Sudden Cardiac Arrest in Athletes Capital City Sports Summit June 7, 2012
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1 Sudden Cardiac Arrest in Athletes Capital City Sports Summit June 7, 2012 John Katopodis, MD, FACC Southern Medical Group Cardiology Tallahassee, Florida
2 Scope of the Problem Relating to Screening and Prevention of Sudden Death in Athletes > 5 Million individual competitive high school athletes > 500,000 college athletes 5,000 professional athletes Circulation 2007; 115:
3 Incidence of Sudden Cardiac Death in NCAA Athletes All cases of sudden death in NCAA student athletes were identified using an NCAA database, weekly search of public media reports and catastrophic insurance claims from There were 273 deaths and a total of 1,969,663 athlete participant years Circulation 2011; 123:
4 Causes of sudden death in National Collegiate Athletic Association athletes, 2004 to Harmon K G et al. Circulation 2011;123: Copyright American Heart Association
5 Incidence of Sudden Cardiac Death in NCAA Athletes Overall 1:43,770 Male 1:33,134 Female 1:76,646 African American 1:17,696 Caucasian 1:58,653 Circulation 2011; 123:
6 Incidence of Sudden Cardiac Death in NCAA Athletes Basketball 1:11,394 Swimming 1:21,293 Lacrosse 1:23,357 Football 1:38,497 Cross Country 1:41,695 Circulation 2011; 123:
7 Incidence of Sudden Cardiac Death in NCAA Athletes Division I 1:29,186 Division II 1:42,457 Division III 1:95,032 Circulation 2011; 123:
8 Incidence of Sudden Cardiac Death in NCAA Athletes Division I Black Male Basketball 1:1,281 Division I White Male Basketball 1:3,947 Circulation 2011; 123:
9 Figure. Distribution of cardiovascular causes of sudden death in 1435 young competitive athletes. Maron B J et al. Circulation 2007;115: Copyright American Heart Association
10 Hypertrophic Cardiomyopathy (36-44%)
11 Hypertrophic Cardiomyopathy
12 Coronary Anomalies (17%)
13 Dilated Cardiomyopathy (2%)
14 Dilated Cardiomyopathy
15 Bicuspid Aortic Valve
16 Bicuspid Aortic Valve
17 Should an EKG be Included in the Pre-participation Evaluation? The American Heart Association says no, cost per life saved is $3.4 Million for an annual cost of $2 Billion per year The European Society of Cardiology says yes based on extensive Italian experience with screening EKG s
18 The Italian Experience ,735 athletes screened 621 (1.8%) were disqualified for cardiovascular reasons: 38% rhythm and conduction abnormalities 27% hypertension 21% valve disease 3.6% hypertrophic cardiomyopathy NEJM 1998; 339:
19 Causes of Death (%) Athletes Non- Athletes ARVD Anomalous Coronary HCM DCM 2 4 NEJM 1998; 339:
20 The 12 Element AHA Recommendations for Preparticipation Cardiovascular Screening of Competitive Athletes
21 Personal History 1. Exertional chest pain or discomfort 2. History of syncope or near syncope 3. Excessive exertional and unexplained dyspnea/fatigue associated with exercise 4. Prior recognition of a heart murmur 5. Elevated blood pressure
22 Family History 6. Premature death (sudden and unexpected, or otherwise) before age 50 due to heart disease in one or more relatives 7. Disability from heart disease in a close relative <50 years of age 8. Specific knowledge of certain cardiac conditions in family members such as HCM, DCM, LQTS, Marfan s, or arrhythmias
23 Physical Examination 9. Heart murmur 10.Femoral pulses to exclude aortic coarctation 11.Physical stigmata of Marfan syndrome 12.Blood pressure
24 Collapsed and Unresponsive Athlete AIRWAY BREATHING CIRCULATION Rhythm assessment with an AED
25 Implement Emergency Action Plan Have certifications in BLS (ACLS?) Know location and use of AED Call EMS, have prearranged protocols with local EMS agencies
26 Differential Diagnosis of Non- Traumatic Syncope or Pre-Syncope Cardiac arrest Exertional heat stroke Heat exhaustion Hyponatremia Hypoglycemia Exertional sickling Neurocardiogenic syncope Seizures Pulmonary embolus Cardiac arrhythmias Valvular disorders Coronary artery disease Cardiomyopathy Ion channel disorders Other structural heart disease
27 AT s are the Front Line Be vigilant Keep in constant communication with the athletes Obtain accurate data when events happen Work closely with the medical team Follow the medical team s instructions
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