What Is Sudden Cardiac Death in Sport and Football? What Causes It?

After the 29-year-old Danish footballer Christian Eriksen suddenly fainted in the 42nd minute of the European Cup match against Finland on the evening of June 12, 2021, we summarized medical information about "sudden cardiac arrest in sport."  

What is sudden cardiac death in sport?

Sudden cardiac arrest is the leading cause of sport-related deaths in competitive athletes.

However, studies seeking to determine the exact incidence and causes of sudden cardiac arrest in athletes have shown substantial differences. Early studies on this subject suggest that a condition involving thickening of the heart muscle, called hypertrophic cardiomyopathy, may be responsible for one-third of sudden cardiac death cases. However, electrical (rhythm-related) problems of the heart and hereditary heart diseases are another common cause of sudden cardiac arrest in athletes.

How common is sudden cardiac arrest in athletes?

Research puts the frequency of sudden cardiac arrest in sport at one per 50 thousand athletes per year as an estimate.

A study of young people who experienced sudden cardiac arrest during sports activities found that up to 52.3% of athletes survived with interventions. The same study also emphasizes that this condition occurs more frequently in male athletes (83.7%).

What to know about sudden cardiac arrest in sport

• Although exercise generally promotes health, it is associated with an increased risk of sudden cardiac death for a small number of people with cardiac conditions.

• The risk and causes of sudden cardiac death vary by type of sport. Male sex, Black race and sports such as football and basketball place an athlete at higher risk. In younger athletes (<35 years), sudden cardiac death usually results from hereditary heart conditions, whereas in older athletes (>35 years), it is most commonly due to atherosclerotic coronary artery disease.

• There is considerable ongoing debate about the best strategy for preventing sudden cardiac death in athletes and the role of the electrocardiogram (EKG) in screening before beginning a sporting career. The optimal evaluation for a particular group of athletes depends on the risk of the sport to be undertaken and the specialist resources available.

Causes of sudden cardiac arrest in athletes

The most common causes of sudden cardiac death in athletes are:

In athletes under 35:

• Hereditary heart conditions accompanied by hypertrophic cardiomyopathy, and
• A coronary artery with abnormal anatomy

In athletes older than 35:

• Most of these cases have acquired atherosclerotic coronary artery disease (that is, narrowing over time of the vessels supplying the heart)

What are the symptoms of sudden cardiac arrest in an athlete?

Underlying heart conditions in these people may cause no symptoms beforehand and may first present with sudden cardiac arrest.

Approximately 30% of athletes with sudden cardiac arrest have been reported to have symptoms such as chest pain, shortness of breath, declining performance, palpitations and fainting.

Evaluation of such exertion-related symptoms by a qualified team of sports medicine and cardiology physicians is an important aspect of athletes' medical care and prevention of sudden cardiac arrest.