By Dr. Neerav Sheth, M.D., FACC, FSCAI.
Every second that passes after cardiac arrest is heart muscle lost.
High-contact sports like football, ice hockey, and soccer will oftentimes leave players sidelined with any number of injuries. So, when an athlete collapses — professional or not — some of the most common assumptions might leave witnesses in the immediate aftermath to blame dehydration or a concussion.
In recent years, highly publicized criticism from former NFL players has focused on complications from years of repeated concussions. Much less commonly discussed are the cardiovascular risks that athletes of all levels and ages face every time they play the sport they love. And as we saw this week, cardiac arrest doesn’t discriminate against the young and the athletic.
In 2020 Pennsylvania passed Peyton’s Law — named after a vibrant young athlete who lost her life to sudden cardiac death in 2013 — which sets a standard for Sudden Cardiac Arrest (SCA) education for both athletes and parents. It requires that Pennsylvania Interscholastic Athletic Association (PIAA) provide student-athletes with information on the importance of EKG testing for detecting issues that could lead to SCA.
Which begs the question: How can cardiologists work with their communities to save the greatest number of lives?
Cardiovascular screening that includes electrocardiogram (EKG) in athletes is vitally important. But on its own, it isn’t enough. Even with the screening precautions, the risk of a sudden cardiac death (SCD) in an athlete is far too great.
A 2016 study from Current Sports Medicine Reports examined the risks of SCD in high school and college athletes. Those findings showed that the risk for college-aged basketball players was estimated at 1 in 13,426. The authors of the study notably added, “these alarmingly high rates have occurred in athletes already screened using at minimum the standard PPE consisting of a medical history and a physical examination.”
The majority of people who have experienced cardiac arrest have had a completely normal EKG; this makes screening alone an ineffective strategy to prevent sudden cardiac events in athletes.
To save the greatest number of lives, we must conduct screening while also investing in training and education, increasing access to defibrillators — especially to those in at-risk and/or low-income communities — and spreading awareness of risk factors, common and uncommon symptoms, and family history to parents, coaches, and players.
Education will always save lives; it plays a pivotal role in creating a safer environment for young athletes, coaches, and parents alike. Increasing opportunities for automated external defibrillator (AED) or manual defibrillator training in addition to CPR certification courses can improve an athlete’s chance of survival, should they experience SCA. Wider availability of and better access to AEDs will equip our communities to care for and protect those who need it most — when they need it most.
Last but not least, the significance of considering family history during cardiac screening cannot be overstressed. There is not enough discussion about the importance of family screening when it comes to cardiology. We should be looking back multiple generations, not just at immediate family. Even if an uncle or cousin has experienced a cardiac event, the chances of personal injury due to heart-related incidents increase greatly. Reporting such histories to doctors can give them a better idea of the risks athletes may face.
We need to continue to alter the way we think about and screen for potential cardiac events in every athlete nationwide, because every second that passes matters.
Dr. Neerav Sheth, M.D., FACC, FSCAI attended Northeastern Ohio University for medical school and completed residency at Thomas Jefferson University Hospital, before completing a fellowship at Providence Hospital and Medical Center. He practices at Cardiology Consultants of Philadelphia and specializes in Interventional Cardiology.