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Sudden Cardiac Death

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Other Names

  • Cardiac Arrest
  • SCD


  • Sudden cardiac death (SCD) are rare but tragic event that always receives public attention


  • Estimated incidence ranges from 0.7 - 3.0 per 100,000 athletes in individuals under 35[1]
  • Male:Female ratio of 2.3[2]
  • Marijon et al: Only 6% occur in young athletes, more than 90% in recreational athletes with an average age of 46[3]


  • In the majority of cases, there is an underlying cardiac disorder unknown prior to the event[4]
  • Exercise is generally considered an activity with numerus health benefits
  • Vigorous exercise may transiently increase risk of acute cardiac events[5]


Cardiac Adaptations to Training

  • Heart adapts to training through hypertrophy, improved function
    • Morphological (eccentric muscle hypertrophy and chamber dilatation)
    • Electrophysiological (increased vagal tone and bradycardia)
    • Functional changes (augmented stroke volume and increased diastolic function)
  • Varies by sport, duration, level of participation, age, sex, ethnicity

Risk Factors

  • Male
  • Older age (>35)
  • Black
  • Duration of activity
    • Risk of SCD doubles during physical activity and resolves around 1 hour after cessation[9]
  • Competition level
    • Higher in competitive sports compared to leisure-time physical activities[9]
    • Risk of SCD increases with increasing level of competition, highest in top division of college[2]
  • Endurance athletes
    • South African study found SCD risk higher in half marathon (6.7 per 100 000) compared to runners of the ultramarathon (0 per 100 000)[10]

Differential Diagnosis

Clinical Features

  • Sudden collapse of athlete without a pulse


  • N/A


  • N/A



  • Individuals often have unknown underlying risk factors for SCD
    • Estimated that up to 1/300 athletes have such underlying risk factors[11]


  • See: Cardiac Screening
  • Advocated by American Heart Association (AHA)[12], European Society of Cardiology (ESC)[13]
    • Considered an important public health initiative
    • Adopted by sporting bodies including Fédération Internationale de Football Association (FIFA), Union of European Football Associations (UEFA), International Olympic Committee (IOC)
  • There is not a consensus about how to screen
    • AHA advocates personal/family history, physical exam
    • ESC advocates the same but also includes electrocardiogram (ECG)
  • Young athletes (<35)
    • Normal screening, athlete can compete
    • Abnormal screening, athlete may require further work up
  • Older Athletes (>35)
    • In addition to history, physical and ECG
    • Consider excercise stres testing

Arena Safety & Emergency Preparedness

  • There should be emergency medical services immediately available at all times
  • When possible, a physician should be available
  • Coaches, trainers and staff should have ready access to automatic external defibrillator (AED)
    • AED access directly correlates to survival of out of hospital cardiac arrest (OHCA)[14]
  • All arenas, stadiums and events should have an Emergency Action Plan (EAP)
    • e.g. ‘who does what’ in the case of emergency, the responsible doctor, available equipment, and personnel
    • Proper training
    • Established relationship with EMS

Rehab and Return to Play

  • N/A

See Also


  1. Siscovick DS, Weiss NS, Fletcher RH, Lasky T. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med 1984; 311: 874–7
  2. 2.0 2.1 Harmon KG, Asif IM, Klossner D, Drezner JA. Incidence of sudden cardiac death in National Collegiate Athletic Association Athletes. Circulation 2011; 123: 1594–600.
  3. 3.0 3.1 Marijon E, Tafflet M, Celermajer DS et al. Sports‐related sudden death in the general population. Circulation 2011; 124: 672–81.
  4. Corrado, Domenico, et al. "Does sports activity enhance the risk of sudden death in adolescents and young adults?." Journal of the American College of Cardiology 42.11 (2003): 1959-1963.
  5. 5.0 5.1 Thompson, P. D., et al. "American Heart Association Council on Nutrition, Physical Activity, and Metabolism American Heart Association Council on Clinical Cardiology American College of Sports Medicine: Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology." Circulation 115.17 (2007): 2358-2368.
  6. 6.0 6.1 Corrado D, Schmied C, Basso C et al. Risk of sports: do we need a pre‐participation screening for competitive and leisure athletes? Eur Heart J 2011; 32: 934–44.
  7. Schmied, Christian, and Mats Borjesson. "Sudden cardiac death in athletes." Journal of internal medicine 275.2 (2014): 93-103.
  8. Siscovick, David S., et al. "Habitual vigorous exercise and primary cardiac arrest: effect of other risk factors on the relationship." Journal of chronic diseases 37.8 (1984): 625-631.
  9. 9.0 9.1 Maron BJ. The paradox of exercise. N Engl J Med 2000; 343: 1409–11.
  10. Schwellnuss M, Derman W. Overmedicalising‐ again! (letter). S Afr Med J 2013; 301: 131–2.
  11. Corrado D, Pelliccia A, Heidbuchel H et al. Recommendations for interpretation of 12‐lead electrocardiogram in the athlete. Eur Heart J 2010; 31: 243–59.
  12. Maron BJ, Thompson PD, Puffer JC et al. Cardiovascular preparticipation screening of competitive athletes. A statement from the Sudden Death Committee (Clinical Cardiology) and Congenital Cardiac Defects Committee (Cardiovascular Disease in the Young), American Heart Association. Circulation 2007; 115: 1–13.
  13. Corrado D, Pelliccia A, Bjornstad HH et al. Cardiovascular pre‐participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus statement of the Study Group of Sports Cardiology of the Working Group of Cardiac rehabilitation and exercise physiology and the Working Group of Myocardial and Pericardial diseases of the European Society of Cardiology. Eur Heart J 2005; 26: 516–24.
  14. Caffrey SL, Willoughby PA, Pepe PE, Becker LB. Public use of automated external defibrillators. N Engl J Med 2002; 347: 1242–7.
Created by:
John Kiel on 13 June 2019 08:33:08
Last edited:
29 January 2020 00:57:29