Sudden Cardiac Death in Athletes: Scope of the Problem and Emergency Response

  • Eric E. Coris
  • Steve Walz
  • Anne B. Curtis
  • Frances Sahebzamani
  • Kira Zwygart


Exceeding 300,000 cases annually, sudden cardiac death (SCD) is the leading cause of death in the United StatesUSA [1, 2]. [1, 2] SCD is also the leading cause of death in athletes [3].[ 3] Defined as occurring within one 1 hour of participation in sports [4],[4] exercise-related SCD occurs in 1-5 one to five cases per one million athletes per year. Of the approximately 25 million competitive athletes in the USAUnited States, there are 25-125 documented cases of SCD per year, likely a significant underestimation.[5].


Sudden Cardiac Death Brugada Syndrome Right Bundle Branch Block Automate External Defibrillator National Collegiate Athletic Association 
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  1. 1.
    Huikuri HV, Agustin C, Myerburg RJ. Sudden Death Due to Cardiac Arrhythmias. New England Journal of Medicine 2001;345(20):1473–1482.PubMedCrossRefGoogle Scholar
  2. 2.
    Gillum RF. Sudden Coronary Death in the United States. Circulation 1989;79:756–765.PubMedCrossRefGoogle Scholar
  3. 3.
    Ackerman MJ. The Long QT Syndrome: Ion Channel Diseases of the Heart. Mayo Clinic Proceedings 1998;73:250–269.PubMedCrossRefGoogle Scholar
  4. 4.
    Basilico F. Current Concepts: Cardiovascular Disease in Athletes. American Journal of Sports Medicine 1999;27(1):108–121.PubMedGoogle Scholar
  5. 5.
    Futterman LG MR. Sudden Death in Athletes: An Update. Sports Medicine 1998;26(5):335–350.PubMedCrossRefGoogle Scholar
  6. 6.
    Van Camp SP. Sudden Death. Clinics in Sports Medicine 1992;11(4):273–289.PubMedGoogle Scholar
  7. 7.
    Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular Pre-Participation Screening of Competitive Athletes. Circulation 1996;94(4):850–856.PubMedCrossRefGoogle Scholar
  8. 8.
    Cantu RC. Congenital Cardiovascular Disease: The Major Cause of Athletic Death in High School and College. Medicine and Science in Sports and Exercise 1992;24:279–280.PubMedGoogle Scholar
  9. 9.
    Myerburg RJ, Kessler KM, Castellanos A. Sudden Cardiac Death: Structure, Function, and Time-Dependence of Risk. Circulation 1992;85(Suppl I):I2–I10.PubMedGoogle Scholar
  10. 10.
    Maron BJ. Triggers for Sudden Cardiac Death in the Athlete. Cardiology Clinics 1996;14(2):195–210.PubMedCrossRefGoogle Scholar
  11. 11.
    Maron BJ SJ, Poliac LC, et al. Sudden Death in Young Competitive Athletes. JAMA 1996;276(3):199–204.PubMedCrossRefGoogle Scholar
  12. 12.
    Maron BJ, Thompson PD, Ackerman MJ, Balady G, et al. Recommendations and Considerations Related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update. Circulation 2007;115:1643–1655.PubMedCrossRefGoogle Scholar
  13. 13.
    Fuller CM, McNulty CM, Spring DA. Prospective Screening of 5,615 High School Athletes for Risk of Sudden Cardiac Death. Medicine and Science in Sports and Exercise 1997;29:1131–1138.PubMedCrossRefGoogle Scholar
  14. 14.
    Maron BJ, Bodison SA, Wesley YE, et al. Results of Screening a Large Group of Intercollegiate Competitive Athletes for Cardiovascular Disease. Journal of the American College of Cardiology 1987;10:1214–1221.PubMedCrossRefGoogle Scholar
  15. 15.
    Murray PM, Cantwell JD, Heath DL, et al. The Role of Limited Echocardiography in Screening Athletes. American Journal of Cardiology 1995;76:849–850.CrossRefGoogle Scholar
  16. 16.
    Lewis JF MB, Diggs JA, et al. Preparticipation Echocardiographic Screening for Cardiovascular Disease in a Large Predominantly Black Population of Collegiate Athletes. American Journal of Cardiology 1989;64:1029–1033.PubMedCrossRefGoogle Scholar
  17. 17.
    Matheson GO, Boyajian-O’Neill LA, Cardone D, Dexter W, et al. Preparticipation Physical Evaluation: Third Edition. Minneapolis, New York City: McGraw-Hill Companies, 2005.Google Scholar
  18. 18.
    Coris EE SF, Walz SJ, Ramirez AM. Automated External Defibrillators in Division I Athletics. American Journal of Sports Medicine 2004;32(3):744–754.PubMedCrossRefGoogle Scholar
  19. 19.
    White RD, Hankins DG, Bugliosi TF. Seven Years’ Experience with Early Defibrillation by Police and paramedics in an Emergency Medical Services System. Resuscitation 1998;39:145–151.PubMedCrossRefGoogle Scholar
  20. 20.
    Drezner JA, Courson RW, Roberts WO, Mosesso VN, et al. Interassociation Task Force Recommendations on Emergency Preparedness and Management of Sudden Cardiac Arrest in High School and College Athletic Programs: A Consensus Statement. Journal of Athletic Training 2007;41(1):143–158.Google Scholar
  21. 21.
    Coris EE, Miller E, Sahebzamani F. Sudden Cardiac Death in Division I Collegiate Athletics. Clinical Journal of Sports Medicine 2005;15(2):89–91.CrossRefGoogle Scholar
  22. 22.
    Bille K, Figueiras D, Schamasch P, Kappenberger L, et al. Sudden Cardiac Death in Athletes: the Lausanne Recommendations. European Journal of Cardiovascular Prevention and Rehabilitation 2006;13:859–875.PubMedCrossRefGoogle Scholar
  23. 23.
    Wingfield K, Matheson GO, Meeuwisse WH. Preparticipation Evaluation: An Evidence-Based Review. Clinical Journal of Sports Medicine 2004;14(3):109–122.CrossRefGoogle Scholar
  24. 24.
    Maron BJ, Poliac LC, Roberts WO. Risk of Sudden Cardiac Death Associated with Marathon Running. Journal of the American College of Cardiology 1996;28:428–431.PubMedCrossRefGoogle Scholar
  25. 25.
    Siscovick DS, Weiss NS, Fletcher RH, et al. The Incidence of Primary Cardiac Arrest During Vigorous Exercise. New England Journal of Medicine 1984;311:874–877.PubMedCrossRefGoogle Scholar
  26. 26.
    Link MS, Homoud MK, Wang PJ, Estes NAM. Cardiac Arrhythmias in the Athlete. Cardiology in Review 2001;9(1):21–30.PubMedCrossRefGoogle Scholar
  27. 27.
    Maron BJ, Towbin JA, Thiene G, Antzelevitch G, et al.. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 2006;113(14):1807–1816.PubMedCrossRefGoogle Scholar
  28. 28.
    Maron BJ, Roberts WC, Epstein SE. Sudden Death in Hypertrophic Cardiomyopathy: a Profile of 78 Patients. Circulation 1982;65:1388–1394.PubMedCrossRefGoogle Scholar
  29. 29.
    Shah JS, Tome Esteban MT, Thaman R, Sharma R, et al. Prevalence of Exercise Induced Left Ventricular Outflow Tract Obstruction in Symptomatic Patients with Non-obstructive Hypertrophic Cardiomyopathy. Heart 2008;94:1288–1294.PubMedCrossRefGoogle Scholar
  30. 30.
    Maron BJ, Gohman TE, Aeppli D. Prevalence of Sudden Cardiac Death During Competitive Sports Activities in Minnesota High School Athletes. Journal of the American College of Cardiology 1998;32:1881–1884.PubMedCrossRefGoogle Scholar
  31. 31.
    Lawless CE, Best TM. Electrocardiograms in Athletes: Interpretation and Diagnostic Accuracy. Medicine and Science in Sports and Exercise 2008;40(5):787–798.PubMedCrossRefGoogle Scholar
  32. 32.
    Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Gaetano T. Trends in Sudden Cardiovascular Death in Young Competitive Athletes After Implementation of a Preparticipation Screening Program. JAMA 2006;296(13):1593–1601.PubMedCrossRefGoogle Scholar
  33. 33.
    Feinstein RA, Colvin E, Oh MK. Echocardiographic Screening as Part of a Preparticipation Examination. Clinical Journal of Sports Medicine 1993;3:149–152.CrossRefGoogle Scholar
  34. 34.
    Koester MC. A Review of Sudden Cardiac Death in Young Athletes and Strategies for Preparticipation Cardiovascular Screening. Journal of Athletic Training 2001;36(2):197–204.PubMedGoogle Scholar
  35. 35.
    Cardiology ACo. ACC/ESC Clinical Expert Consensus Document on HCM. Journal of the American College of Cardiology 2003;42(9):1687–1713.Google Scholar
  36. 36.
    Orliaguet G, Ferjani M, Riou B. The Heart in Blunt Trauma. Anesthesiology 2001;95(2).Google Scholar
  37. 37.
    Perron AD, Brady WJ, Erling BF. Commotio Cordis: An Underappreciated Cause of Sudden Cardiac Death in Young Patients: Assessment and Management in the ED. American Journal of Emergency Medicine 2001;19(5):406–409.PubMedCrossRefGoogle Scholar
  38. 38.
    Kyle JM, Leaman J, Elkins G. Planning for Scholastic Cardiac Emergencies: The Ripley Project. The West Virginia Medical Journal 1999;95(September/October):258–260.PubMedGoogle Scholar
  39. 39.
    Berger, S Dhala A, Friedberg DZ. Sudden Cardiac Death in Infants, Children, and Adolescents. Pediatric Clinics of North America 1999;46(2):221–227.PubMedCrossRefGoogle Scholar
  40. 40.
    Thiene G, Basso C, Corrado D. Is Prevention of Sudden Death in Young Athletes Feasible. Cardiologia 1999;44:497–505.PubMedGoogle Scholar
  41. 41.
    Liberthson RR, Dinsmore RE, Fallon JT. Aberrant Coronary Artery Origin from the Aorta: Report of 18 Patients, Review of the Literature and Delineation of Natural History and Management. Circulation 1979;59:748–754.PubMedCrossRefGoogle Scholar
  42. 42.
    Basso C, Maron BJ, Corrado D, Thiene G. Clinical Profile of Congenital Coronary Artery Anomalies with Origin from the Wrong Aortic Sinus Leading to Sudden Death in Young Competitive Athletes. Journal of the American College of Cardiology 2000;35:1493–1501.PubMedCrossRefGoogle Scholar
  43. 43.
    Moss AJ. Sudden Cardiac Death and National Health. Pacing and Clinical Electrophysiology 1993;16:2190–2191.PubMedCrossRefGoogle Scholar
  44. 44.
    Weidenbener EJ, Krauss MD, Waller BF, et al. Incorporation of Screening Echocardiography in the Preparticipation Examination. Clinical Journal of Sports Medicine 1995;5:86–89.CrossRefGoogle Scholar
  45. 45.
    Bresler MJ. Acute Pericarditis and Myocarditis. Emergency Medicine 1992;24:35–51.Google Scholar
  46. 46.
    Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE. Task Force 4: HCM and Other Cardiomyopathies, Mitral Valve Prolapse, Myocarditis, and Marfan Syndrome. Journal of the American College of Cardiology 2005;45(8):1340–1345.PubMedCrossRefGoogle Scholar
  47. 47.
    Lecomte D, Fornes P, Fouret P, Nicholas G. Isolated Myocardial Fibrosis as a Cause of Sudden Cardiac Death and Its Possible Relation to Myocarditis. Journal of Forensic Science 1993;38:617–621.Google Scholar
  48. 48.
    Maron BJ, Chaitman BR, Ackerman MJ, Bayés de Luna A, et al., Working Groups of the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention; Councils on Clinical Cardiology and Cardiovascular Disease in the Young. Recommendations for Physical Activity and Recreational Sports Participation for Young Patients with Genetic Cardiovascular Diseases. Circulation 2004;109(22):2807–2816.PubMedCrossRefGoogle Scholar
  49. 49.
    McKeag DB. Preparticipation Screening of the Potential Athlete. Clinics in Sports Medicine 1989;8:373–397.PubMedGoogle Scholar
  50. 50.
    Kapetanopoulos A, Kluger J, Maron BJ, Thompson PD. The Congenital Long QT Syndrome and Implications for Young Athletes. Medicine and Science in Sports Exercise 2006;35(5):816–825.Google Scholar
  51. 51.
    Reiserdorff EJ, Prodinger RJ. Sudden Cardiac Death in the Athlete. Emergency Medical Clinics of North America 1998;16:281–294.CrossRefGoogle Scholar
  52. 52.
    Lawless CE. Implantable Cardiac Defibrillators in Athletes. Current Sports Medicine Reports 2008;7(2):79–85.Google Scholar
  53. 53.
    Sarubbi B. The Wolff–Parkinson–White Electrocardiogram Pattern in Athletes: How and When to Evaluate the Risk for Dangerous Arrhythmias. The Opinion of the Paediatric Cardiologist. The Journal of Cardiovascular Medicine 2006;7(4):271–278.CrossRefGoogle Scholar
  54. 54.
    Basso C, Corrado D, Thiene G. Arrhythmogenic Right Ventricular Cardiomyopathy in Athletes: Diagnosis, Management, and Recommendations for Sport Activity. Cardiology Clinics 2007;25:415–422.PubMedCrossRefGoogle Scholar
  55. 55.
    Rampazzo A, Nava A, Malacrida S, et al. Mutation in Human Desmoplakin Domain Binding to Plakoglobin Causes a Dominant Form of Arrhythmogenic Right Ventricular Cardiomyopathy. American Journal of Human Genetics 2002;71:1200–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Anderson JC, Courson RW, Kleiner DM, McLoda TA. National Athletic Trainers’ Association Position Statement: Emergency Planning in Athletics. Journal of Athletic Training 2002;37(1):99–104.Google Scholar
  57. 57.
    Cummins RO, Ornato JP, Thies WH, et al. Improving Survival From Sudden Cardiac Arrest: The Chain of Survival Concept. Circulation 1991;83:1832–1847.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Eric E. Coris
    • 1
    • 2
  • Steve Walz
  • Anne B. Curtis
  • Frances Sahebzamani
  • Kira Zwygart
  1. 1.Department of Family MedicineUniversity of South Florida College of MedicineTampaUSA
  2. 2.Department of Orthopaedics and Sports MedicineUniversity of South Florida College of MedicineTampaUSA

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