Causes of sudden death in competitive athletes

Cardiovascular diseases responsible for sudden unexpected death in highly conditioned athletes are largely related to the age of the patient. In most young competitive athletes (less than 35 years of age) sudden death is due to congenital cardiovascular disease. Hypertrophic cardiomyopathy appears to be the most common cause of such deaths, accounting for about half of the sudden deaths in young athletes. Other cardiovascular abnormalities that appear to be less frequent but important causes of sudden death in young athletes include congenital coronary artery anomalies, ruptured aorta (due to cystic medial necrosis), idiopathic left ventricular hypertrophy and coronary artery atherosclerosis. Diseases that appear to be very uncommon causes of sudden death include myocarditis, mitral valve prolapse, aortic valve stenosis and sarcoidosis. Cardiovascular disease in young athletes is usually unsuspected during life, and most athletes who die suddenly have experienced no cardiac symptoms. In only about 25% of those competitive athletes who die suddenly is underlying cardiovascular disease detected or suspected before participation and rarely is the correct clinical diagnosis made. In contrast, in older athletes (greater than or equal to 35 years of age) sudden death is usually due to coronary artery disease, and rarely results from congenital heart disease.

This article has been cited by other articles:

				B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, H. Rakowski, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 13, 2011; 58(25): 2703 - 2738. [Full Text] [PDF]

				B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, H. Rakowski, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 13, 2011; 58(25): e212 - e260. [Full Text] [PDF]

				Writing Committee Members, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 13, 2011; 124(24): e783 - e831. [Full Text] [PDF]

				Writing Committee Members, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 13, 2011; 124(24): 2761 - 2796. [Full Text] [PDF]

				L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, A. M. Hutter Jr, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 6, 2011; 58(24): e123 - e210. [Full Text] [PDF]

				Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 6, 2011; 124(23): e652 - e735. [Full Text] [PDF]

				Writing Committee Members:*, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J. Thorac. Cardiovasc. Surg., December 1, 2011; 142(6): 1303 - 1338. [Full Text] [PDF]

				Writing Committee Members:*, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J. Thorac. Cardiovasc. Surg., December 1, 2011; 142(6): e153 - e203. [Full Text] [PDF]

				S. F. Saleeb, W. Y. V. Li, S. Z. Warren, and J. E. Lock Effectiveness of Screening for Life-Threatening Chest Pain in Children Pediatrics, November 1, 2011; 128(5): e1062 - e1068. [Abstract] [Full Text] [PDF]

				R. E. Eckart, E. A. Shry, A. P. Burke, J. A. McNear, D. A. Appel, L. M. Castillo-Rojas, L. Avedissian, L. A. Pearse, R. N. Potter, L. Tremaine, et al. Sudden Death in Young Adults: An Autopsy-Based Series of a Population Undergoing Active Surveillance J. Am. Coll. Cardiol., September 13, 2011; 58(12): 1254 - 1261. [Abstract] [Full Text] [PDF]

				A. Steinvil, T. Chundadze, D. Zeltser, O. Rogowski, A. Halkin, Y. Galily, H. Perluk, and S. Viskin Mandatory Electrocardiographic Screening of Athletes to Reduce Their Risk for Sudden Death: Proven Fact or Wishful Thinking? J. Am. Coll. Cardiol., March 15, 2011; 57(11): 1291 - 1296. [Abstract] [Full Text] [PDF]

				A. P. Landstrom, C. A. Kellen, S. S. Dixit, R. J. van Oort, A. Garbino, N. Weisleder, J. Ma, X. H. T. Wehrens, and M. J. Ackerman Junctophilin-2 Expression Silencing Causes Cardiocyte Hypertrophy and Abnormal Intracellular Calcium-Handling Circ Heart Fail, March 1, 2011; 4(2): 214 - 223. [Abstract] [Full Text] [PDF]

				M. Rai and P. D. Thompson The definition of exertion-related cardiac events Br. J. Sports Med., February 1, 2011; 45(2): 130 - 131. [Abstract] [Full Text] [PDF]

				A. P. Landstrom, M. J. Ackerman, and C. Y. Ho Mutation Type Is Not Clinically Useful in Predicting Prognosis in Hypertrophic Cardiomyopathy Circulation, December 7, 2010; 122(23): 2441 - 2450. [Full Text] [PDF]

				E. Kramer, J. Dvorak, and W. Kloeck Review of the management of sudden cardiac arrest on the football field Br. J. Sports Med., June 1, 2010; 44(8): 540 - 545. [Abstract] [Full Text] [PDF]

				B R Anderson and V L Vetter Return to play? Practical considerations for young athletes with cardiovascular disease Br. J. Sports Med., September 1, 2009; 43(9): 690 - 695. [Abstract] [Full Text] [PDF]

				P Borrione, M Rizzo, A Spaccamiglio, R A Salvo, A Dovio, A Termine, A Parisi, F Fagnani, A Angeli, and F Pigozzi Sport-related hyperhomocysteinaemia: a putative marker of muscular demand to be noted for cardiovascular risk Br. J. Sports Med., November 1, 2008; 42(11): 894 - 900. [Abstract] [Full Text] [PDF]

				J. F. Rhodes, Z. M. Hijazi, and R. J. Sommer Pathophysiology of Congenital Heart Disease in the Adult, Part II: Simple Obstructive Lesions Circulation, March 4, 2008; 117(9): 1228 - 1237. [Full Text] [PDF]

				M G Wilson, S Basavarajaiah, G P Whyte, S Cox, M Loosemore, and S Sharma Efficacy of personal symptom and family history questionnaires when screening for inherited cardiac pathologies: the role of electrocardiography Br. J. Sports Med., March 1, 2008; 42(3): 207 - 211. [Abstract] [Full Text] [PDF]

				S. Basavarajaiah, M. Wilson, R. Naghavi, G. Whyte, M. Turner, and S. Sharma Physiological upper limits of left ventricular dimensions in highly trained junior tennis players Br. J. Sports Med., November 1, 2007; 41(11): 784 - 788. [Abstract] [Full Text] [PDF]

				R. A. Nishimura and S. R. Ommen Hypertrophic Cardiomyopathy, Sudden Death, and Implantable Cardiac Defibrillators: How Low the Bar? JAMA, July 25, 2007; 298(4): 452 - 454. [Full Text] [PDF]

				B. J. Maron, P. D. Thompson, M. J. Ackerman, G. Balady, S. Berger, D. Cohen, R. Dimeff, P. S. Douglas, D. W. Glover, A. M. Hutter Jr, et al. Recommendations and Considerations Related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update: A Scientific Statement From the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation Circulation, March 27, 2007; 115(12): 1643 - 1655. [Full Text] [PDF]

				S. Basavarajaiah, A. Shah, and S. Sharma Sudden cardiac death in young athletes Heart, March 1, 2007; 93(3): 287 - 289. [Abstract] [Full Text] [PDF]

				K. M. Harris, A. Sponsel, A. M. Hutter Jr., and B. J. Maron Brief communication: Cardiovascular screening practices of major North American professional sports teams. Ann Intern Med, October 3, 2006; 145(7): 507 - 511. [Abstract] [Full Text] [PDF]

				S Basavarajaiah, M Wilson, S Junagde, G Jackson, G Whyte, S Sharma, and W O Roberts Physiological left ventricular hypertrophy or hypertrophic cardiomyopathy in an elite adolescent athlete: role of detraining in resolving the clinical dilemma * Commentary Br. J. Sports Med., August 1, 2006; 40(8): 727 - 729. [Abstract] [Full Text] [PDF]

				F Pigozzi, A Spataro, A Alabiso, A Parisi, M Rizzo, F Fagnani, V Di Salvo, G Massazza, and N Maffulli Role of exercise stress test in master athletes Br. J. Sports Med., August 1, 2005; 39(8): 527 - 531. [Abstract] [Full Text] [PDF]

				M. Rizzo, M. C. R. Vono, L. Toncelli, P. Pecagna, P. Manetti, L. Stefani, and G. Galanti The feasibility and usefulness of contrast exercise echocardiography for the assessment of left ventricular function in master athletes Eur Heart J Cardiovasc Imaging, January 1, 2005; 6(1): 24 - 30. [Abstract] [Full Text] [PDF]

				R. E. Eckart, S. L. Scoville, C. L. Campbell, E. A. Shry, K. C. Stajduhar, R. N. Potter, L. A. Pearse, and R. Virmani Sudden Death in Young Adults: A 25-Year Review of Autopsies in Military Recruits Ann Intern Med, December 7, 2004; 141(11): 829 - 834. [Abstract] [Full Text] [PDF]

				K. Thygesen and B. F Uretsky Acute ischaemia as a trigger of sudden cardiac death Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D88 - D90. [Abstract] [Full Text] [PDF]

				S Firoozi, S Sharma, and W J McKenna Risk of competitive sport in young athletes with heart disease Heart, July 1, 2003; 89(7): 710 - 714. [Abstract] [Full Text] [PDF]

				S. Sharma, B. J. Maron, G. Whyte, S. Firoozi, P. M. Elliott, and W. J. McKenna Physiologic limits of left ventricular hypertrophy in elite junior athletes: Relevance to differential diagnosis of athlete's heart and hypertrophic cardiomyopathy J. Am. Coll. Cardiol., October 16, 2002; 40(8): 1431 - 1436. [Abstract] [Full Text] [PDF]

				S.G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, A.J. Camm, R. Cappato, S.M. Cobbe, C. Di Mario, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology Eur. Heart J., August 2, 2001; 22(16): 1374 - 1450. [PDF]

				S. Sharma, P. M. Elliott, G. Whyte, N. Mahon, M. S. Virdee, B. Mist, and W. J. McKenna Utility of metabolic exercise testing in distinguishing hypertrophic cardiomyopathy from physiologic left ventricular hypertrophy in athletes J. Am. Coll. Cardiol., September 1, 2000; 36(3): 864 - 870. [Abstract] [Full Text] [PDF]

				S. S. Chugh, K. L. Kelly, and J. L. Titus Sudden Cardiac Death With Apparently Normal Heart Circulation, August 8, 2000; 102(6): 649 - 654. [Abstract] [Full Text] [PDF]

				H. Kokado, M. Shimizu, H. Yoshio, H. Ino, K. Okeie, Y. Emoto, T. Matsuyama, M. Yamaguchi, T. Yasuda, N. Fujino, et al. Clinical Features of Hypertrophic Cardiomyopathy Caused by a Lys183 Deletion Mutation in the Cardiac Troponin I Gene Circulation, August 8, 2000; 102(6): 663 - 669. [Abstract] [Full Text] [PDF]

				F. Quigley A survey of the causes of sudden death in sport in the Republic of Ireland Br. J. Sports Med., August 1, 2000; 34(4): 258 - 261. [Abstract] [Full Text] [PDF]

				C. Basso, B. J. Maron, D. Corrado, and G. Thiene Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1493 - 1501. [Abstract] [Full Text] [PDF]

				F. C. Basilico Cardiovascular Disease in Athletes Am. J. Sports Med., January 1, 1999; 27(1): 108 - 121. [Abstract] [Full Text] [PDF]

				B. J. Maron, T. E. Gohman, and D. Aeppli Prevalence of sudden cardiac death during competitive sports activities in Minnesota High School athletes J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1881 - 1884. [Abstract] [Full Text] [PDF]

				D. W. Glover and B. J. Maron Profile of Preparticipation Cardiovascular Screening for High School Athletes JAMA, June 10, 1998; 279(22): 1817 - 1819. [Abstract] [Full Text] [PDF]

				N R SONI and J E DEANFIELD Assessment of cardiovascular fitness for competitive sport in high risk groups Arch. Dis. Child., November 1, 1997; 77(5): 386 - 389. [Full Text]

				A. J. Marian, G. Zhao, Y. Seta, R. Roberts, and Q.-t. Yu Expression of a Mutant (Arg92Gln) Human Cardiac Troponin T, Known to Cause Hypertrophic Cardiomyopathy, Impairs Adult Cardiac Myocyte Contractility Circ. Res., July 19, 1997; 81(1): 76 - 85. [Abstract] [Full Text]

				B. J. Maron, P. D. Thompson, J. C. Puffer, C. A. McGrew, W. B. Strong, P. S. Douglas, L. T. Clark, M. J. Mitten, M. H. Crawford, D. L. Atkins, et al. Cardiovascular Preparticipation Screening of Competitive Athletes: A Statement for Health Professionals From the Sudden Death Committee (Clinical Cardiology) and Congenital Cardiac Defects Committee (Cardiovascular Disease in the Young), American Heart Association Circulation, August 15, 1996; 94(4): 850 - 856. [Full Text]

				B. J. Maron, J. Shirani, L. C. Poliac, R. Mathenge, W. C. Roberts, and F. O. Mueller Sudden Death in Young Competitive Athletes: Clinical, Demographic, and Pathological Profiles JAMA, July 17, 1996; 276(3): 199 - 204. [Abstract] [PDF]

				E. D. Wigle, H. Rakowski, B. P. Kimball, and W. G. Williams Hypertrophic Cardiomyopathy : Clinical Spectrum and Treatment Circulation, October 1, 1995; 92(7): 1680 - 1692. [Full Text]

				A.J. Marian and R. Roberts Recent Advances in the Molecular Genetics of Hypertrophic Cardiomyopathy Circulation, September 1, 1995; 92(5): 1336 - 1347. [Full Text]

				B. J. Maron, J. M. Gardin, J. M. Flack, S. S. Gidding, T. T. Kurosaki, and D. E. Bild Prevalence of Hypertrophic Cardiomyopathy in a General Population of Young Adults : Echocardiographic Analysis of 4111 Subjects in the CARDIA Study Circulation, August 15, 1995; 92(4): 785 - 789. [Abstract] [Full Text]

				J. N Wight Jr and D. Salem Sudden Cardiac Death and the `Athlete's Heart' Arch Intern Med, July 24, 1995; 155(14): 1473 - 1480. [Abstract] [PDF]

				H. Nishi, A. Kimura, H. Harada, Y. Koga, K. Adachi, K. Matsuyama, T. Koyanagi, S. Yasunaga, T. Imaizumi, H. Toshima, et al. A Myosin Missense Mutation, Not A Null Allele, Causes Familial Hypertrophic Cardiomyopathy Circulation, June 15, 1995; 91(12): 2911 - 2915. [Abstract] [Full Text]

				B. J. Maron, A. Pelliccia, and P. Spirito Cardiac Disease in Young Trained Athletes : Insights Into Methods for Distinguishing Athlete's Heart From Structural Heart Disease, With Particular Emphasis on Hypertrophic Cardiomyopathy Circulation, March 1, 1995; 91(5): 1596 - 1601. [Full Text]

				Report of the Board of Trustees Athletic Preparticipation Examinations for Adolescents Arch Pediatr Adolesc Med, January 1, 1994; 148(1): 93 - 98. [Abstract] [PDF]

				T. J. Abrunzo Commotio Cordis: The Single, Most Common Cause of Traumatic Death in Youth Baseball Arch Pediatr Adolesc Med, November 1, 1991; 145(11): 1279 - 1282. [Abstract] [PDF]

				R. Brooks, B. A. McGovern, H. Garan, and J. N. Ruskin Current Treatment of Patients Surviving Out-of-Hospital Cardiac Arrest JAMA, February 13, 1991; 265(6): 762 - 768. [Abstract] [PDF]

				F. M. McCaffrey, L. D. S. Braden, and W. B. Strong Sudden Cardiac Death in Young Athletes: A Review Arch Pediatr Adolesc Med, February 1, 1991; 145(2): 177 - 183. [Abstract] [PDF]