The recent death of a young badminton player raises several questions.
How can a seemingly healthy young athlete, at the peak of his physical fitness, collapse, resulting in death?
Second, was it at all preventable?
While Sudden Cardiac Arrest (SCA) among athletes is fairly uncommon, it is the leading medical cause of death among athletes during physical activity, affecting men more than women.
In the majority of cases, the cause of SCA during sports activity is due to structural and electrical changes in the heart, which can be either congenital or acquired.
A study in the United Kingdom was unable to find the leading cause of SCA among its athletes, but it hypothesised that it might be due to cardiac anomalies at a molecular level.
Though not apparent physically, these abnormalities can trigger cardiac arrest arrhythmias. This again poses the question of genetic predisposition and whether genetic screening is necessary.
Thus, pre-participation health screening is essential to identify people at risk to this condition and advise them, especially for young athletes.
The American Heart Association recommends a targeted medical history and cardiovascular physical examination as sufficient steps to identify high-risk patients.
This includes looking for symptoms, such as shortness of breath, chest pain, fainting spells or episodes of transient loss of consciousness, or a decline in physical performance.
Specific inquiries regarding sudden deaths among family, relatives with inherited cardiac conditions, as well as family members with pacemakers or defibrillators in place, should be made.
Further tests in the form of electrocardiograph (ECG) and echocardiogram can be done on the identified athletes.
The ECG looks at the electrical activity of the heart and can display any abnormal rhythms, while the latter looks for any structural abnormalities and the function of the heart.
By this stage, consultation with a cardiologist is greatly advised.
Among athletes aged 35 and above, coronary artery disease stands out as the most frequent cause of sudden cardiac death.
In older athletes, further screening questions should include pre-existing risk factors for a heart attack, such as a strong family history, active smoker, and chronic illnesses such as diabetes and hypertension.
These characteristics, when present, pose risks for SCA, and thus should be addressed before continuing with sporting activities.
Pre-participation screening is useful in detecting certain inherited conditions.
However, as mentioned, for some, the cause of SCA remains unknown.
Other aggravating factors, such as extreme heat or dehydration during the day of the event, may unmask an underlying condition that may not have been detected during screening.
In the event SCA occurs, all effort should be made to improve survival outcomes and prevent death. The effectiveness of cardiopulmonary resuscitation and early defibrillation using an
automated external defibrillator (AED) for the treatment of
SCA is proven and well established.
The key factor for resuscitation with a favourable outcome is early CPR initiation and defibrillation, which requires rapid recognition of the signs of SCA.
With the Paris Olympics around the corner, our sports authorities need to be prepared for any eventuality.
DR AISHAH MOHD HAFIZSenior lecturer, Faculty of Health and Medical Sciences, Taylor's University