An academician says pre-participation screening, and quick basic lifesaving skills, are crucial in detecting and treating athletes who suffer from sudden cardiac arrest during play.
Dr Aishah Mohd Hafiz, a senior lecturer in emergency medicine at the School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, was responding to the recent tragic death involving China’s young shuttler Zhang Zhijie on June 30.
Zhang collapsed on court during a Badminton Asia Junior Championships match in Yogyakarta, Indonesia, after suffering from cardiac arrest. He died several hours later.
“The recent tragic death of a young badminton player brings about several questions. How can a seemingly healthy young athlete, at the peak of his physical fitness, suddenly collapse, resulting in death? Secondly, was it at all preventable?
“Sudden cardiac arrest among athletes is fairly uncommon. However, it is the leading medical cause of death among athletes during physical activity, affecting males more than females by 10-fold,” Dr Aishah added.
She said that sudden cardiac arrest happens when there is a sudden disruption of the heart’s normal electrical conduction activity, resulting in the heart to either stop abruptly or beat abnormally (ventricular fibrillation or ventricular tachycardia).
“In both instances, the heart fails to function as a pump, denying the vital organs a continuous blood flow, rich in oxygen and nutrients. If normal rhythm of the heart is not promptly restored, this can lead to death.
“In the majority of cases, the cause of SCA during sport activity is due to structural and electrical changes in the heart, which can be either congenital or acquired.”
A recent study in the United Kingdom says that the leading cause of SCA among their athletes are actually unknown. It is hypothesised that this may still be due to cardiac anomalies, at a molecular level. Though not apparent physically, these abnormalities can trigger cardiac arrest arrhythmias.
“This again poses the question of genetic predisposition and whether genetic screening is necessary,” she said.
“Preventative measures through advocation of pre-participation health screening is essential, especially for young, at-risk athletes. While this is common practice prior to major events such as the Olympics, smaller competitions such as at school or intervarsity levels, may not enforce this.
“In addition, screening is not a pre-requisite for participation in endurance sporting events that are open to the public, such as marathons and long-distance cycling races. Instead, participants are only mandated to sign a waiver form, releasing the organisers from any responsibilities in the event of sudden cardiac arrest.”
She added that in such instances, it is up to the individual athletes, parents, teachers, and the sport team members to take on necessary screening measures.
The American Heart Association recommends a targeted medical history and a focused cardiovascular physical examination as sufficient initial steps to identify high-risk patients. This includes looking for symptoms such as shortness of breath, chest pain, fainting spells or episodes of transient loss of consciousness, or a notable decline in physical performance.
Specific inquiries regarding sudden deaths within the family, relatives with known inherited cardiac conditions, as well as family members with pacemakers or defibrillators in place, should be made.
“Further tests in the form of electrocardiograph (ECG) and echocardiogram can be done in the identified athletes. The ECG looks at the electrical activity of the heart and can display any abnormal rhythms, while the latter looks for any structural abnormalities and the function of the heart. By this stage, consultation with a cardiologist is greatly advised for their expert opinion.
“Among athletes aged 35 years and above, coronary artery disease stands out as the most frequent cause of sudden cardiac death. In older athletes, further screening questions should include pre-existing risk factors for a heart attack, such as a strong family history, actively smoking, and chronic illnesses such as diabetes and hypertension.
“These characteristics, when present, pose additional risks for SCA, thus should be addressed before continuing with any vigorous sporting activities.
She added that some individuals may still develop sudden cardiac arrest despite receiving a clean bill of health.
“Pre-participation screening is useful in detecting certain inherited conditions. However, for some, the cause of sudden cardiac arrest remains unknown. Other aggravating factors such as extreme heat or dehydration during the day of event may unmask an underlying condition, which may not be detected during screening.
“In the event where sudden cardiac arrest occurs, all efforts should be made to improve survival outcomes and prevent death. The effectiveness of CPR and early defibrillation using an automated external defibrillator (AED) are proven and well-established.
Dr Aishah said the key factor for successful resuscitation with favourable outcome is early CPR initiation and defibrillation, which ultimately requires rapid recognition of the signs of sudden cardiac arrest.
“Therefore, it is of the utmost importance that the general public have a heightened awareness of sudden cardiac arrest and possess these basic lifesaving skills, so that treatment can be initiated by anyone even before medical assistance arrives.
“In addition, it is the responsibility of the sporting event organisers to ensure that the AED devices are readily available and accessible, strategically placed within the compounds of the event. An Emergency Response Plan should also be formulated prior to the event, which includes appointing a highly trained and certified medical standby team.”
