The Olympic Athlete and the Risk of Sudden Cardiac Death

It has been a thrilling 31st (XXXI) Summer Olympics watching exceptional athletes who have endured years of intense training and personal sacrifices to compete for the gold. But what about those athletes who have invested years into their sport to only find out one day that they have a potentially life-threatening heart disease that disqualifies them from ever training and competing again? Unfortunately, some athletes are born, unknowingly, with a genetic predisposition to a heart disease that can cause their heart to suddenly stop beating.

David Epstein, author of New York Times bestselling book, “The Sports Gene, Inside the Science of Extraordinary Performance,” labels it the “heartbreak gene,” a genetic mutation that causes hypertrophic cardiomyopathy (HCM), a chronic heart condition that can sideline, or worse, kill an athlete in his or her prime.

HCM affects 1 in 500 people, and it is the leading cause of sudden death in athletes. With more than 11,000 athletes competing in the 2016 Summer Olympics, it is possible that an athlete could have cardiomyopathy or another heart condition that puts him or her at risk of sudden cardiac death. Former Olympic medalists like American volleyball star Flo Hyman, Great Britain’s swimmer Shelagh Ratcliffe and Norway’s swimmer Alexander Dale Oen all suffered sudden cardiac arrests (SCA). Ratcliffe nearly drowned, and sadly, Hyman and Dale Oen did not survive.

Because cardiomyopathy is an extremely variable disease, it is difficult to determine who is more at-risk of sudden cardiac death. However, we do know that age is a factor and those under age 30—athletes at the peak of their game—are at higher risk. We also know that extreme exercise such as Olympic training places tremendous strain on a HCM heart. This is why we need to make cardiac safety a priority, and athletes need to learn how to manage their cardiac health so they can perform at an optimal level without deadly consequences.

Most international sports organizations are taking preventative measures to protect athletes from underlying heart conditions. The International Olympic Committee (IOC) recommends—but does not mandate—that all countries screen their athletes for serious heart conditions such as HCM. For the 2012 Summer Olympics held in London, officials formed a cardiology team to safeguard athletes competing in high endurance events such as the marathon, triathlon and cycling. The cardiac team placed automated external defibrillators (AEDs) for every mile of the marathon, and cycle responders equipped with AEDs were stationed in between to handle potential cardiac emergencies.

While these efforts are commendable, I wonder what else we can do to protect young athletes. Only 20 percent of athletes with a serious heart condition like cardiomyopathy manifest with any symptoms, which leaves some at risk of sudden cardiac death. Watching the Olympic closing ceremonies tomorrow, I will be thinking about a 16-year-old swimmer named Chloe Waddell who missed her chance at the Olympics. Chloe was expected to represent Team Great Britain in Rio this summer but died unexpectedly from undiagnosed HCM.

Until there is universal protocol on cardiac screening among athletic associations and heart organizations, we need to focus on educating the public about sudden cardiac death associated with cardiomyopathy. This September, the Children’s Cardiomyopathy Foundation, along with partners including the American Academy of Pediatrics, Centers for Disease Control and Prevention, National Athletic Trainers’ Association, and National Alliance for Youth Sports, will be a part of a team working to raise awareness of cardiomyopathy during Children’s Cardiomyopathy Awareness Month. The goal is to highlight the signs, symptoms and risk factors associated with the disease and identify more undiagnosed at-risk children so that they can get the appropriate medical care.

Knowing your family cardiac history is important as heart disease is often inherited. If you have a family member with a known heart condition or who died suddenly or during exercise before the age of 50, a cardiologist should be consulted for an evaluation. Recognizing the signs and symptoms for cardiomyopathy is equally important. Common symptoms include fatigue, feeling light-headed or dizzy, chest pain, shortness of breath, heart palpitations, and nausea.

Having a cardiac emergency plan in place is critical to saving lives. HCM is often called the “silent killer” because the first sign can be a cardiac arrest and then death if intervention is not immediate. CPR trained individuals on site and automatic external defibrillators (AEDs) in accessible locations can make the difference between life or death.

There are thousands of promising athletes training every day for a chance to compete in the next Olympics. These guidelines for preventing sudden cardiac death not only applies to Olympic hopefuls but to student athletes, coaches and the school and community centers where they practice. Taking the proper precautions for sports include a thorough pre-participation physical examination and review of family health history. If our efforts during Children’s Cardiomyopathy Awareness Month can save more talented athletes like Chloe Waddell, it will be worth all the gold medals ever won.

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