Sudden Death in Sports: Case Report and Review of an Ongoing Problem

Sudden death (SD) is defined as an unexpected fatal event that occurs in an apparently healthy person. The relationship between SD and sports is time-bound, as most of these events occur during or immediately after training or competition. These cases consistently make headlines in sports media, generating uncertainty in this community, as it is difficult to understand how young, energetic and apparently healthy people can die while playing their usual sports. So it is necessary to invest sufficient resources to address the problem through a multidisciplinary approach, identifying individuals at high risk who may benefit from preventive treatment strategies.

This paper described the case of sudden death in a young professional athlete who was successfully aided and resuscitated outside the hospital, and reviewed the literature about sudden death in sports. A 16-year-old boy, competing on an elite rowing team, felt dizzy and lost consciousness during a monitored training session. Upon confirming that the boy had no pulse or breathing, his coach immediately proceeded to perform basic cardiopulmonary resuscitation (CPR) and another person present at the scene provided an automatic external defibrillator, and the boy was administered two pulses of 300 Joules. After the second pulse, the boy resumed spontaneous cardiac rhythm and breathing.

The authors also searched for Sudden Death (according to the International Classification of Diseases (ICD-9 and ICD-10)) in the hospital but found no other relevant cases. They performed a literature search on the state of the art in sudden death (Google Scholar, PubMed, LILACS, Scielo and the Revista Española de Cardiología). Although the authors observed that the prevalence of sudden death was not very high, it still represented a potentially avoidable event. An adequate medical examination prior to regular sporting practice can decrease the incidence of sudden death in athletes under the age of 35. Data available in the literature support medical check-ups that include history-taking, physical examination and electrocardiogram. The findings of this evaluation may also prompt further assessment (electrocardiograph, ergometry). 

In summary, the authors propose: 1) a pre-participation medical check-up for all competitive athletes as a pre-condition to their registration in nationally recognized sporting events; 2) the performance of a basic physical examination, assessing key medical indicators; 3) performance of a 12-lead resting ECG. In short, identifying people at high risk would enable the medical community to persuasively discourage them from participating in sports, thereby reducing their risk and preventing new cases of SD.

Article by María Elena Caparrós-Hernández, et al, from Spain.

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