Heart Attacks in Soccer and Other Sports: Causes, Outlook, Prevention

In the 42nd minute of a 2020 European Championship match in Copenhagen, 29-year-old Danish soccer player Christian Eriksen collapsed to the ground as he received a throw-in.

As the medical staff rushed to the field to administer defibrillation, teammates gathered around to shield Eriksen from the view of nearly 14,000 fans in attendance.

Prompt emergency medical care likely saved Eriksen’s life. Studies consistently show that more than half the number of athletes who experience sudden cardiac arrest, often erroneously called a heart attack, die before they reach or are discharged from the hospital.

Sudden cardiac arrest isn’t unique to soccer. despite being rare, every year there are reports of amateur or professional athletes in sports like hockey, basketball, or football dying suddenly. In most casessudden cardiac death is linked to heart defects present from birth.

Read on as we explore why athletes develop cardiac arrest and what they can do to lower the risk.

It’s rare for athletes to develop cardiac arrest. Congenital heart conditions, or heart conditions present from birth, are the most common cause in athletes under 35 years. In older athletes, most sudden cardiac deaths are due to coronary artery disease.

Congenital conditions

Researchers believe the most common congenital heart conditions that lead to cardiac arrest in athletes in the United States are:

  • Hypertrophic cardiomyopathy (HCM): a thickening of the walls in the left ventricle. HCM is thought to be the most common cause of sudden cardiac death in athletes and affects about 1in500 people in the general population.
  • Anomalous origin of a coronary artery: an improper placement of one of the coronary arteries that supply the heart with blood.

There’s some debate whether HCM really is the most common cause.

A 2015 study looked at autopsies of National Collegiate Athletic Association (NCAA) athletes who died of sudden cardiac arrest from 2003 to 2013. One in four athletes had structurally normal hearts, implying that arrhythmias or electrical disorders may have been the most common cause of death.

The researchers only found definitive evidence of HCM in 8 percent of cases compared to 30 to 40 percent in previous studies.

Other heart anomalies that can contribute to sudden cardiac death include:

Dilated cardiomyopathy and Brugada syndrome can also be acquired conditions.

Acquired conditions

Acquired conditions are those that develop through your life.

the most common cause of sudden cardiac arrest in athletes over the age of 35 is atherosclerosis, which is the buildup of plaque in the wall of your arteries. Risk factors for atherosclerosis include:

Other acquired conditions that can lead to cardiac arrest include:

Estimates on how often athletes experience sudden cardiac arrest vary based on the definition of athlete and whether studies include cardiac events away from sport. They range anywhere from 1 in 3,000 to 1 in 1 million.

A 2016 study estimates that the risk of sudden cardiac death among Division 1 NCAA athletes is 1 in 53,703 athletes per year. Some groups of people, such as Black athletes, basketball players, and males, seem to be at a heightened risk.

in to 2020 studyresearchers looked at how common sudden cardiac arrest was in middle school to professional athletes using a national surveillance program in the United States.

They identified 74 cases of sudden cardiac arrest with survival, and 105 that resulted in death. More than 80 percent of people were male, and the average age was 16.6 years.

Cardiac arrest by sport

in to 2021 studies, researchers looked at the incidence of sudden cardiac arrest in athletes ages 11 to 29 in the United States over 4 years. They identified 331 total cases.

How to best prevent sudden cardiac arrest in athletes is still a matter of considerable debate. Guidelines and laws vary between countries.

the American College of Cardiology and American Heart Association (AHA) recommend screening by examining your medical history and performing a physical exam.

Researchers continue to debate the implementation of screening with an electrocardiogram (ECG), as is done in some countries. An ECG is a device that measures the activity of your heart.

since 1982, Italian law has required pre-participation screening with an ECG for competitive sports practice. But this screening hasn’t been uniformly accepted by the international scientific community.

In Italy, the most common cause of sudden cardiac death in athletes is arrhythmogenic right ventricular cardiomyopathy. Some researchers argue that ECG isn’t necessary in the United States, where HCM may be the most common cause of sudden cardiac death.

Researchers are continuing to examine the potential usefulness of genetic tests.

Eating a balanced diet may help reduce the risk of coronary heart disease, especially for older athletes. Foods that lower your risk of heart disease are also likely to support athletic performance and overall health.

Benefits of having an athletic training and defibrillator on-site

Having a certified athletic trainer and on-site defibrillator is linked to a much higher chance of survival after sudden cardiac arrest.

in to 2019 study, researchers found overall survival among athletes who had sudden cardiac arrest was 48 percent. However, if a certified athletic trainer was present and involved in resuscitation, survival rose to 83 percent. It increased to 89 percent with the use of an on-site automated external defibrillator.

Careful evaluation from a medical professional is needed before you can return to sport. A study by the AHA found evidence that athletes with genetic heart disease can remain competitive with a reasonably low incidence of cardiac events.

In some cases, it might not be possible to safely return. Your team or institution may also disqualify you over liability concerns.

Eriksen returned to football 8 months after his sudden cardiac arrest. Doctors fitted him with an implantable cardioverter defibrillator. However, Italian medical authorities banned him from playing in Italy with his club team Inter Milan, leading him to sign with Brentford in the United Kingdom’s Premier League.

The most common cause of sudden cardiac death in young athletes is congenital heart disease. In older athletes, it’s coronary artery disease.

Sudden cardiac death is rare in athletes, and there’s still debate on how to best screen for risk factors.

If you have a known heart problem, you can talk with your doctor about whether it’s safe for you to participate in sports and whether you should undergo further testing.

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