Millions of television viewers were watching as Loyola Marymount’s basketball star Hank Gathers collapsed near mid-court during the semifinals of the East Coast Conference basketball game last year. Gathers, 23, had been getting medical treatment for a heart problem, but thought he could continue to play the game he loved. His unexpected death brought new attention to what doctors call exercise-related sudden death.
Gathers was one of a handful of high-level athletes who have died suddenly while participating in sports. Two years earlier, professional basketball player “Pistol Pete” Maravich died during a low-key pickup basketball game. In 1986, Flo Hyman, a U.S. Olympic volleyball star, died unexpectedly as she exercised. And in 1984, Jim Fixx, a famous runner who had written books about fitness, died while jogging.
These events, when they occur to a well-known athlete, always attract an avalanche of media attention, because the victims were thought to have been healthy and fit. Another reason for so much interest is the rarity of this kind of death, although statistics are hard to compile. It is very likely that many exercise-related sudden deaths are not reported.
Four Main Causes
Exercise-related sudden death occurs in men and women of all ages. Among people older than 30, almost all cases have been attributed to heart attack. For athletes younger than that, causes of death fall into four main categories: heart problems, bleeding in the brain, drugs, and heat stress.
Most deaths of young athletes are due to structural abnormalities or diseases of the heart. They can involve the heart’s arteries, valves, connective tissue, or the aorta, the main vessel that carries blood from the heart to the rest of the body. These problems are usually congenital, which means they have existed since birth. Maravich, for example, was found to be missing a left coronary artery, an important vessel that supplies blood to the heart muscle.
The second most common cause of sudden death in young athletes is bleeding, known as hemorrhage, in the brain. One type of this kind of bleeding is a ruptured aneurysm, a condition in which a blood vessel becomes dilated and bursts. The tendency to develop this condition may be hereditary.
Some drugs, particularly cocaine, cause an irregular heartbeat that can contribute to collapse, unconsciousness, and death. Cocaine abuse has been blamed for blood clots that caused heart attacks even in people who were otherwise healthy and had no history of heart disease.
The fourth category, heat stress, may occur when an endurance event, such as a marathon or triathlon, is held in hot weather with high humidity.
Who’s at Risk?
Studies of people older than 30 who died of exercise-related sudden death indicate that risk factors of high blood cholesterol, a history of cigarette smoking, and a family history of coronary artery disease are common. With younger athletes, predicting risk of sudden death is more difficult.
Many heart problems go undetected until the teen years and some aren’t discovered until the person dies. In 75 percent of exercise-related sudden death cases, neither the athlete nor family members were aware of anything wrong with the victim’s heart.
Young people who can be identified as being at risk include those who have lost consciousness during exercise in the past, those with a family history of sudden death or heart attack at an early age, and those with family members who have had seizures, congenital heart disease, or early coronary artery disease.
The Sickle-cell Question
Another possible risk factor is the presence of sickle-cell trait, a disorder that occurs when a child inherits an abnormal gene from one parent. The trait is related to the often fatal sickle-cell anemia people develop when they inherit the gene from both parents. About 8 percent of the African-American population in the United States has the trait, which is rare among nonblack Americans.
Prevention Where Possible
One way to possibly help prevent some exercise-related sudden death in young athletes is to require a pre-participation screening for high school and college sports.
One way to avoid injury-related tragedy is to require competitors to wear proper protective equipment, such as throat protectors for hockey players. In some people, the body’s response to pain from a blow anywhere can cause brain hemorrhage and death.
Finally, sporting events are safer if they are supervised by physicians with resuscitative equipment. That way, immediate care can be provided if needed. In the United States, football and wrestling generally have adequate, consistent medical coverage, but other sports don’t fare as well. Because a physician may not be available for emergencies, coaches in all sports should be trained in basic life-support techniques, such as cardiopulmonary resuscitation (CPR) and first aid.
Exercise-related sudden death in athletes cannot always be prevented. However, with proper screening, protective devices, safe training techniques, and adequate emergency care, the chances of unexpected tragedy can be reduced.