Cardiovascular Conditions & Athlete Deaths

Cardiovascular Conditions of the Athlete:

• Medical conditions related to cardiovascular issues in athletes are a key focus

Division by Age: Under 35 Years Old

• Sudden death in athletes under 35 tends to stem from abnormalities within the heart

Division by Age: Over 35 Years Old

• Sudden death over 35 is more commonly linked to coronary heart disease

Common Mechanism

• Sudden death in both age groups often results from myocardial ischemia, or lack of blood flow to the heart
• Myocardial ischemia can cause arrhythmias, which are irregular heartbeats
• Arrhythmias can progress to ventricular fibrillation – the heart flutters and cannot maintain a regular beat
• Ventricular fibrillation can lead to a heart attack and potentially death

Additional Causes of Sudden Death

• Sudden death is not always related to heart attacks
• Head trauma may be cause of sudden death
• Hypothermic events (extreme cold exposure) may be cause of sudden death
• Other types of severe injuries may be cause of sudden death

Preparedness

• Even though these events are rare, athletic therapists must be prepared to handle life-threatening emergencies

The DeMar Hamlin Incident

• DeMar Hamlin, a Buffalo Bills athlete, suffered an unexpected cardiac arrest during a game, which took place over a year prior

Medical Response in the DeMar Hamlin Incident

• The athletic trainer and medical staff on the field were instrumental in saving Hamlin's life
• Emergency response needs to be immediate and efficient during cardiac arrests

Video Preparation

• A video showing DeMar collapsing on the field can be used to see a real life example
• The outcome was positive with DeMar making a full recovery
• Students are warned about the seriousness of the incident.

Observation Focus from Incident

• Focus on how quickly they respond and what procedures medical staff follow
• Analysis of reactions and the psychological impact of witnessing such a severe medical emergency.

Future Discussion about incident

• This incident can be revisited to analyse emotional and psychological effects on teammates, coaches, and medical staff.

DeMar Hamlin’s Incident Particulars

• Hamlin suffered a cardiac arrest and was clinically dead on the field (no breathing, no pulse) despite being a young, healthy professional football player
• Quick and effective medical response was critical to saving Hamlin’s life

Commotio Cordis Condition

• Commotio cordis is a condition caused by sudden, blunt force trauma to the chest disrupting the heart’s electrical cycle
• This condition is often referred to as a "cardiac concussion”

Key facets that Commotio Cordis Requires

• Timing: Impact at a vulnerable point in the cardiac cycle
• Location: Direct force to the chest wall
• Intensity: Force not excessive as timing is what makes the event dangerous
• Commotio Cordis Leas to arrhythmias, potentially causing the heart to enter fibrillation and stop functioning
• It is rare although it can happen during contact sports

Implications For Athletic Therapists

• Athletic therapists should be prepared for life-threatening cardiac events during coverage
• Therapists need a response protocol and should exercise rapid recognition of cardiac arrest as well as give immediate intervention (CPR, AED)
• Made a full recovery and returned to active participation following his cardiac arrest; this was a very unusual outcome

Important Steps

• Students should observe the medical staff's response on the field based on videos from the DeMar Hamlin Incident
• Student need to Analyze the reactions of other athletes and personnel based on videos from the DeMar Hamlin Incident

Key Takeaway

• This incident highlights the importance of emergency response protocols and psychosocial impacts on teammates and staff.
• Understanding commotio cordis and recognizing cardiac arrest signs are critical skills in athletic therapy

Steve's Cardiac Arrest Incident

• Steve Rush recalls his competitive squash match where he suddenly collapsed due to cardiac arrest.
• Steve's wife and others nearby initiated CPR immediately, highlighting the urgency of the situation.

Actions of Bystanders

• Bystanders, performed CPR to sustain Steve until professional help arrived due to him being unconscious and failing to breathe
• A quick was response was crucial in these initial moments by bystanders

Use of an AED

• An Automated External Defibrillator (AED) was used during the rescue, analyzed the condition and advised a shock to restore heart rhythm
• AEDs are critical in emergencies.

Importance of AEDs

• Wide availability of AEDs in public places can increase survival rates for cardiac emergencies
• Action First Aid training prepares citizens act confidently in crises.

Life after Cardiac Arrest

• Desire to return to normal life was mentioned as well as resume activities
• Important to be prepared for emergencies.

Importance of being Prepared

• Sudden cardiac arrest (SCA) can happen without warning
• Immediate response can be the difference between life and death
• All locations, sporting venues, malls, or homes can be locations of SCA

SCA Statistics

• Out-of-hospital cardiac arrests have a survival rate of 10%
• 350,000 incidents of sudden cardiac arrest occur annually in the U.S.
• 90% of people experiencing out-of-hospital cardiac arrest do not survive
• 70% of out-of-hospital cardiac arrests happen at home
• Survival rate increases to 21% for in-hospital cardiac arrests

Key Steps to Respond

• Quick CPR is essential
• Survival rates depend on how quickly CPR is started and how soon an AED is applied
• Survival decreases by 10% for every minute CPR and AED use are delayed

Key Steps to Respond cont.

1. Recognize the emergency (no breathing, no pulse).
2. Start CPR immediately (chest compressions).
3. Send someone to get an AED.
4. Use the AED as soon as it arrives.
5. Continue CPR until professional help arrives.

AED Awareness:

• Know the location of the nearest AED in places you frequent (e.g., gym, school, mall)
• AEDs are increasingly available in public spaces

Why Quick Response Matters:

• Effective bystander CPR can be as effective as receiving care in a hospital
• Early recognition and rapid action save lives.

Habit of Preparedness:

• Identify AED locations whenever entering a new environment
• Being aware can make you ready to respond in an emergency during such events

Final thoughts

• Understanding and preparation are essential even if the topic is a bit frightful
• You don't need to be certified to help

Sudden Death in Sport:

• Sudden death is typically defined as a non-traumatic, unexpected event
• Sudden death occurs instantaneously or within minutes of an abrupt change in an individual's clinical state

Key Characteristics:

• Non-traumatic: Not caused by an external physical injury
• Unexpected: No prior warning signs or symptoms
• Rapid Onset: Happens almost immediately or shortly after symptoms appear

General Causes of Sudden Death:

• Numerous causes can lead can sudden death.
• Causes can differ based on age, health status, and context (e.g., exercise vs. rest)
• Typically related to cardiovascular events but can include other medical emergencies

Main Causes of Sudden Death: Coronary Artery Abnormalities:

• Coronary artery abnormalities are a significant cause of sudden death
• These abnormalities affect blood flow to the heart

Main Causes of Sudden Death: Hypertrophic Cardiomyopathy (HCM):

• Hypertrophic Cardiomyopathy (HCM) is the most common cause of sudden death
• HCM refers to an enlarged heart

Other Potential Causes:

• Various heart abnormalities can contribute to sudden death
• Understanding these abnormalities helps in recognizing risk factors

Cardiac Causes in Younger Athletes:

• Cardiac issues generally concern those under 35
• structural abnormalities of the heart includes Hypertrophic Cardiomyopathy (HCM)
• Coronary Artery Abnormalities are a cardiac cause

Non-Cardiac Causes in Younger Athletes:

• Non-cardiac is when sudden death in younger athletes relates to like Head Trauma and Hypothermia
• Other injuries or conditions unrelated to the heart may cause this

Sudden Death in Athletes Over 35:

• Sudden death in older athletes is primarily caused by coronary heart disease
• Different risks and causes between younger and older athletes must be considered

Cardiac Causes in Young Athletes:

• Cardiac causes include: Hypertrophic Cardiomyopathy, Coronary Artery Abnormalities, Aortic Rupture - Marfan's Syndrome, Arrhythmias, Myocarditis and Acquired Valvular Heart Disease

Hypertrophic Cardiomyopathy (HCM):

• Enlarged heart is the most common cardiac cause of sudden death in younger athletes
• Can lead to arrhythmias and ventricular fibrillation

Coronary Artery Abnormalities:

• Malformations in the coronary arteries can restrict blood flow to the heart

Aortic Rupture:

• Aortic Rupture is often associated with Marfan Syndrome, a connective tissue disorder affecting heart and blood vessels

Arrhythmias:

• Irregular heartbeats can disrupt the normal heart rhythm and lead to sudden cardiac events

Myocarditis:

• Inflammation of the heart muscle is often caused by viral infections
• Can weaken heart function and cause arrhythmias

Acquired Valvular Heart Disease:

• Damage or dysfunction of heart valves affects blood flow within the heart

Cardiac Conduction System Disorders:

• Disrupts the heart's electrical system, causing abnormal rhythms and potentially leading to sudden death

Definition of Hypertrophic Cardiomyopathy (HCM)

• Enlargement of the left ventricle and left ventricular wall is what makes it HCM
• Reduces the volume of blood that can be ejected from the left ventricle

The Mechanism of Hypertrophic Cardiomyopathy (HCM)

• Abnormal filling and emptying of the left ventricular cavity is it's mechanism
• Increased heart effort during physical activity can lead to arrhythmias and heart attacks

Diagnosis of Hypertrophic Cardiomyopathy (HCM)

• Echocardiogram to assess the size of heart chambers

Common Symptoms of Hypertrophic Cardiomyopathy (HCM)

• Common symptoms include: Syncope, Palpitations, Chest Pain and Dyspnea
• Family History: Sudden death before the age of 50

Later Signs and Symptoms of Hypertrophic Cardiomyopathy (HCM)

• Dizziness, Increased Blood Pressure, Decreased Heart Rate and symptoms that worsen with physical activity

Key Considerations of Hypertrophic Cardiomyopathy (HCM)

• Young athletes may be unaware they have HCM until testing is done
• Early detection is critical to prevent sudden death
• Monitoring family history and recognizing early symptoms can aid in diagnosis and management

Normal Heart vs Non-Athletic Heart

• Non-athletic heart with a standard ventricular wall thickness shows a regular chamber size

Endurance-Trained Heart vs Thicker ventricular walls

• These variations mean that there is a wider ventricular chamber to accommodate greater blood volume
• Wall thickness remains similar to a normal heart
• Enhanced capacity for aerobic and endurance activities

Strength-Trained Heart vs Thicker ventricular walls

• These variations mean that there is now thicker ventricular walls due to muscle development
• Reduced chamber size leads to lower blood volume ejection
• Less efficient for aerobic endurance activities compared to endurance-trained hearts

Hypertrophic Cardiomyopathy

• Results in a Significantly thicker left ventricular wall, leading to a dramatically reduced chamber size
• The heart is less efficient at ejecting blood with each beat because increased risk of heart attack

Enlarged Heart Impact

• Enlarged Heart Impact: HCM results in an enlarged heart that is less efficient, despite appearing larger

Performance Consequences of Hypertrophic Cardiomyopathy

• The heart must work harder to supply oxygen to muscles during physical exertion, which can lead to complications

Risk of Hypertrophic Cardiomyopathy

• Due to the reduced volume capacity and excessive workload, athletes with HCM are put at higher risk of sudden cardiac events

Definition Coronary Artery Abnormalities:

• Occurs in one or more of the coronary can restrict blood flow

Coronary Artery Abnormalities:

• Supply the heart muscle with oxygen-rich blood
• The coronary arteries supplies oxygen-rich blood to the heart muscle

Causes of Coronary Artery Abnormalities Under 35:

• Abnormal formation of coronary arteries may impair blood and is often present from birth

Causes of Coronary Artery Abnormalities Over 35:

• Coronary artery issues are often due to atherosclerosis (plaque buildup) caused by lifestyle factors (e.g., diet, lack of exercise)

Impact of Abnormalities:

• Abnormal coronary arteries can lead to reduced blood flow to the heart, causing arrhythmias (irregular heartbeats) or even heart attacks

Coronary Artery Key Points:

• Coronary arteries are vital for supplying oxygen to the heart
• defects or blockage can impair blood flow, increasing the risk of sudden cardiac events
• In younger athletes, coronary artery abnormalities are typically structural rather than lifestyle-related

Key fact about Aortic Rupture:

• A rare but serious cause of sudden death in younger athletes that may involve an aneurysm: a bulge in the aorta, i.e the body's largest artery in which if it tears, is fatal

Causes and facts Aortic Rupture:

• Most commonly occurs in athletes with Marfan Syndrome
• Can result in an enlarged aorta prone to tearing and rupture.

Impact Of Rupture

• This Condition leas to leads to internal bleeding and life-threatening situations

Key points Aortic Rupture

• Aortic rupture is a significant concern for athletes with underlying conditions like Marfan Syndrome. Also Screening can be done for Marfan Syndrome or related conditions can help identify at-risk athletes
• It might also be important to note that Symptoms might not be obvious until a rupture occurs, making early detection crucial.

Characteristics Of Marfan Syndrome

• Tall and thin body type can be an indication
• Arm length or wingspan typically exceeds their height
• Normally, wingspan and height are about equal, but with Marfan syndrome, the wingspan is noticeably longer

Characteristics Signs and Symptoms Of Marfan Syndrome Include

• Pectus Excavatum know as a sunken chest and Caused by excessive growth of costal-sternal cartilage
• Hyperextensibility of Joints which means Joints are hypermobile or excessively loose
• Scoliosis meaning abnormal spinal curvature or posture.
• Myopia is also a sign meaning Nearsightedness or vision issues
• Mitral Valve Prolapse :Defective mitral value means improper function
• Aortic Regurgitation : is dysfunctional leading to blood moving into ventricle
• Increased Risk means this condition can lead to aortic rupture.

Wolff-Parkinson-White Syndrome (WPW). Characteristics.

• Causes an extremely rapid heart rate
• Often referred to as supraventricular tachycardia (SVT).

prolonged QT syndrome

• Time between ventricular depolarization (QRS) and repolarization (T) is prolonged
• Can occur in individuals who abuse Cocaine or methamphetamines

Bradycardia description

• Refers to a slow heart rate.
• Key points electrical heart:
• P-wave (atrial depolarization)
• QRS complex ( Ventrical depolarization)
• T-wave ( ventricular re-polarization)
• Definition of WPW involved in the electrical pathway
• Characteristic : leads to Supraventricular tachycardia which can lead to 200-300bpm
• Can use the Electrical cardiogram
• Leads to rapid heart rate and high blood pressure

Definition Myocarditis

• Refers to inflammation of the heart often with general fatigue, tachyardia
• Can be caused by viral infection

Impact:

• Can cause inefficiency of blood flow

Commonalities

• Chest pain, feeling a fluttering heartbeat

Pulmonary valve stenosis definition

• Valve become thickened and obstructed
• This leads ventrical wall hyperthropy
• Similar to hypertonic cardio myopathy
• Blood pressure exerts increased blood pressure making it hard to breath leading to death. Mitral Valve Prolapse (MVP). Definition:
• Where this valve becomes floppy . Where your valve prolapses.

Bacteria travel though bloodstream.

• Treat with dental cleaning
• Dental Vistis

Commotio Cordis

• Cardiac Concussion that occurs through blunt force trauma can lead to cardiac arrest.
• Descirbed as Cardiac Concussion . Can lead to heart issues

The following lead to cardiac arrest

• Substance abuse. Can cause aritmias, lead to heart attack.
• Exertion hyperthermia
• Caused by body to not properly regulate .
• Causes cardiovasicular collapse.
• Over exertion
• RHabdmyolysis:

Characteristics

• Commotio Cordis: from blunt chest impact
• Substance Abuse is to not maintain heart health.
• Exertional Hyperthermia- over exhaustion causing heat stroke
• Rhabdomyolysis - extreme Overt exertion. .

Signs of cardiac are as follow

• History of fainiting indicates needs for evaluation
• Any symptoms indicate heart failure
• Athletes feeling irregular heart beat are likely to be heart falure.
• May also be labored breathing
• Family history for heart conditions such as death hypertension. These are red flags.

General Red Flags

• Fatigue and unusual symptoms for the athlete fitness levels.

Cardio Artary Blockages

• These are the leading cause of death
• When blockage occue
• May lead to lack of oxygen Implications for older audlts with cardio problems.

Coronary artery disease (CAD)

• CAD leads to an increase risk of deadly events
• Recognizing symptoms and risk factors is imporatn
• Involves getting screened as well identifying red flags,.

Referral For Further Testing

• Athletes with conditions like Marfan syndrome, hypertrophic
• Should be assessed and monitored imaging.

Challenges in Prevention

• Younger lack signs a snyptoms which means one can assess

Monitoring Risks to for see conditions

• Syncope meaning dizzzness
• Heart palpatations.
• Warning for the 35's are family history
• Syncope is sign, along Palpatations, dypnea.

Steps to Respond to an Unresponsive Person:

• Check if person is sfae .
• Assess the person's responsiveness.
• Breathing for 10 seconds .
• CHeck circlation.

Proceudre

• Then perfrom compeession
• Do a head tilt in case of heart failure.
• Follow voice prompt

Anemia definition

• Anemia is low red bloofd cell count.
• Visual left to right is lack of white and red bloid cells.

Excessive Bleeding:

• Occurs durign over use of medicine such as asprin
• leads to anmenirc response with female attlets
• Low iron levels . Results is results in body not being able to
• Geetic pre does individual anemic tendencies/ Anema Most common is Fatyuge with low energy

Iron Defiency Symptoms

• A major fatigue - Anemia . Not general tired but abormal fatigue.
• Naucease is a sign of this.

Identifiable through blood tests

• Lw iron level .
• Lw iron level .
• Lw iron level .
• Lw iron level .

Inadquate Intake

• Not enough.
• The body taing enuohg but is no being properly
• The GI is not abrobong .

Listen . Role the Therapist

• The rol efo therpist as a soundboard to listen .

Managements

• Eating meat products helps with iron absorbtions
• Take supplement . C rich foods helps with absorptions.
• Take supplement . Can supplement as well.

Rare - Ruiness Arhemia

• Rare Is a rare type of anemia . Which impact destroying normal. The impact. Can cuase feet to be destroyed .
• Dependant on miliage if runnig to much .

Managing with hydration is important .

• Need to be well hydrated.

Hydrations:

• Stay hydrates and use anticagolunts

• Can get genetic test to see if. This conidition is possible.

• Can give better red or oxygen can help improve Respiratory conditions:

• nasal cavity

• upper is eaiser to manage low is more difficult

• Gas exchange

Pnuemonia

• is viral infecioun bacteria
• Causs bacterial or viral

The Respiratory system is divided into nasal cavity and mouth then the air travels into the lower respitory which is the larynx. Next the air travels into the lower part respitory called bronchioal tree.

Categories

• is the upper/lower respiratory tract in sections of infection

.

Definiton Common Cold

• is a vrius caused condition . From touching places to spread can be from people people touch or dirrect contact .
• Contatc -

How to manage

• Manage
• Drink fluid with fluid
• AVOID CONTACT Medications help .
• Influenza:
• Three is A,B and C virsus . And
• Is high commneded for at tisk groups Cough,musclar issue head ache

Cough is bad if 24 hours. Is important

• 4. Fever Monitoring

Avoids high Fever

• Hot showers
• humiderfers
• gargling

• The definition of Sinutitis: Overview this inflammation causes congested Facial pains

• Pnuermial -

Definition Tonsilits

• Can become fungal . S/S bad tonls headache

Important Antibiotic s are important.

Definition Allergic rhinitis (hay fever):

• A condition caused by Pollen. Dust . S/S is itchy eyes , throath watery
• Aviod allergens. Antihistamines helpt

Def Aute Bronchitis.

• Is when the infection gets viral

Astma

• Wheezing

Trigger:

• viral
• stress
• Temoeratiires

The exact causes of asthma is unclear

• but in haled broncidalator is helpfil.

• Diabetes

• Is a hormone based disease

• Type 1 dependent

• Type 2 non dep

• Cared for sugar levels.

• Always. Type 1 - under 35 genetic , regular Ype 2 lifestyle habits .. All impact heart eye Insulin helps bring donw glucose which can lead to heart.

Diabetes with.

• Excessive water

Diabietic Comma

• caused high levels of Glucose is
• Insuline low
• Difficultly breathiong
• Can go unto coma:
• The person is comatose
• Manage:
• In hospital ..
• A good is when person can better manage
• Diet and exerciss helps with tyep two. Insulin injectiojsh elp with typee one.
• Diet is imprptant in diabetes with high carb
• Hocke , eat protein - carbs with snack,
• Team work is imprtaont.
• A good focuse Dexcom G6

Seizure

• Is generioc and can be a result with discharge

• Alters sensation

• perception

• Loss of conc Seizure -aggerssice sudden . And to protect from others if it happens To contact if its new.

• Seizure

• simple = altered Complex are unconsisnes.

• Iddophatic. - unkowm provokes by stress

• Meningtiidis - Infection lead to ezeuries Febrile

• High fever Stroke Drug The diet is linled

Alchhol can affect trigger

Be awre of what the trigger is . What tyupe it is . The parts involvd . Type of Seizuers are partial , Genralizreed , special-

Examine cardiovascular conditions leading to sudden death in athletes, differentiating causes by age (under/over 35). Common mechanisms includes myocardial ischemia leading to arrhythmias and ventricular fibrillation. Note head trauma and hypothermia as additional causes.