 Sudden death syndrome is a
subject always reported emotively
When a young and
apparently fit person dies unexpectedly of heart failure, it is always
shocking and upsetting . Sudden death is defined as unexpected death
occurring as a result of natural causes in which loss of all functions
occurred instantaneously or within six hours of the onset of symptoms or
collapse (Shama et al,British Journal of Sports Medicine.)
Sport blamed
As a number of these
deaths happen to sports people, reports of the death often try to lay the
blame at the door of the sport- the intensity of the training regime,
training when ill, and even drugs.
However, sudden cardiac
death in young people is most frequently unrelated to the sport.
The weakness in the
heart is present and the heart attack could come at any time-even just
running up the stairs.
Inherited problems
Accurate statistics are
not available, but experts estimate that up to eight young people die
suddenly each week in the UK of cardiac abnormalities-sudden death
syndrome or sudden cardiac death. Approximately
80 per cent of all non – traumatic sudden deaths in young, competitive
athletes are due to inherited structural of functional cardiovascular
abnormalities.
(Shama et al ,Br J
Sports Med.)
Irregular heart beat
The majority of these
deaths are due to inherited forms of heart muscle disorder and irregular
heart beat. Hypertrophic
Cardiomyopathy is the most common of these conditions.
Recent research carried
out in the USA by Dr Barry Maron shows that one in 500 people have
hypertrophic Cardiomyopathy (Maron,1995,
Circulation)
A national programme for
systematic pre-participation screening of all young, competitive athletes
has been in place in Italy since 1971. In Italy to get your racing licence-even
as an amateur-you need to undergo a whole battery of fitness tests,
including an ECG to assess whether you are fit and healthy enough to
compete.
Italian law requires
every athlete, across all sports, to have an annual fitness certificate
before they are permitted to participate in any event.
Recent research there confirms that ECG testing is the most
cost-effective way to test for cardiac abnormalities (Corrado et al, New
England Journal of Medicine August 6, 1998). A competitive athlete was
defined as a participant in an organised sports programme requiring
regular training and competition.
Taking responsibility
Sports clubs and schools
have to take responsibility for their students fitness to participate.
One pathologist, Gaetano
Thiene, collated all statistical data on sudden death in young people in
the Veneto region of northern Italy and as a result discovered that
cardiovascular screening was effective in identifying individuals at risk
(Corrado et al, New England Journal of Medicine, August 6, 1998)
CRY (Cardiac Risk in the
Young ) is an organisation which aims to raise awareness about cardiac
risk, offer screening, campaign for better recognition of the problem and
to offer help and counselling for the bereaved.
CRY recently had a
significant breakthrough in its campaign when a private member’s bill on
March 12 agreed to set up an expert group to include sudden cardiac death
within the National Health Service framework.
The bill agreed to promote awareness among medical professionals so
that signs and symptoms are recognised and acted upon.
Wide variation
CRY’s founder, Alison
Cox is pleased with this outcome, as she says there is currently a wide
variation in the way that GPs treat symptoms of cardiac problems in young
people.
“If a 60 year old has
chest pains or breathlessness it would immediately be assumed they had a
heart problem. In an under-35 it’s the last thing you think of.
CRY wants the same
conscientious treatment of young people as elderly; ignoring or dismissing
the symptoms is wrong. Symptoms are a chance to save a life” she said.
While it is frequently
said that there are no prior symptoms with sudden cardiac death,
Alison said that in her
experience of dealing with bereaved families there were actually symptoms,
but they weren’t recognised until after the event:
“Most of the deaths have symptoms that are dismissed. A family
will say there are no symptoms but later they will remember occasional
times of breathlessness and heart pain”
The problem is that when
a young person shows these symptoms, the last thing they think of is a
heart problem.
On April 15,2002 Cry
held a parliamentary reception at the House of Commons to launch its
Centre for Sports Cardiology at the British Olympic Medical Centre at
Northwick Park, Harrow.
International leader
The chairman, Dr Greg
Whyte, is national science coordinator for the English Institute of Sport
and former research manager for the British Olympic Association.
“ We aim to establish
the Cry Centre for Sports Cardiology as an international leader in its
field, with the ongoing development of our cardiac screening programme,
training of experts and contribution to research.
The centre caters for
athletes of all standards and ages, and recommends that if you are an
elite competitor (representing your country in sport) you should consider
screening.
CRY is closely connected
with sport and has among its patrons Sir Steve Redgrave and Ian Botham
OBE.
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