordan; MD, MHS; Salerno, Jack; Zigman, Monica; Ellenbogen, Rachel; Rao, Ashwin; Ackerman, Michael; MD, PhD; Drezner, Jonathan Circulation. 132(1):10-19, July 7, DOI: /CIRCULATIONAHA Figure 1. Causes of death in NCAA athletes 2003 to Etoh indicates ethanol; NCAA, National Collegiate Athletic Association; and SCT, sickle cell trait by the American College of Cardiology Foundation and the American Heart Association, Inc.. Published by American Heart Association. 4
11 Breakdown of Accidental Death Type Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review. Harmon, Kimberly; Asif, Irfan; Maleszewski, Joseph; Owens, David; MD, MS; Prutkin, Jordan; MD, MHS; Salerno, Jack; Zigman, Monica; Ellenbogen, Rachel; Rao, Ashwin; Ackerman, Michael; MD, PhD; Drezner, Jonathan Circulation. 132(1):10-19, July 7, DOI: /CIRCULATIONAHA by the American College of Cardiology Foundation and the American Heart Association, Inc.. Published by American Heart Association. 3
12 Source of Information for Determination of Cause of Death Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review. Harmon, Kimberly; Asif, Irfan; Maleszewski, Joseph; Owens, David; MD, MS; Prutkin, Jordan; MD, MHS; Salerno, Jack; Zigman, Monica; Ellenbogen, Rachel; Rao, Ashwin; Ackerman, Michael; MD, PhD; Drezner, Jonathan Circulation. 132(1):10-19, July 7, DOI: /CIRCULATIONAHA by the American College of Cardiology Foundation and the American Heart Association, Inc.. Published by American Heart Association. 8
13 Incidence of Sudden Cardiac Death in NCAA Athletes Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review. Harmon, Kimberly; Asif, Irfan; Maleszewski, Joseph; Owens, David; MD, MS; Prutkin, Jordan; MD, MHS; Salerno, Jack; Zigman, Monica; Ellenbogen, Rachel; Rao, Ashwin; Ackerman, Michael; MD, PhD; Drezner, Jonathan Circulation. 132(1):10-19, July 7, DOI: /CIRCULATIONAHA by the American College of Cardiology Foundation and the American Heart Association, Inc.. Published by American Heart Association. 5
14 Causes of Sudden Cardiac Death in Athletes Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review. Harmon, Kimberly; Asif, Irfan; Maleszewski, Joseph; Owens, David; MD, MS; Prutkin, Jordan; MD, MHS; Salerno, Jack; Zigman, Monica; Ellenbogen, Rachel; Rao, Ashwin; Ackerman, Michael; MD, PhD; Drezner, Jonathan Circulation. 132(1):10-19, July 7, DOI: /CIRCULATIONAHA Figure 2. A, Causes of sudden cardiac death in athletes. B, Cause and activity at time of death. One person figure equals 1 death; female figures follow male figures, unless no male deaths were present. AN-SUD indicates autopsynegative sudden unexplained death; ARVC, arrhythmogenic right ventricular cardiomyopathy; CAD, coronary artery disease; DCM, dilated cardiomyopathy; HCM, hypertrophic cardiomyopathy; LVH, left ventricular hypertrophy; NOS, not otherwise specified; SCT, sickle cell trait; SUD, sudden unexplained death; and WPW, Wolff-Parkinson-White by the American College of Cardiology Foundation and the American Heart Association, Inc.. Published by American Heart Association. 9
15 Activity at time of SCD 56% with exertion 22% at rest 14% during sleep 9% unknown
16 Incidence of Sudden Cardiac Death in Sports Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review. Harmon, Kimberly; Asif, Irfan; Maleszewski, Joseph; Owens, David; MD, MS; Prutkin, Jordan; MD, MHS; Salerno, Jack; Zigman, Monica; Ellenbogen, Rachel; Rao, Ashwin; Ackerman, Michael; MD, PhD; Drezner, Jonathan Circulation. 132(1):10-19, July 7, DOI: /CIRCULATIONAHA by the American College of Cardiology Foundation and the American Heart Association, Inc.. Published by American Heart Association. 7
17 Incidence of Sudden Cardiac Death in Male Basketball Athletes Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review. Harmon, Kimberly; Asif, Irfan; Maleszewski, Joseph; Owens, David; MD, MS; Prutkin, Jordan; MD, MHS; Salerno, Jack; Zigman, Monica; Ellenbogen, Rachel; Rao, Ashwin; Ackerman, Michael; MD, PhD; Drezner, Jonathan Circulation. 132(1):10-19, July 7, DOI: /CIRCULATIONAHA by the American College of Cardiology Foundation and the American Heart Association, Inc.. Published by American Heart Association. 6
18 Where Do We Go? Current recommendation is the screening PPE cardiac questions. Consider and studies ongoing on using an EKG High level or High risk ( Male Division 1 basketball) consider EKG and echocardiogram Interesting point is SCD incidence is much higher in NCAA sports than both heat illness and sickle cell trait reported death,
19 Thank You?
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