Sudden Death

In 490 BC,Pheidippides ran from the battlefield of Marathon to Athens to announce the Greek victory over Persia in the battle. Legend says he ran the distance and said,We have won, and then collapsed and died. Some 2,500 years later,doctors almost unanimously agree that his affliction was the same as that of Venkatesh and Muamba. Sudden cardiac death.

Evidently,football is not the only sport with a recurrent association of sudden cardiac arrest in young men. Athletes who experienced SCD include marathon runner Jim Fixx 1984,Olympic volleyball player Flo Hyman 1986,former basketball star Pete Maravich 1988,college basketball star Hank Gathers 1990,professional basketball All-Star Reggie Lewis 1993,and Olympic figure skating champion Sergei Grinkov 1995 says an article in the Journal of Athletic Training. According to a study published in the British Journal of Sports Medicine in 2010,the reported incidence of sudden cardiac arrest SCA varies from one in 65,000 athletes to on in two lakh. An estimated 0.1 to 0.2 per cent of all deaths are attributed to SCD.

But this phenomenon of an apparently healthy heart ceasing to beat often at a time when it is stretched to its limits is hardly an affliction limited to sports,though it does tend to affect fit people more than those who are unfit,possibly because fitter people are more likely to push their heart to the limit. This may cause an existing heart condition to suddenly turn fatal. In 2008,a 12-year-old student of Amity International School,Noida collapsed and died in her school field while waiting to play football.

There are certain warning signs which if taken seriously can prevent a heart condition from becoming fatal. Any sudden fainting episode should be taken very seriously. If such an episode happens while exercising,it is even more significant. If the heart seems to skip a beat once in a while,that is a warning,as is a family history of any person below thirty years dying in similar circumstances. Deafness is associated with the same gene as sudden cardiac death,so that is another red flag, says Dr Vikas Kohli,senior consultant cardiologist Indraprastha Apollo Hospital.

Common causes of SCD include malfunctioning of the heart8217;s electrical circuit which provides it the stimulus to keep beating,or of the heart muscle which may,due to some inherent deficiencies some of them congenital not be able to translate that impulse into action. In simpler words,it is a condition triggered by a disruption in normal beating of the heart a condition called arrhythmia. This condition is believed to claim some 4,000 young lives around the world every year.

The lack of awareness also means that a potential patient is rarely ever picked up until it is too late.

Medical discourse on heart is disproportionately loaded in favour of coronary artery disease CAD,SCD,and its causes like long/short QT syndrome. Though not very rare,problems like Brugada syndrome,dilated cardiomyopathy and Wolff Parkinson White Syndrome,are hardly ever talked about.

Dilated cardiomyopathy is a condition in which the heart becomes weak and enlarged and hence cannot pump blood properly. This is often caused by common viral infections which means that working out while suffering from flu can result in far greater complications than resting for a few more days.

Another condition usually associated with athletes,called athletic heart syndrome,can predispose a person to sudden cardiac arrest. It can occur in any individual doing more than five hours of aerobic exercise per week or can even occur in people who do extensive weight training. The heart is enlarged and resting pulse rate is lower. In extreme cases,the amount of enlargement can actually reduce the heart8217;s pumping capacity. Even in moderate cases,the condition may bias the outcome of an ECG and thus prevent an existing heart condition from being picked up.

Screening with an ECG and an echo cardiography most often remains the only way of identifying patients. Dr S S Kothari,professor of cardiology in AIIMS,says that for a country like India it is hardly a cost-effective option. 8220;Children starting off on a new sport,if they have a family history,should be screened. In fact,anybody with a family history should undergo screening. Defibrillators should be made available in prominent public places and people should be trained in resuscitation,8221; he says.

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