The risk of sudden cardiac arrest in young athletes

It’s every parent’s worst nightmare: the loss of a child to a preventable death. Sadly, some grieving parents learn too late that their child’s life could have been saved if they had been screened for heart conditions prior to participating in sports.

“Teens can have various heart issues,” says Dr. Nassir Azimi, an interventional cardiologist affiliated with Sharp Grossmont Hospital’s Burr Heart & Vascular Center. “The one we are most concerned about is sudden cardiac arrest, which can lead to sudden cardiac death.”

Sudden cardiac arrest (SCA) is the No. 1 killer of student athletes and the leading cause of death on school campuses, according to the Eric Paredes Save A Life Foundation, a nonprofit organization established after the death of Eric Paredes, a San Diego high school student athlete who died suddenly from SCA. His parents established the foundation to honor him through their commitment to prevent the same tragedy from happening to other families.

Sudden cardiac arrest is the abrupt loss of heart function. According to the American Heart Association, although it’s often confused with a heart attack, the two conditions are very different. A heart attack happens when blood flow to the heart is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. With SCA, the heart stops beating.

Causes of SCA
SCA can occur in people who may or may not have been diagnosed with heart disease. What’s more, many people who have SCA may not experience or notice any symptoms, or there are symptoms present but they are unrecognized, unreported, missed or misdiagnosed.

Studies show that 1 in 300 young people has an undetected heart condition that puts them at risk of sudden cardiac arrest. The loss of heart function can be wholly unexpected for both the athlete and their loved ones.

According to Dr. Azimi, some of the conditions that could cause SCA include:

• Hypertrophic cardiomyopathy (HCM), which occurs when the muscle in the heart’s lower chambers thicken, causing an abnormal heart rhythm.

• Long QT syndrome (LQTS), an arrhythmia (irregular heart rhythm) that causes a fast and chaotic heartbeat.

• Wolff-Parkinson-White syndrome (WPW), which occurs when an extra electrical pathway in the heart creates a detour for blood flow, resulting in the heart pumping quickly.

• Arrhythmogenic right ventricular dysplasia (ARVD), an inherited condition, it occurs if the muscle tissue in the right ventricle dies and is replaced with scar tissue, which disrupts the heart’s electrical signals and causes irregular heart rhythms.

• Coronary artery abnormalities, which are typically congenital.

• Other primary arrhythmias, or irregular heartbeats, such as sinus tachycardia, supraventricular tachycardia, nonspecific arrhythmia, bradycardia and atrial fibrillation (AFib).

• Myocarditis, which is inflammation of the heart muscles caused by viral infections; it was recently linked in very rare cases to receiving a COVID-19 vaccine.

• Marfan syndrome, a connective tissue disorder that leads to weakening of the aorta and a sudden tear.

“There is also a phenomenon called commotio cordis, in which a sudden blunt impact to the chest can cause sudden death,” Dr. Azimi says. “This condition was first described in the 18th century in the context of chest trauma among workers but has since been seen in modern-day athletes who play baseball, softball, lacrosse and hockey as well.”

Preventing SCA
Adults who spend time with student athletes — parents, coaches, teachers and trainers — should ensure that all students participating in athletic activities get a sports physical and additional testing as needed.

However, heart screenings — such as EKGs, the most effective screening tool — are not included in standard well-child checkups or pre-participation sports physicals. It has been found that regular checkups miss 90% of young people at risk for sudden cardiac arrest.

Select organizations, such as the Eric Paredes Save A Life Foundation, offer free heart screenings to young people. Though, because these events are limited, experts advise parents to ask their child’s doctor to order a youth heart screening, especially if warning signs or risk factors are present.

Responsible adults should also be aware of the warning signs of conditions that could cause SCA and take action if they are recognized. Warning signs include:

• Fainting or seizure, especially during or right after exercise

• Fainting repeatedly or with excitement or startle

• Excessive shortness of breath during exercise

• Racing or fluttering heart palpitations or irregular heartbeat

• Repeated dizziness or lightheadedness

• Chest pain or discomfort with exercise

• Excessive, unexpected fatigue during or after exercise

“Parents and coaches can protect the athlete at risk by having them get an EKG,” Dr. Azimi says. “If the screening results are abnormal, the young athlete must be evaluated by a cardiologist, particularly if they have a family history of heart disease.”

Treating heart disease and SCA
According to Dr. Azimi, if your child’s EKG results are positive for conditions that could lead to SCA, your child’s doctor may request additional tests, recommend not participating in competitive sports, or suggest procedures to address the underlying condition.

Additionally, Dr. Azimi recommends that all coaches, trainers and school staff should have training in basic cardiac life support (BCLS), which includes techniques to stabilize a person’s airway, breathing and circulation, as well as instruction on how to do cardiopulmonary resuscitation (CPR). Automated external defibrillators (AEDs) should also be made available and accessible wherever sports take place.

“During sudden cardiac arrest, your young athlete’s survival might depend on those who are nearby calling 911, starting CPR and knowing how and when to use an AED,” Dr. Azimi says. “Make sure all those elements are in place to occur if ever needed.”