Sudden cardiac death
Sudden death in athletes is normally due to problems with the heart. It is most common in 45-75 year olds when it is associated with coronary artery disease, the risk increasing with age. In athletes under 35 it’s mainly due to inherited abnormalities such as thickening of the heart muscle (hypertrophic cardiomyopathy) and electrical abnormalities, which increase the risk of arrhythmia (irregular heartbeat).
The risk of sudden death due to coronary artery disease is highest when vigorous exercise is first taken up. The risk approximately doubles during physical activity and is two to three times more common in athletes than in non-athletes. The risk is low – 1-3 per 100,000 for young athletes, rising to one per 1000 in older age groups. Men are more commonly affected than women. More than 80 per cent of sudden cardiac deaths in older adults are due to coronary artery disease. In this group regular exercise reduces the early peak in risk due to its positive effect on the causes of coronary artery disease. In the long term, the more you cycle, the lower your risk of sudden cardiac death. In Italy it is mandatory to have an ECG (a test that looks at the electrical conduction pathways around the heart using electrodes placed on the chest) before taking part in any competitive sports. This test is most useful in younger athletes where it can pick up hypertrophic cardiomyopathy in 95-97 per cent of cases. The charity CRY (www.c-r-y.org.uk) offers subsidised ECG screening to athletes between 14 and 35 years of age and is recommended if you’re considering participating in nonamateur level sports.
In older adults, where coronary artery disease is the biggest cause, an ECG is less likely to be helpful. Age, family history of heart disease and presence of risk factors such as high blood pressure and cholesterol will help decide whether screening tests are needed.
Dr Ian Loke, consultant cardiologist, tells us: “A confirmed history of any immediate family member suffering a previous cardiac arrest, particularly in their youth, requires evaluation.
“See your GP if there’s a history of chest discomfort, palpitations or dizziness associated with exertion, as well as a family history of sudden death. It may well require specialist assessment by a cardiologist.”
Ian also recommends looking after yourself during a ride: “It’s always a good idea to be well hydrated during activity and you should be well prepared before strenuous and long rides, as severe dehydration can increase the risk of cardiac events.”