Young, fit, healthy and still at risk
One of the most shocking aspects of Danish footballer, Christian Eriksen’s (pictured) televised mid-match cardiac arrest was that such a thing could happen to someone like him.
Here is a young professional athlete, one of the fittest people on the planet. How could he be a candidate for cardiac arrest?
Christian Eriksen apparently couldn’t believe it himself when he regained consciousness.
As it turns out, young athletes are three times as likely to experience sudden cardiac arrest compared to non-athletes of a similar age.
First, let’s make something clear: sudden cardiac death in young people is relatively rare; it impacts one per 100,000 per year. But young athletes are more at-risk than young non-athletes.
It is believed sudden cardiac death in younger people results from an otherwise dormant cardiac abnormality, which is activated by strenuous exercise. This particular study offers a laundry list of disorders that could cause cardiac abnormalities in young people.
Being dormant, health professionals would have little cause to look for these cardiac abnormalities until they manifest into a coronary event.
Preparticipation screening to reduce risk
That said, preparticipation screening is mandatory for young athletes in many parts of the world, to identify cardiovascular risk.
Preparticipation screening is a process by which teenagers and young adults are screened for cardiological and other significant disorders before they participate in athletic activity.
The core element of this screening is a 12-lead ECG (electrocardiogram), to measure the heart’s electrical activity. This would be viewed in the context of the patient’s history and a physical examination,
While it doesn’t pick up every potential cardiovascular risk, ECG testing is a fast, non-invasive, low-cost way to determine if an aspiring young athlete is in danger of a cardiac event.
Organisations including the European Society of Cardiologists, the International Olympic Committee, and the American College of Preventive Medicine all advocate use of a 12-lead ECG for preparticipation screening in young athletes.
Following an ECG, preparticipation screening then requires a medical professional to determine if an athlete is fit to compete.
This resource suggests a variety of questions the screener should ask, and the different levels of clearance they could subsequently provide – from unconditional clearance, through to prohibition to compete in any sport or level of competition.
No test is foolproof
While preparticipation screening is an effective way to determine cardiac risk in young people, it is not conclusive.
For example, as a professional footballer, Christian Eriksen was regularly subjected to a battery of physical tests, including preparticipation screening. These tests did not show he was at risk of cardiac arrest.
There is also a risk that preparticipation screening can result in false positives, leading to otherwise promising careers being prevented. It isn’t just athletes impacted when this happens; members of the military have also been disenfranchised by false positive preparticipation screening.
As University of Notre Dame Professor of Cardiology, David Playford explained to us recently, no test is foolproof.
For young, fit, healthy people, being aware that they may be at risk of sudden cardiac arrest is the critical first step towards surviving an event if it does occur.
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