Sudden cardiac arrest can occur in apparently healthy, well-trained people. I’ve only seen this happen once. It is tragic and scary. Since I often write about Crossfit I will state write off that Crossfit had nothing to do with this particular case. A young boy was running a 400 m race when he collapsed and died at about the 300 m mark. I was a senior in high school. The boy was a kid I coached as a volunteer. I remember him telling me before the race that he felt like something “bad” was about to happen. I spoke with him about how we all get nervous before a competition. At 17, I don’t know there was anything I could have done to prevent this horrible outcome. Such things happen, even today, with presumably better screening. One thing to keep in mind in Crossfit, is that while people are usually asked to complete a waiver, they may have no idea if they are at risk for cardiac arrest. Sudden cardiac arrest is believed to affect 1,000 people annually. In young people who experienced arrest during vigorous exercise, only ~70% showed any abnormality on autopsy (Pilmer et al. 2014).
Major causes of sudden cardiac arrest in athletes.
Here are some causes of sudden cardiac arrest for which there may be no obvious outward signs.
- Hypertrophic cardiomyopathy: This is more commonly known as an enlarged heart. It may be genetic or triggered by disease.
- Coronary artery Disease: This can happen to young people too, for example, if they have a genetic disorder that leaves them unable to clear cholesterol from their blood streams.
- Commotio Cordis: This can be caused by a blow to the chest that disrupts the heart beat. Commotio Cordis has happened to weight lifters, including Russian powerlifter Igor Golushkin, during a bench press. It might be worth keeping risk from chest blows in mind for your general population too. I’ve been told by a well-meaning “authority” at my Crossfit Box (not a coach, just another member with an authoritative personality and “natural leadership ability”) that I couldn’t get hurt weight lifting because I am female and not strong enough. It is stunning what people believe sometimes. Yes . . . just about everyone is strong enough to get themselves in serious trouble.
- Anomalous arteries: this is basically a birth defect. Some people have extra artery branches or arteries that take unusual pathways. This can cause problems when the heart is stressed, or it may not. Most people will nerve know if they have anomalous arteries.
- Wolff-Parkinsons White syndrome: is an irregularity in the heart’s electrical system. It may be genetic. People with this disorder may get sudden rapid increases in heart rate that can increase their risk of heart failure.
- Myocarditis: this is inflammation usually due to an infection.
- Arrythmogenic Right ventricular dyplasia: the right ventricle becomes weak. This may be genetic but can occur for no apparent reason in a healthy person. This may be the leading cause of sudden cardiac arrest in athletes.
- Long QT syndrome: This is also an electrical irregularity of the heart’s conduction system. It can cause irregular heart beat, fainting or death.
Get Training and Offer Training for Basic Life Support
Getting trained in basic life support is easy. It might be something your box members would enjoy doing as an organized workshop. Here is a video explaining the cardiac conditions discussed above. It is a little dry, but helpful anyway.
There has been much debate as to whether the costs of screening outweigh the benefits to the few individuals who would benefit from them. You can read more here in Link & Estes 2012:
Link MS, & Estes NA 3rd (2012). Sudden cardiac death in the athlete: bridging the gaps between evidence, policy, and practice. Circulation, 125 (20), 2511-6 PMID: 22615422
Refaat, M., Hotait, M., & London, B. (2015). Genetics of Sudden Cardiac Death Current Cardiology Reports, 17 (7) DOI: 10.1007/s11886-015-0606-8
Pilmer, C., Kirsh, J., Hildebrandt, D., Krahn, A., & Gow, R. (2014). Sudden cardiac death in children and adolescents between 1 and 19 years of age Heart Rhythm, 11 (2), 239-245 DOI: 10.1016/j.hrthm.2013.11.006