The risk of Sudden Adult Deaths could be reduced if young athletes were screened, writes Dr Aideen Henry
The recent tragic deaths of Cormac McAnallen and John McCall raise difficult questions about our policy on medical screening for young sports people in Ireland.
Undetected heart problems are the main cause of sudden death in young sports people.
Medical screening before involvement in schools level sport has been shown to be effective at detecting these potentially lethal heart problems.
Since the 1970s in the US and Italy, all active second-level and third-level students have had annual screening medicals carried out. This currently involves four million high-school students annually in the US and five million people annually in Italy (see panel).
By contrast, since pre-participation medical screening was introduced to Ireland in 1998 it involves the annual medical assessment of more than 120 professional provincial rugby players and 250 national elite athletes (including Olympic athletes).
We need to consider whether pre-participatation medical screening should be extended beyond the small numbers (300-400) currently being tested to mass screening of all secondary school and third-level students?
Is it justified to allocate resources for mass screening to detect an uncommon but potentially lethal medical problem in the place of using those resources to treat segments of the population with already diagnosed medical problems?
How big a problem is Sudden Adult Death syndrome?
In the United States athletic field deaths occurs in approximately one in 200,000 high school-age athletes and it is more common in males. Among older athletes sudden cardiac death, principally due to Coronary Artery disease (narrowing of the coronary arteries due to fatty deposits), is more common; one in 15,000 in joggers and one in 50,000 in marathon runners.
Hence in older age groups although those who participate in endurance sports are less likely to suffer from heart disease because of the benefits of exercise, there is a slightly increased risk while taking part in exercise.
What is the cause of sudden death in Athletes?
The most common cause of sudden death in athletes stems from heart problems (85 per cent). In youthful athletes (under 35 years) the vast majority of deaths are due to several congenital heart malformations most commonly Hypertrophic Cardiomyopathy (HOCM), a hereditary abnormal thickening of the heart muscle which prevents it from working properly. Hypertrophic Cardiomyopathy (HOCM) has been found to occur in one in 500 in the 25 to 35 year age group.
The vast majority of heart-related deaths in older athletes (35 and older) are caused by atherosclerotic coronary artery disease (narrowing of the coronary arteries due to fatty deposits).
Apart from problems with the heart, other less common causes of sudden death in athletes (15 per cent) include cardiac arrest secondary to blunt chest trauma, drug abuse, (e.g. cocaine can have severe cardiovascular side-effects), lung problems (e.g. asthmatic attack), and heat stroke.
Who is at risk?
A competitive athlete is anyone who participates in an organised individual or team sport requiring regular training and regular competition. This description includes not just elite or professional athletes. It embraces all age groups within the population who participate in regular exercise including schoolchildren, the active young and older populations along with amateur and professional sports people.
Dr Aideen Henry is a sports medicine physician, national medical screening coordinator to the National Coaching & Training Centre, former team physician with Connacht Rugby, university lecturer at NUI, Galway, Honorary Secretary to the Faculty of Sports & Exercise Medicine, RCPI & RCSI.