The sudden death of a 25-year-old man, who collapsed while playing in a doubles badminton match at Nagole Stadium in Hyderabad on Sunday moments after bending down to pick up the shuttlecock, has raised concerns about sudden cardiac arrest among young, apparently fit people.
A sudden cardiac arrest happens when the heart comes to a standstill and loses all its electrical activity due to an irregular heart rhythm. It simply shuts down. In the first few minutes, the blood flow to the brain is poor, causing the patient to lose consciousness. And within eight minutes, all major organs shut down in the absence of a blood flow. So unless help is at hand, there is very little hope of reviving the person.
Many would argue that someone who is physically fit enough and plays regularly is least expected to experience a sudden cardiac arrest. Or even a heart attack, assuming his vigorous physical activity resulted in dislodging of a plaque in the blood vessels of the heart. But most likely a young fit person, who is often assumed to be disease-free, would rarely have undergone a detailed heart checkup to rule out underlying conditions. Some sportspersons can sometimes develop an athlete’s heart.
WHAT’S ATHLETE HEART?
Sometimes, if you have been subjecting your heart to intense physical activity continuously, heart rhythm abnormalities develop. This is what we call an athlete heart, where the heart muscle fibre can be in a disarray and the increased stress can cause irregular heartbeats in the heart’s pumping chamber, leading to sudden cardiac arrest. Sometimes there are changes in the size of the pumping chamber (ventricle) and filling chamber (atrium). Alternatively, there are changes in the thickness of the heart muscle and it may become enlarged. These changes happen because the sportsperson’s heart tries hard to increase the ability of pumping blood and oxygen to the tissues that are being exercised during a sport.
This is the reason why we insist on an echocardiogram for sportspersons, especially those in high intensity sports. Sometimes, when the heart gets stretched under these conditions, things can get unpredictable for short burst activity. So we don’t know when any activity — in this case while rallying during a badminton game — might just cross the tolerance threshold and cause arrhythmia.
What about dehydration?
Dehydrated blood becomes “thicker” and is likely to clot faster, potentially triggering heart attacks or strokes, both of which may result in cardiac arrest. The thicker blood means the heart has to pump harder, leading to malfunctioning heartbeats, leading to sudden cardiac arrest.
Could there be other clinical conditions?
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A clinical condition called Hypertrophic Cardiomyopathy (HCM), usually a rare genetic disorder, ends up thickening the heart muscle. As the heart muscle stiffens up, it cannot pump the required amount of blood with each heartbeat. Some people with HCM don’t have symptoms while others may only feel symptoms with physical exercise or exertion.
Sometimes the person could have stress cardiomyopathy, when emotional and physical stress can lead to a massive adrenaline rush that overwhelms the heart muscle. Excess adrenaline can cause narrowing of the small arteries that supply the heart with blood, causing a temporary decrease in blood flow. Sometimes, the adrenaline may bind to the heart cells directly, causing large amounts of calcium to enter the cells. This calcium overload can prevent the heart cells from beating properly.
HOW CAN WE PREVENT SUCH SUDDEN DEATHS?
All sports federations and clubs must insist upon basic tests, electrocardiogram and echocardiogram. We must have automated external defibrillators (AED) in public places to revive people within the tightest window of survival. An AED should be there in every gym, with the trainer instructed on how to use it. Every citizen should learn cardio-pulmonary resuscitation (CPR) techniques for such emergencies.
(The author is HOD, Cardiology, Manipal Hospital, Bengaluru)
