Book Review
Sudden Cardiac Death in the Athlete
N Engl J Med 1999; 340:740March 4, 1999
- Article
Sudden Cardiac Death in the Athlete
Edited by N.A. Mark Estes III, Deeb N. Salem, and Paul J. Wang. 600 pp., illustrated. Armonk, N.Y., Futura, 1998. $89. ISBN: 0-87993-6916The sudden death of an athlete from cardiac causes, although extremely rare, is always perceived by the public as particularly tragic, because the victims are young and seemingly the healthiest people in our society. In this book, 47 authors give up-to-date information on medical, legal, and ethical issues concerning sudden death in athletes.
Many of the underlying cardiovascular diseases that predispose a person to sudden death, such as coronary artery disease, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, and coronary anomalies, are now well identified. Information about these topics is presented repeatedly in this book, making it longer than necessary. The list of causes and special circumstances of sudden death, including commotio cordis and illicit drug use, appears complete; however, only in the last chapter is the Brugada syndrome mentioned. In this disorder, young men die of idiopathic ventricular fibrillation, usually at night or when resting. The electrocardiographic hallmark of the syndrome is right bundle-branch block and ST-segment elevation in right precordial leads. Young Thai men who are victims of sudden death from cardiac causes seem to share the same electrocardiographic pattern. Since asymptomatic persons with the syndrome also appear to be at increased risk of dying suddenly, it should be given more attention.
With respect to screening of athletes, all the North American authors agree that in a population with a very low prevalence of the disease, a history and physical examination is sufficient. This view is at variance with that of the Italian authors (chapter 15). In a clinicopathologic study of sudden death in young people carried out in the Veneto region of northeastern Italy, the prevalence of hypertrophic cardiomyopathy as a cause of sudden death in athletes was much smaller than that found in a U.S. series. According to a recent article by these authors in the Journal (“Screening for Hypertrophic Cardiomyopathy in Young Athletes.” 1998;339:364-9), this difference can be attributed to the more detailed screening of athletes in Italy, which leads to the disqualification of men with hypertrophic cardiomyopathy, thereby preventing sudden death in athletes affected by this disease. Alternatively, these results may — at least in part — reflect differences in the ethnic, geographic, and genetic background of the populations studied. The Italian authors argue for 12-lead electrocardiography as a part of screening. All experts concur, however, that the efficacy and costs of additional high-technology screening, which is common in Italy as well as in Germany, should be rigorously assessed before it is used in large-scale screening programs.
The chapter on response to emergencies at athletic events is another highlight of this book. After describing the “chain of survival” concept, Cummins and Hazinski convincingly argue for public access to defibrillators. The authors predict that automatic external defibrillators will in the future be used on a victim among the athletes at an event (or, more likely, on victims among the spectators) by trained, but nontraditional, emergency responders, such as team physicians or team trainers. One can foresee the use of these defibrillators by police and flight attendants, as well.
For athletes with documented or suspected heart disease of any kind, including arrhythmias, the book presents practical guidelines for diagnostic workup, therapy, recommendations about exercise, and eligibility for athletic competition. The book ends with recommendations for the care of high-profile athletes (follow the simple guideline: provide good medical care, establish good relationships with the athlete and his or her family, and protect confidentiality), legal considerations, and the viewpoints of team physicians (most of whom are not familiar with cardiac problems) and athletic organizations, all of which make this part of the book informative and easy to read. The editors have achieved their goal of providing a summary of present knowledge about the sudden death of athletes from cardiac causes for physicians, the athletic community (trainers), and the public.
Gerhard Steinbeck, M.D.
University of Munich, Munich 81366, Germany- Citing Articles (1)
Citing Articles
1
Ambrogio Orlando, Gioacchino Leandro, Mirko Olivo, Angelo Andriulli, Mario Cottone. (2009) Radiofrequency Thermal Ablation vs. Percutaneous Ethanol Injection for Small Hepatocellular Carcinoma in Cirrhosis: Meta-Analysis of Randomized Controlled Trials. The American Journal of Gastroenterology 104:2, 514-524
CrossRef
