Sudden cardiac death (SCD) or sudden cardiac arrest (SCA) is like an intruder that attacks even the most unlikely victim.

The unexpected, unexplained, sudden death of a professional athlete, a recreational marathoner, especially a teen participating in athletic competitions is a big blow to the family, team, school, and to the sports and medical communities.

A few months ago, basketball aficionados were deeply saddened by the sudden death of a PBA player. In February this year, running enthusiasts were caught flat-footed when two of their colleagues collapsed and died during the Skyway Marathon.

From 2009 to 2011, three high school students (a basketball, baseball and rugby player) died in the campus playing field, two in the middle of the game, one while warming up. A triathlete died in Subic during the Iron Man competition and could not be revived.
Similar unfortunate cases had taken place in the global sports arenas. These stories dramatize the urgent need for the athletic and medical worlds to look into the real underlying cause of death of these athletes.

At the Philippine College of Physicians/Philippine Heart Association (PHA) Health Forum on July 19, 2016, Filipino heart doctors, collectively known as, the PHA and Rain or Shine Coach Joseller “Yeng” Guiao, told athletes, wanna-be athletes and sporty people that these tragic incidents should serve as a wake-up call.

“Before pursuing a competitive sport, embarking on a regular or an extreme exercise regimen, undergo screening tests (at least an ECG and physical examination). Put your whole heart into it but in the process, always listen to your body. Don’t overwork your heart,” said PHA President Dr. Raul Lapitan.

There is this misconception that athletes and physically active people are physically infallible. Their hearts are enduring and perpetually strong.

“In some athletes, extreme exercise might even promote heart disease. Most likely these people succumbed to heart condition they did not know they had since birth or they had acquired because of lack of screening.”

During diagnostic tests, these particular cases were not detected. Some may be asymptomatic. For a few, there have been red flags that needed medical attention that had been ignored like unexplained fainting spells (syncope) especially during physical activity, chest pains, palpitations or shortness of breath. “They were unheeded because they thought people who have always been fit and sporty are the last ones to acquire heart disease,” Lapitan added.

During pre-participation cardiovascular screenings, some heart ailments may not be picked up. In addition, it is sometimes hard to replicate the actual stressful conditions that the heart may be subjected to during intensive sports compared to the clinic setting.

“When someone as young as 20- or 30-something suddenly dies during an athletic or a high-intensive workout, usually the most common cause is hypertrophic obstructive cardiomyopathy (HOCM) or (HCM). It is genetic but can’t be detected at birth. They can be diagnosed in teenagers,” said PHA Vice President Dr. Jorge Sison.

HOCM is a primary disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious case, creating functional impairments of the cardiac muscle. It is the leading cause of sudden death in people with an underlying cardiac disorder. The training for athletes are rigid and too long. There have been reported cases of irregular heart beat or arrhythmia that led to SCD,” said Dr. Alex Junia, PHA Cardiopulmonary Resuscitation (CPR)-Ready Philippines adviser.

A marathoner himself, Junia added that “as a regular runner, I have learned to listen to my body. When it tells me to slow down, I slow down. When it tells me to stop, I stop. Running or any sport is also a de-stressor but it can be strenuous and cause you stress when you don’t know when to slow down or halt."

The PHA also added that a history of premature sudden death in the family (less than 55 years of age) warrants further investigation as well. Additional cardiac evaluation may include an ECG and stress exercise testing. An echocardiogram will rule out majority of the structural and functional heart abnormalities that can cause sudden death. Stress exercise testing on the other hand, measures exercise capacity and overall cardiopulmonary fitness.

PHA Director and Advocacy Committee chair Dr. Orlando Bugarin said that “there are also non-cardiac conditions that may cause athletes to collapse in the field such as asthma, electrolyte imbalance, severe dehydration and heat stroke but since a majority of death in athletes is cardiac in origin, heart screening is a must.”

Though the benefits of exercise are still recognized to enhance our well-being and quality of life, overdoing it is tough for the heart.

Former Pampanga Congressman Guiao believes that “to achieve optimum performance put balance between health and fitness, of course with professional help.”
One of the staunch CPR-Ready Philippines allies of the PHA, Guiao is the main author of House Bill 6204, the CPR Bill or Samboy Lim Bill which requires compulsory hands-only CPR for K-12 students. Approved as Senate Bill 3204 and was enrolled last month, it is expected to lapse into law on July 20, 2016.

PHA conducts advanced cardiac life support trainings for health professionals and basic CPR trainings for the bystander (lay).

Any CPR-equipped person can save the life of a cardiac arrest victim. Effective chest compressions started within 3-5 minutes increases the victim’s chance of survival.

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