Heart Health Heart Disease Palpitations & Arrhythmias Sudden Death in Young Athletes By Richard N. Fogoros, MD facebook linkedin Richard N. Fogoros, MD, is a retired professor of medicine and board-certified internal medicine physician and cardiologist. Learn about our editorial process Richard N. Fogoros, MD Medically reviewed by Medically reviewed by Yasmine S. Ali, MD, MSCI on January 27, 2020 facebook twitter linkedin Yasmine S. Ali, MD, MSCI, is a board-certified preventive cardiologist and lipidologist. Dr. Ali is also an award-winning writer. Learn about our Medical Review Board Yasmine S. Ali, MD, MSCI Updated on December 15, 2020 Print The sudden death of a young, apparently healthy athlete is a great tragedy. While the odds that any given athlete will die suddenly are very small (with estimates ranging from 1 in 50,000 to 1 in 300,000 over 10 years), each sudden death that does occur is devastating to family, friends, and community. The large majority of these sudden deaths are related to underlying cardiac conditions that were undiagnosed prior to the lethal event. The lethal event itself is usually a malignant cardiac arrhythmia called ventricular fibrillation. In most of these unfortunate young people intense physical exertion, in the face of their underlying heart condition, trigger the lethal arrhythmia. kristian sekulic / Vetta / Getty Images Cardiac Conditions That Increase the Risk The age that seems to divide "young" athletes from "non-young" athletes is 35 years. Above 35 years of age, sudden death in athletes is usually caused by coronary artery disease due to atherosclerosis. Below 35 years of age, sudden death in athletes is commonly related to congenital or genetic heart conditions, or in some, to infections or inflammatory disease. The cardiac conditions that may increase the risk for sudden death fall into two general categories: Structural heart disease (in which the heart is structurally, or anatomically, abnormal), and non-structural heart disease (in which the heart is structurally normal; these patients have "electrical" heart abnormalities). Here is a list of cardiac conditions which can increase the risk for sudden death young athletes. Structural heart disease: Hypertrophic cardiomyopathyCongential abnormalities of the coronary arteriesMitral valve prolapseMyocarditisArrhythmogenic right ventricular cardiomyopathyMarfan syndromeCongenital heart disease No structural heart disease: Long QT syndromeBrugada syndromeCatecholamine polymorphic ventricular tachycardia In the United States, the most common underlying cardiac problems found in the post-mortem examinations of young athletes who die suddenly are hypertrophic cardiomyopathy and congenital abnormalities in the coronary arteries. Myocarditis contributes to a smaller, but still significant amount of deaths. Notably, African-American race and male gender are additional risk factors for sudden death, perhaps especially in hypertrophic cardiomyopathy. The relative incidences of these conditions does not appear to hold for other locations. For instance, in Northern Italy, the most common cause of sudden death in young athletes is arrhythmogenic right ventricular cardiomyopathy (22%), while hypertrophic cardiomyopathy only accounts for 2%. In general, for most of these conditions the risk of sudden death is highest during physical activity that requires a) bursts of extreme exertion, such as sprinting, football, soccer, basketball, and tennis; 2) intensive training programs; or 3) exercise in extreme conditions of heat, humidity, and/or altitude. The exercise recommendations for each condition thus take these features into account. Screening Young Athletes Whether, and how extensively, to screen young athletes for cardiac conditions that might put them at risk for sudden death turns out to be a difficult and somewhat controversial question. Was this page helpful? Thanks for your feedback! Did you know the most common forms of heart disease are largely preventable? Our guide will show you what puts you at risk, and how to take control of your heart health. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Wasfy MM, Hutter AM, Weiner RB. Sudden cardiac death in athletes. Methodist DeBakey Cardiovascular Journal. 2016;12(2):76-80. doi: 10.14797/mdcj-12-2-76 Maron Barry J., Udelson James E., Bonow Robert O., et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 3: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis. Circulation. 2015;132(22):e273-e280. doi:10.1161/CIR.0000000000000239 Additional Reading Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society. Circulation. 2018;138(13). doi: 10.1016/j.jacc.2017.10.054