Sudden Cardiac Death in Sports
Unexpected cardiac death within 1 hour of symptom onset (or within 24 hours of last being well) in a presumed healthy person. The most common medical cause of death in athletes during sport.
Cardiac arrest vs heart attack
| Cardiac arrest | Heart attack (MI) | |
|---|---|---|
| Problem | Electrical: heart stops pumping effectively | Plumbing: coronary artery blocked |
| Onset | Abrupt collapse | Often gradual: chest pain, sweating, nausea |
| Consciousness | Lost immediately | Usually preserved |
| Pulse | Absent | Present |
| Treatment | CPR and defibrillation | Reperfusion (PCI) |
| Untreated | Death within minutes | Survivable, time-critical |
An MI can cause arrest, but most arrests in young athletes are not MIs.
Causes by age
- Under 35: hypertrophic cardiomyopathy (most common in most series), coronary artery anomalies, ARVC (the commonest cause in Veneto, Italy), channelopathies (long QT, Brugada, CPVT), myocarditis, commotio cordis, Marfan or aortic dissection, WPW. Many are autopsy-negative.
- Over 35 (mostly over 45): atherosclerotic coronary disease dominates.
Emergency steps: DRSABCDE
| Step | Action | |
|---|---|---|
| D | Danger | Assess the scene |
| R | Response | Talk, gently shake. Jaw thrust if spinal injury suspected |
| S | Send for help | Call EMS and send someone for the AED |
| A | Airway | Open it, clear obstruction, consider face-guard removal |
| B | Breathing | Agonal gasps are not normal breathing |
| C | Circulation | Start CPR immediately: 30:2, 100 to 120/min, 5 to 6 cm depth |
| D | Defibrillation | Attach the AED as soon as it arrives |
| E | Exposure | Assess other injuries. Do not delay CPR to undress |
Chain of survival
- Early recognition and call for help
- Early CPR
- Early defibrillation
- Advanced life support
- Post-arrest care
Links 1 to 3 are the pitch-side team’s responsibility. Every venue needs a rehearsed emergency action plan and an AED reachable within 3 minutes.
Critical tip: do not rush to transfer
High-quality CPR and early AED use take priority over transport.
- Definitive care is on scene: compressions and a shock.
- Transport interrupts CPR, and CPR in a moving vehicle is poorer.
- Do not “scoop and run”.
Sequence
call for help and AED, start compressions, apply AED, continue CPR. Transfer only after return of circulation, or when ALS takes over.
Key numbers
defibrillation within 3 to 5 minutes gives 50 to 70% survival. Each minute of delay cuts survival by about 7 to 10%.
References
- J Am Coll Cardiol 2024, doi:10.1016/j.jacc.2023.10.032
- Lancet 2024, doi:10.1016/s0140-6736(24)02086-5
- Drezner et al., Br J Sports Med 2017, doi:10.1136/bjsports-2016-097331
Related
Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.