sudden death

Monday, December 4, 2017

Citius, Altius, Fortius. Nowhere in the Olympic motto does it say higher, faster, stronger, suddenly die. And for that reason, when an athlete collapses on the court, our ability to understand the body is more than a little strained. For the basketball fans watching North Carolina State hosting South Carolina State, the collapse of Tyvoris Solomon was more than unexpected, it was not understandable. There is a happy ending because of the quick actions of the South Carolina medical staff and with CPR, Mr. Solomon was resuscitated, resting in hospital and able to talk about he cheated sudden death. Actually, he doesn’t remember…he remembers sitting on the bench and then nothing until he awoke in the ambulance. Other elite athletes have been less fortunate and have died on the court. Regardless of the success rate in television fiction, sudden death is often permanent.

There are a variety of causes of sudden death but most all revolve around the heart and its ability to pump blood to the body. Not only does the muscle have to work, but also there needs to be normal electricity to allow the electric pump that is the heart to squeeze in a coordinated fashion. If the brain loses blood supply for even a few seconds, it turns off and the victim can fall unconscious to the floor. The most common cause of this sudden in an athlete is hypertrophic cardiomyopathy, an abnormal thickening of the heart muscle that causes the fatal heart rhythm of ventricular fibrillation or V-Fib. Instead of sending a coordinated electrical signal to all heart muscle cells to squeeze at the same time, the electricity is chaotic, each cell squeezes to its own drummer, the heart quivers like a bowl of Jello-O and no blood gets pumped to the body.

                

Normal Heart Rhythm                                         Ventricular Fibrillation 9V Fib)

The question becomes, how do we find those at risk before sudden death becomes sudden? There has always been debate about how much time, effort and money should be spent on screening all high school and college athletes just to find the one person at risk. There is some debate by medical experts as to whether heart screening with EKGs and echocardiograms (heart ultrasound) would actually work, but there are guidelines on how to find athletes who might have a higher risk of heart abnormalities that could lead to sudden death.

This is where school administrator, parents and the medical community have to step up and realize the importance of the yearly pre-participation exam.

These findings that should trigger a more intense look for heart problems that could result in sudden death:

  • Family History
    • Family member who had premature sudden cardiac death
    • Heart disease in a family member who is younger than 50
  • Personal History
    • Heart Murmur
    • High Blood Pressure
    • Previous passing out event
    • Unexplained fatigue
    • Unexpected shortness of breath with activity
    • Chest pain with activity
  • Physical Exam
    • Listening for a heart murmur
    • Feeling for normal pulses in the groin
    • Blood pressure measurements
    • Assessing for Marfan Syndrome (a genetic disease that is associated with abnormal aorta)

Sudden death may not be completely preventable, but instead of blindly filling out paperwork and having a perfunctory physical exam in a school gym, taking the time and effort to actually have an athlete examined may be lifesaving.

And the last most important thing to do…learn CPR, know where the nearest AED is located, and come to the aid of somebody in distress. Don’t expect that somebody else will step up. There is no guarantee that there will be a trainer, nurse or doctor nearby to take the lead.

 

 

 

 

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