Young people are not supposed to die; they are the leaders of tomorrow. Young or old, untimely death is not desirable. Sudden death in athletes is rare and when it happens the whole nation or world feels the agony. It is preventable if we all play our roles.

Who is an Athlete?
An athlete is an individual that participates in organized competitive sports, or those that exercise regularly and vigorously and have an active life style including sports, or sometimes physically conditioned military personnel.  Individuals that lead a sedentary lifestyle and exercises occasionally are not listed as athlete.

What is sudden death?
Sudden death is defined as “an abrupt unexpected death of cardiovascular cause, in which the loss of consciousness occurs within 1-12 hours of the onset of symptoms”. Sudden death in athletes can occur during or immediately after exercise, some at rest or during sleep.
As rare as it is, Nigerians still have sad memory of Late Sam Okparaji on the field of play.  Antonia Puerta at age 22 had a heart attack in the middle of a game in front of a stadium full of fans in Seville, Italy.  Chaswe Nsofwa died while playing in Israel, and Anton Reid, a 16-year-old professional soccer player, collapsed in the middle of a game in England.

Prevalence
The rate of occurrence vis-à-vis specific prevalence of sudden death in athlete is difficult to determine. There are non-elite athletes that die unnoticed. From few newspaper reports, it is estimated that 1 in 15,000 joggers and 1 in 50,000 marathoners die suddenly on the field. The number will increase if the search is further focused on other sports that lack recognition.

Causes of death in athletes
The precise disease causing sudden death in athletes varies with age.  In younger age group, congenital heart disease cause majority of deaths. In older athletes, the cause is usually as a result of coronary artery disease resulting in heart attack during the exercise. This is why though physical activities are good for cardiovascular system, the exercise has to be prescribed based on your cardiac status and properly supervised.

Hypertrophic Cardiomyopathy (HCM)
This is genetically determined and runs in the family.  There is the thickening and enlargement of the ventricular septum (partition that separates the two lower chambers) and/or other segments of the left ventricle with or without a partial obstruction to the blood flow out of the left side of the heart.
During intense training, there is an increased demand on the heart, producing alteration in the “blood ions”, volume and level of hydration. The  disarray heart muscle fibers in HCM cannot cope with this state, thereby leading to  ventricular arrhythmias (abnormal heart beat) which if untreated leads to death in minutes.  With the enlargement of the heart muscles, the ‘out flow’ of blood to brain is partially blocked at rest. The partial obstruction may increase twice as high with intense physical exercise compared with level at rest making reduced perfusion of brain and heart muscle more marked.
The warning signs are unusual tiredness or dizziness on mild exertion. More importantly if there is family history of sudden death, please see your doctor for evaluation.

Congenital coronary artery anomalies
Mostly, a wrong origin of the left main coronary artery is the second most frequent cause of athletics field deaths. It may not be as common in this environment.   If you study our usual picture in this column, you will see the usual location of left main coronary artery (LCA) and it supplies the major parts of the heart. So any anomaly will definitely affect the function of the heart. These anomalies result in positioning of less efficient artery to carry out the function of (LCA). In addition the anomalous arteries may dive into the heart muscle instead of lying on the surface (epicardial) and may be occluded when the heart muscle that surrounds the abnormally placed artery squeezes aggressively, as with the exercise, shutting off blood supply to part of the heart. This initiates the electrical system and can cause ventricular fibrillation and sudden death.
Echocardiography, radionuclide studies and coronary angiogram can be used to diagnose the disease.
Before you embark on that vigorous sport, kindly check up you cardiac status.
The pre-participation athletics physical examination is a useful tool to screen children and adolescents for their risk of sudden cardiac death.
Sporting activities is a unifying force among different ethnic groups worldwide and we cannot watch you dying on the field of play. Let us be wise, check you cardiac status.

Dr Moshood Abiodun Adeoye. Mbbs, Fwacp
Consultant Cardiologist
Division Of Cardiovascular Medicine
Department Of Medicine
University College Hospital Ibadan
Oyo State, Ibadan, Nigeria