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Sudden Cardiac Death in Young Athletes . Yann Ping Pan, MD Ruey-Kang Chang, MD, MPH. What do they have in common?. Hank Gathers (1967-1990) Reggie Lewis (1965-1993) Flo Hyman (1954-1986) Sergei Grinkov (1967-1995) Pete Maravich (1947-1988). Athlete SCD– why is it important.

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sudden cardiac death in young athletes

Sudden Cardiac Death in Young Athletes

Yann Ping Pan, MD

Ruey-Kang Chang, MD, MPH

what do they have in common
What do they have in common?
  • Hank Gathers (1967-1990)
  • Reggie Lewis (1965-1993)
  • Flo Hyman (1954-1986)
  • Sergei Grinkov (1967-1995)
  • Pete Maravich (1947-1988)
athlete scd why is it important
Athlete SCD– why is it important
  • Family physicians see a lot of athletes for sports related issues
  • Family physicians are involved in school health and pre-participation examinations
  • It is important to know the clinical characteristics of SCD and identify athletes who are at risk
  • It is important to know the current recommendations for pre-participation examinations
what do we know about scd in athletes
What do we know about SCD in Athletes?
  • 12-15 million young (<30 years) competitive athletes in the US
  • Estimated incidence of sudden cardiac death at 2.1 per 100 000 athletes per year
  • Estimated 200 athletes in the US die per year of sudden cardiac death
  • Sudden death of the young athletes is mostly unexpected, dramatic, tragic and carries huge emotional impact on the society
epidemiology based on autopsy series

Sudden Cardiac Death of Athletes

Epidemiology Based on Autopsy Series
  • Age--
    • 9% in middle school
    • 62% in high school
    • 22% in college
    • 7% in professional
  • Sex—90% male, 10% female
  • Caucasians at highest risk

Maron BJ et al, JAMA 1996 ; 276 : 199 - 203

research questions
Research Questions
  • What are the epidemiologic characteristics of athlete SCD from the an active surveillance, population-based sample?
  • What are the major causes for athlete SCD from the an active surveillance, population-based sample?
objectives
Objectives
  • To evaluate an active surveillance system of athlete SCD from a population-based sample using Google Internet search engine
  • To compare the active surveillance of athlete SCD by Google with reported athlete SCD data using autopsy or passive report systems
methods
Methods
  • Advanced Google Internet search was conducted once a week (every Friday) from April 2007 to March 2008
  • Combinations of keywords were used– athlete, player, practice, game, collapse, pass out, die, gym class, etc.
  • Only US athletes died in a game or practice or immediately after, occurred in the US
  • Age 11 to 30 years, death between 4/07 to 3/08
  • Exclusions– known cardiac history, trauma, non-US athletes, died in sleep or at home, possible drugs or alcohol,
methods17
Methods
  • First 200 Google search results are carefully examined
  • For cases that fulfill inclusion criteria, the web pages are printed/saved
  • All demographic data, history and circumstances (CPR, use of AED), are recorded and compiled for analysis
  • Autopsy results are searched 1 month to 12 months later to determine the cause of death
results
Results
  • Total of 74 athletes died in April 2007 to March 2008 in a game or during or after practice (comotio cordis are excluded)
  • 25 athletes died in a game (34%), and 49 died in or after practice (66%)– consistent with the literature or 1:2
  • Most common sports are basketball and football– consistent with the literature
slide23

Sudden Cardiac Death of Athletes

Maron BJ et al, JAMA 1996 ; 276 : 199 - 203

conclusion
Conclusion
  • Excluding comotio cordis, there are 74 SCD of young athletes in the US in 2007-2008
  • 1/3 SCD occurs in a game, 2/3 in practice
  • Including gym class death, there are more females than previously described
  • Blacks may be at higher risk, ore studies needed
  • Basketball and football are common sports associated with SCD
  • HOCM/LVH accounts for almost 50%, coronary anomaly and arrhythmia are next common causes
slide28

Sudden Cardiac Death of Athletes

Circulation 2007;115;1643-1655

endorsement of aha guidelines
Endorsement of AHA Guidelines
  • American Academy of Family Physicians
  • American Academy of Pediatrics
  • American College of Cardiology
  • American College of Sports Medicine
  • American Medical Society for Sports Medicine
  • American Orthopaedic Society for Sports Medicine
  • American Osteopathic Academy of Sports Medicine
european guidelines for ppe
European Guidelines for PPE
  • In 2005, The European Society of Cardiology issued official recommendation for PPE, including 12-lead ECG
coronary artery anomaly32

Sudden Cardiac Death of Athletes

Coronary Artery Anomaly
  • With increased stroke volume during exercise ascending aorta expands and the take-off angle is further exaggerated
  • LMCA may also be compressed against root of pulmonary trunk during exercise
  • ECG is likely normal
  • Very difficult to screen or diagnose even with echocardiogram
  • Treatment: Surgery for coronary reimplantation
commotio cordis

Sudden Cardiac Death of Athletes

Commotio Cordis
  • Sudden disturbance of heart rhythm as the result of a blunt, non-penetrating impact to the precordial region
  • Impact occurring within a specific 10-20 millisecond portion of the cardiac cycle in the ascending phase of the T wave, when the ventricular myocardium is repolarizing, moving from systole to diastole
  • Most effective preventions are:
    • Chest shield
    • Automatic External Defibrillator (AED)
slide34

Sudden Cardiac Death of Athletes

J Am Coll Cardiol 2008;52:1990–6