Sudden Cardiac Death in Athletes

Many people may recall the sudden deaths of basketball greats such as Hank Gathers and Reggie Lewis who both suddenly died while playing basketball and recall that the cause of death was related to an enlargement of the left side of the heart, which is a disease entity called Hypertrophic Cardiomyopathy (a.k.a. HOCM). Usually a murmur is heard when one listen to the heart and the murmur softens as one squats, however, in many instances the murmur is not heard and the disease is missed. This is the most common cause of sudden death in young athletes (less than 30 years old). However, there are other causes of sudden cardiac death, including coronary artery disease, sickle cell trait, hyponatremia, and commotion cordis (sudden blow to chest/heart causing an arrhythmia).

Another famous athlete who died of sudden cardiac death while running a marathon. Jim Fixx, who made running a popular sport in the US with his 1977 best seller: The Complete Book of Running, also died suddenly at age 52, but not from Hypertrophic Cardiomyopathy (a.k.a Hypertrophic Obstructive Cardiomyopathy-HOCM), rather he died of a heart attack (myocardial infarction). What is interesting about his tragic death and story is that he in fact was a world class athlete who despite his endurance, had severe coronary artery disease. Ironically, he was a former smoker who quit smoking at the age of 35 and began to jog then run and lost 50 pounds. His autopsy revealed that three of his main coronary arteries were severly stenosed (clogged) and was also known to have dyslipidemia (also
known as hypercholesterolemia). Apparently, his total cholesterol was about 250 and he had refused a stress test. Interestingly, his father also died of a heart attack at age 42. This story may cause some to become even more fatalistic and not see much use in prevention considering the fact that a marathon runner with
significant family history died suddenly, however this death could have possibly been prevented if his lipid levels were enhanced.

What is interesting about these two stories is that despite the fact that HOCM is a common cause of death in athletes (especially in younger athletes-less than 30 years old), as one ages, there is an increased
likelihood that sudden cardiac death is due to coronary artery disease and in those with dyslipidemia and a family history, the risk of sudden death is very high.

In conclusion, individuals should see a physician before starting a rigorous exercise program and to reconsider the weekend “warrior
mentality” that many businessmen/women have adopted. Also, individuals need to take seriously their family history of cardiac disease. The studies on the negative effects of dyslipidemia have been well demonstrated and the effects of statins on reducing this effect are well established.

Jim Fixx should have been on a statin, which were not even on the market until the early 1990s. As mentioned above, he also should have had a stress test done or perhaps with his significant family history a catherization to assess for coronary artery disease.