Athletes Dying Young

Many Cases of Sudden Death Syndrome May Now Be Preventable

News | Lucas Jakobsson, Marlies Dachler | March 2008

Footballer Antonio Puerta collapsed mid-game after SDS-related symptoms (Photo:

One in every 100,000 athletes under the age of 35 dies every year of the sudden death syndrome (SDS), a condition that has fatal consequences only hours after the first symptoms arise.

The recent death of Webster student and competitive ice hockey player Michael Schubert at the age of 19 has raised this issue to a higher profile and emphasized how widespread this pattern is among young athletes around the world.

"The cause is always some form of heart disease, explained sports physician and specialist on internal medicine, Dr. Kurt Moosburger. "Nothing happens without a reason!"

The most common example, according to Moosburger, are Hypertrophic Cardiomyopathy (HCM), a condition in which a part of the hearth is enlarged,  Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), a condition in which the heart muscle is gradually replaced by scar tissue and fat], or Dilated Cardiomyopathy (DCM), a disease of the heart muscle that causes the heart to become enlarged and to pump less strongly.

SDS can also be caused by a stroke in the chest which often results from a direct hit, said Dr. Norbert Bachl, Dean of the Faculty of Sports Science at the University of Vienna, adding that be it from a collision with another player or an object such as a ball. However sports themselves do not cause SDS; they are a catalyst, which puts young players with hereditary heart diseases at increased risk.

This is an old problem. According to popular narratives, the first person to have died of SDS was Greek soldier Phelippides, who ran from Marathon to Athens to deliver the message of victory over the Persians in 490 BC.

More recently, however, the death of 22-year-old Spanish footballer Antonio Puerta last August brought attention to the danger of undetected heart diseases. Puerta, had collapsed during a Primera División game of his club Sevilla against Getafe CF, dying of ARVC according to the diagnosis of his doctor Francisco Murillo.

"In addition to inherited heart diseases or abnormalities, doping is much more an issue than most people would admit," Moosburger said. "Especially anabolic steroids and the human growth hormone (HGH) can harm your cardiac muscle, and, therefore, increase the risk of dying from SDS."

In another high profile death in the late 1990s, the death of sprinting star Florence Griffith-Joyner also caused controversy. Her world records in 100 and 200m sprint in 1988 after an improvement of almost 1 second, and her sudden death in 1998 have been accompanied by speculations regarding the use of anabolic steroids or other performance-enhancing drugs.

And in a perhaps even more alarming example, the Austrian bodybuilder Andreas Münzer died of multiple organ failure at the age of 31, after years of doping abuse in 1996. His daily intake of prohibited substances was three Masteron injections, two Parabolan injections, 2 injections Stromba, 30 Halotestin tablets, 50 Stromba tablets (all anabolic steroids), 24 international units growth hormone somatotropin STH everyday, and if required insulin and thyroid hormone injections as well.

Most can be heart diseases can be detected, argued Dr. Bachl, by a simple ECG scan.

"If any suspicions of a heart problems are found, patients will automatically be given further treatment to inspect the possible cause," he said.

However, while the procedure is mandatory in other countries, it is not for athletes in Austria. In Italy, for example, mandatory scans for all athletes participating in sports more than two times a week have lowered the national SDS rate by 89% since 1979. So why not here?

"In Austria, although recommended by physicians, it is not mandatory as many parents seem to be reluctant to pay for the check up," said Bachl. The basic ECG scan, the minimum required, costs somewhere from €35 to 50 euros. If some suspicions are there, then the medical insurance will pay for further tests, but initial check up costs are still carried by the participant. There have been suggestions that the costs of the scan in the future be shared by sports clubs, the parents or athlete in question and possibly even by the sports ministry.

"The check up varies in cost depending on the extent of the check up, but depending on the doctor," Dr. Bachl said.  However, 35 to 50 Euros seems to be small price to pay for a check up that can potentially save your life.

But even if mandatory checking is enforced in Austria, this will not protect those who participate in other kinds of athletic activities, for example gym goers, joggers and other people doing sport to stay fit.

"It is strongly recommended that anyone that practices any sport more than two times a week take the time and undergo a yearly check up, for which there are many test centers in Austria, for example most hospitals, or by one of the nearly 1000 sport medicine specialists," Dr. Bachl concluded.

Elsewhere, the UK based organization CRY (Cardiac risk in the young), estimates that every week, eight sportspeople under 35 in the UK died of heart related problems during physical activity. Most sudden deaths, however, are believed to go unnoticed unless the athlete in question brings media attention.

According to CRY, about 80% of all SDS deaths are caused by inherited heart abnormalities and could be avoided if the patient was screened before exercising –  meaning the loss of six young lives daily in Britain alone.

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    the vienna review March 2008