CARDIOMYOPATHY AND ITS RELATION TO EXERCISE: SUDDEN DEATH IN ATHLETES

Sudden death is associated with vigorous exercise and has occurred to some professional and collegiate athletes. For example, Hank Gathers, a Loyola Marymount University basketball player collapsed on the court and died later with cardiomyopathy complications, Reggie Lewis, Boston Celtic basketball star, died of a cardio-myopathy heart attack during a pick-up basketball game, Sergei Grinkov collapsed on the ice during a practice for Stars on Ice, and Greg Menton, a University of Massachusetts swimmer and water-polo player collapsed and died at a swim meet against Dartmouth College.

click here to read more about Celtics star Reggie Lewis	click here to read more about Loyola Marymount University basketball star Eric "Hank" Gathers
click here to read more on my teammate, Greg Menton	click here to read more on Sergei Grinkov and his wife Ekaterina Gordeava

Sport by its very nature includes inherent risks, including the risk of death. Death in sport is tragic. Fortunately, it is rare. It is important to be aware of the remote possibility and the need for shared responsibility for sports safety among athletes, parents, coaches, and sport organizations.

A study done by Dr. Van Camp and colleagues (1995) described 160 cases of non-traumatic death in high school and college athletes between 1983 and 1993. The ratio of males to females was about 10 to 1, 146 males (average age 16.9 years) to 14 females (average age 16.2 years), and the age range was 13 to 24 years. In another study, Dr. Barry Maron and colleagues (1996) described the clinical profile of 134 athletes who had cardiovascular causes of sudden death between 1985 and 1995. The ratio of males to females was again about 10 to 1 (120 males to 14 females). The median age at death was 17 years, which means that one-half of the cases were 17 years of age or younger; the age range of the total sample was 12 to 40 years. Interestingly, the sample included 12 boys, 14 years of age or younger, who were involved in organized youth sports or junior high school sports.

In both studies, the major contributor to sudden death from cardiovascular causes during sport was hypertrophic cardiomyopathy. In the study of high school and college athletes, 136 of the 160 cases had adequate information to identify cause of death. Hypertrophic cardiomyopathy was the cause in 50 of 92 males and in 1 of 8 females with cardiovascular conditions. In the other study, hypertrophic cardiomyopathy was cited in 48 of the 134 athletes. The second most common cardiovascular cause of death in the two studies was congenital abnormalities of the blood vessels servicing the heart (the coronary arteries), 16% and 13% in each study. A variety of rare cardiovascular conditions as well as several apparently "normal hearts" were represented in the remainder of the cases of sudden death.

Basketball and football were the two sports most represented among the athletes described in both studies. This is in part due to the relatively larger numbers of youth and young adults who participate in these sports. Overall, 12 sports for males and 6 for females were represented in the study of high school and college athletes. Nevertheless, the occurrence of non-traumatic sports death is rare. The estimated rates for non-traumatic sports death in high school and college athletes are 7.5 and 1.3 per million athletes participating per year in males and females, respectively. Interestingly, the estimated rate is higher among college male athletes than among high school male athletes, 14.5 and 6.6 per million athletes participating per year, respectively.

According to the Center for Disease Control in Atlanta, 100,000 young athletes die each year from all cardio-vascular disorders, including cardiomyopathy, as a result of participation in sports. This is twice as many as die in auto accidents. Of the 100,000 who die annually, 45,000 of them play basketball, not boxing or football.

A case in point is that of the late Boston Celtic basketball star Reggie Lewis. Reggie died of a cardiomyopathy heart attack. The cause of his heart attack was a simple Selenium deficiency. His outcome could have been prevented with the proper mineral supplementation. The cardiologist who cared for Reggie Lewis was also the cardiac expert for the NBA. He was an avid runner and had personally completed the Boston Marathon three times. Well the marathon running doctor, at the age of 48, died one and half years after Reggie due to a cardiomyopathy heart attack. He also died for the exact same reason Reggie died, a simple Selenium mineral deficiency.

In 1996, a University of Pittsburgh Medical Center (UPMC) cardiologist says that routine cardiovascular testing to prevent exercise-related sudden death in athletes has limited usefulness because of the rarity of such events, the cost of screening and poor predictive accuracy of exercise testing for such events. Rather, Paul Thompson, M.D., UPMC director of preventive cardiology, claims physicians should perform routine screenings in young athletes, carefully to evaluate exercise-induced symptoms, and ensure that adults know the symptoms of heart problems.

Coronary artery disease is the major cause of exercise-related cardiovascular complications in adults, while in younger people the cause is congenital abnormality. The incidence of exercise death is low; approximately 0.75 per 100,000 young male athletes and .13 per 100,000 young female athletes. About six per 100,000 middle-aged men die during exertion each year.

Despite the low absolute risk of cardiac problems during exercise in previously healthy men, the death rate per hour of exercise increases as activity continues. In a study in Rhode Island, for example, the relative risk of sudden death was seven times higher during jogging than during other activities.

Routine testing has been advocated to detect hypertrophic cardiomyopathy, the leading cause of sudden death. Hypertrophic cardiomyopathy is inflammation of the heart muscle. Yet, according to Dr. Thompson, five studies which included more than 5,000 high school and college athletes found no definite cases of hypertrophic cardiomyopathy. Similar problems plague routine testing to screen exercising adults, he writes.

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