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Sudden Cardiac Death in Young People

So young-football-cardiac-deathdid you hear about this in the news-

a 16 year-old kid collapses and dies on the football field during Friday night’s game

… and you wonder… “How could this happen?”

Sudden cardiac death (SCD) is usually associated with physical activity like sports. This, many times, causes us to ponder how “healthy” exercise really is. And, yes, exercise has been shown to be a trigger for MI and sudden cardiac death, but routine exercise actually protects against it.

Sudden cardiac death is rare in people under 35 years old, but it does occur and here’s why.

Over 60% of SCD’s are caused by a heart abnormality that leads to ventricular fibrillation (the uncontrolled quivering of the ventricles of the heart).

Specifically, there are several abnormalities that can occur.

  • Hypertrophic cardiomyopathy: This is the most common cause of SCD in people under 30 years old and in athletes. In hypertrophic cardiomyopathy the heart muscle becomes thick, making it harder to pump blood. The normal alignment of heart muscle cells is disrupted and the heart’s electrical functions do not all work properly.   It often goes undetected and has no symptoms until the SCD occurs.
  • Coronary artery and heart muscle abnormalities: Sometimes the coronary arteries or heart muscle form incorrectly in utero.   This may cause the arteries to become compressed during exercise, blocking blood flow to large portions of the heart muscle. Some of the more subtle abnormalities may not cause any symptoms. They remain undetected and allow full athletic development, then suddenly cause death during exercise.
  • Long QT syndrome: This is rare, genetic issue. In this condition, ventricular repolarization is delayed leaving the heart in a depolarized state and open for stimuli. This increases the risk of episodes of Torsades de Pointes- a type of polymorphic ventricular tachycardia that cannot sustain a pulse.
    torsades de pointes rhythm

    Torsades de Pointes

  • Previously unknown congenital heart disease
  • Brugada syndrome: An genetic disease that causes electrical issues in the heart leading to ventricular fibrillation.
  • Heart muscle inflammation/irritation from illness, viruses
  • Commitio cordis: This involves no abnormalities… just bad timing. It occurs usually during sports when the chest is forcefully struck with an object (i.e. football, hockey puck, etc) at just the wrong time, causing the heart to go into ventricular fibrillation or ventricular tachycardia.

Red flags for sudden cardiac death risk- symptoms to watch for that may indicate an underlying problem:

  • Unexplained fainting- syncopal episodes or palpitations, chest pain during physical activity
  • Family history of sudden cardiac death

Source:

http://www.yourhoustonnews.com/humble/living/student-cardiac-screening-saving-lives/article_60b07a19-0340-5d13-a8ea-a021b2f8bed2.html

http://medicalxpress.com/news/2014-08-scientists-sudden-cardiac-death-mystery.html

http://ekgumem.tumblr.com/post/93834148014/brugada-part-ii-2014-revelations-episode-153

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