welcome guys i'm dr mike hansen recently on saturday june 12 2021 christian eriksen a 29
year old from denmark suddenly collapsed during a soccer match as a result of his heart going
into sudden cardiac arrest his heart wasn't able to pump blood to his brain he lost consciousness
and he fell to the ground within minutes the medical staff surround him they check a pulse
there's no pulse so they start cpr and he gets one shock to his chest to defibrillate his heart
fortunately they were able to successfully resuscitate him and he's doing well now
by the time you're watching this he's probably already had an extensive cardiac workup including
blood work measuring troponin levels ekgs an ultrasound of his heart meaning an echocardiogram
and a cardiac mri christian eriksen is far from the only young athlete to have a sudden cardiac
arrest while playing a sport reggie lewis with the boston celtics hank gathers with loyola
between 2004 to 2007 soccer players mark vivian foe myklos fighter and antonio puerta died of
sudden cardiac arrest which led to fifa in forcing players to be screened before competitions at all
levels thankfully francis muamba survived in 2012. sudden cardiac death is defined as unexpected
death due to a previously unknown heart condition and it occurs within one hour of symptom onset
the incidence of std or sudden cardiac death among young athletes is overall pretty low around one
in every 75 000 young athletes per year normally a healthy heart is in sinus rhythm
chances are if you're watching this you're in a sinus rhythm which means if you check
your pulse there's a consistent rhythm to it how does this happen the beginning of the electrical
signal in the heart originates in the sinus node which is located in the right atrium
think of the sinus node as the drummer of a band sure he might be a little crazy but it's
the drummer's job to keep the timing smooth and steady to keep a consistent pace of the song for
example let's say the song is at a tempo of 100 beats per minute the rest of the band is in sync
with that drummer at that tempo of 100 beats per minute the last thing you want is the guitarist
to be soloing at a tempo of 130 beats per minute in the front man singing at 170 and so on because
that leads to nothing but noise and not music and that's essentially what happens with the heart
right before someone has a sudden cardiac arrest this is called ventricular fibrillation aka v-fib
which in essence the ventricles of the heart are not pumping blood to the body because the
electrical circuit is going haywire completely out of sync they're doing nothing more than quivering
in that moment if the heart is not defibrillated meaning shocked with a jolt of electricity the
heart will soon be in even more trouble something called asystole in other words zero electrical
activity in the horror the chances of reviving someone at this point becomes even slimmer
so when someone has a sudden cardiac arrest another rhythm called ventricular tachycardia
sometimes precedes the v-fib this is when the origin of the electrical activity
is in the ventricles instead of the sinus node which is in the atria
persistent v-tac often deteriorates into v-fib and that's why v-tac needs emergent medical attention
and this is why aeds are so important an aed is an automated external defibrillator
you turn it on you put the pads on the chest it senses if it should shock the patient
and if it's appropriate it's going to deliver a shock in an attempt to reset the heart so aed's in
sideline medical teams with specialized training in cpr are required to every professional soccer
stadium in the world had christian eriksen not had cpr with an aed put on his chest
within minutes his chances of survival would have been extremely small after one defibrillation his
heart went back into sinus rhythm thankfully not only did he survive but he didn't even require a
breathing tube to be put down his throat which is usually the case when someone has a cardiac arrest
because when the heart stops the cessation of breathing soon follows so why would an athlete who
by all means is in superb physical conditioning and of extraordinary health all of a sudden
have their heart stop although it rarely happens there are lots of different causes of sudden
cardiac arrest in a young athlete often sudden cardiac arrest or sca is the sentinel event of an
underlying previously undiagnosed heart condition when a person is put through rigorous physical
activity as someone who works in the intensive care unit i've had several young patients who
experience sudden cardiac arrest while exercising when it comes to different types of heart disease
you can think of them falling into one of four broad categories one is there a structural problem
with the heart muscle meaning the myocardium two is there a structural problem with arteries
that feed blood to the heart meaning the coronary arteries three is there a structural
problem with the valves of the heart whose job it is to prevent blood flowing backwards
and the fourth category is there a problem with the electrical conduction system of the heart
so with that in mind let's get to the top seven most common causes of sudden cardiac arrest in
young athletes starting with the least common so number seven drugs although it didn't occur
while playing a sport the most famous case of cocaine causing a young athlete's heart to stop
was len bias bias was incredibly talented selected by my favorite nba team the boston celtics with
the number two pick in the 1986 draft less than two days later he died as a result of
cocaine intoxication at just 22 years old now there have been other case reports describing
scd or sudden cardiac death and young athletes who had previously known known heart disease but were
taking androgens for performance enhancement and they were found to have enlarged hearts at autopsy
i personally had a patient that this happened to now you can imagine how difficult it was
for me to break the news to his mom that her son was clinically brain dead so drugs
including steroids just not worth it number six electrical disturbances of the heart so there are
several different arrhythmia syndromes that some people are bored with and the heart is usually
structurally normal in these cases essentially the electrical wiring of the heart is a little off
examples would include long qt syndrome short qt syndrome brugada syndrome early
repolarization syndrome and catecholaminergic polymorphic ventricular tachycardia these can
usually be diagnosed with an ekg and i'll get to talking about screening athletes with ekgs
at the end of this video but these patients are especially sensitive to electrolyte imbalances
specifically low blood levels of either potassium magnesium and calcium but also low ph levels of
the blood meaning acidosis so when people are participating in vigorous activity not only do
they have the potential to become dehydrated with electrolyte imbalances but the vigorous
physical activity can cause lactic acidosis which is one type of acidosis now there's another type
of acidosis called ketoacidosis which occurs with either starvation ketoacidosis but also the keto
diet also those with an underlying heart condition especially when it comes to their electrical
system are more susceptible to caffeine and energy drinks so that's another thing to keep in mind
number five is myocardial infarction aka a heart attack so myocardial infarction or
mi which is when a part of the heart muscle dies off as a result of not getting enough blood flow
and this occurs when a coronary artery becomes blocked it's a very uncommon cause of sudden
cardiac arrest before the age of 35 but it does become more prevalent with age so jim fix was
the author of the new york times best-selling book the complete book of running not only did
he popularize running he was considered the face of america's fitness revolution he advocated that
regardless of diet or genetic susceptibility an individual would not suffer a fatal heart
attack if they were a non-smoker and exercised sufficiently so although there's a lot of truth in
that especially when it comes to exercise and not smoking the rest wasn't really accurate because
genetics and diet play an important role fix had a family history of premature myocardial infarctions
in 1984 fix was age 52 and he would run 10 miles a day on his final run he had an sca from a
large heart attack autopsy reports showed major blockages in all three major coronary arteries
daryl kyle at 33 was a pitcher for the saint louis cardinals and in june of 2002 he was
missing from pre-game warm-ups and later found dead on his hotel bed autopsy revealed the cause
of death to be myocardial infarction and he was found to have a 90 occlusion in two of his
three coronary arteries number four myocarditis which is inflammation of the myocardium meaning
the heart muscle lots of different causes most commonly it's caused by various viral infections
including covid but sometimes it's caused by an autoimmune condition like giant cell myocarditis
sometimes there's no known specific cause so hank gathers had scd while playing an nba game
autopsy reports revealed that he had idiopathic cardiomyopathy with residual interstitial
myocarditis idiopathic means no known cause and cardiomyopathy means disease of the heart muscle
so what about covid disease or covid vaccination there are reports of covid and the covid vaccine
causing myocarditis in young athletes but it's been reported that christian eriksen did not have
covid and did not have the vaccine okay number three is arvd at age 22 antonio puerta had routine
health checkups three weeks leading up to a match and everything checked out okay but in the game he
suffered an scd in the autopsy report revealed that the cause of death was arrhythmogenic
right ventricular dysplasia so arvd it's a rare form of cardiomyopathy in which the heart muscle
of the right ventricle and sometimes with the left ventricle as well is replaced by fat and or
fibrous scar tissue the right ventricle becomes dilated and does a poor job of pumping blood to
the lungs to pick up oxygen which ultimately leads to the left ventricle not pumping as much blood to
the rest of the body as if that's not bad enough the rv the right ventricle becomes more prone to
developing deadly arrhythmias like vt and v-fib although the cause is not known it tends to run in
families and it's best diagnosed with a cardiac mri number two anomalous origin of a coronary
artery so pistol pete maravich who played for lsu was named the greatest college basketball player
of all time by espn back in 2005. he's the record holder for college basketball's all-time leading
scorer with 3667 points in 1988 he suffered a sudden cardiac arrest at a promotional game
and died at age 40. autopsy report revealed the absence of a left coronary artery and scarring of
his heart tissue that was a result of chronic decreased blood flow to his heart all right
last but not least number one is hypertrophic cardiomyopathy hcm is one of the most common
causes of sudden cardiac arrest in young athletes this was the case with miklos feher reggie lewis
and mark vivian foe who played in two world cups and was playing for cameroon in 2003 when he had
a sudden sca so autopsy results revealed hcm with resultant v-tac ventricular tachycardia
as the likely cause of death hcm is a type of structural heart disease so just like you can
have hypertrophy or enlargement of your muscles from working out this can also happen with the
heart muscle which doesn't happen from working out this type of muscle enlargement of the heart
it's not a good thing because the muscle it starts to get in its own way and less blood
is able to be pumped out of the left ventricle so an echocardiogram can usually make this diagnosis
but sometimes a cardiac mri is required so what about the new apple watch 6. apple
claims that they can have ekg monitoring right on your wrist would this be helpful
maybe one issue is its accuracy it's certainly not as accurate as a 12 lead ekg but how accurate is
it only time and high quality studies will tell but even if it's accurate would it be useful
maybe one problem is that for young people who suffer from a sudden cardiac arrest things are
cruising along just fine for them in sinus rhythm but then boom all of a sudden they go into v-tac
or v-fib and ekg monitoring at that point is useless unless you have an aicd in your chest
which can then shock the rhythm meaning cardiovert back into a sinus rhythm but there may be some
instances where it could actually be useful for example sometimes people can have premature
ventricular contractions that can be a tip-off to v-tac or maybe they have non-sustained vtec
meaning the v-tac is very short-lived and that could prompt someone to seek medical attention
or maybe the monitoring can detect a prolonged qt or a short qt or st elevations or sd depressions
etc that could prompt someone to seek medical attention before it's too late this is something
i'm interested in to learn more about in the near future and we'll have more to come on this matter
can sudden cardiac arrest be prevented or screened for in the first place most athletes have health
screenings including a history and physical exam there are a lot of similarities in the screening
process between europe and the united states but one of the big differences is that europe
includes doing a 12-lead ekg whether or not to screen every athlete with an ekg is a matter of
debate between cardiologists a more aggressive screening process entails a less evidence-based
approach and a higher financial cost on the health system regardless cases like this
highlight the importance of having aeds in their availability not just at sporting events but gyms
and public places in general and since fast action is the key determinant to survival and those
who have sca it would also make sense to have athletes trained in cpr especially in instances
when medical staff is not immediately available so that's all for this video and if you like these
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