Dr Winston Dawes | Urgent action needed to arrest sudden deaths in our athletes, teachers
The recent reports of sudden deaths of athletes and young teachers have once again grabbed headlines. This resulted in knee-jerk reactions to what is a serious problem. The fact that young people in the prime of their lives have passed away needs serious consideration.
In the case of the athletes, it happened on the field of play - during a cross-country race and, most dramatically, on a football field. The teachers, again, were young but were not involved in any physical activity.
Most cases of sudden deaths are caused by cardiac arrhythmia or arrest.
- Cardiomyopathy - the heart muscle is damaged by viruses, bacteria or parasites. Many people believe that they can sweat out a fever by exercising. Occasionally, this results in a viral cardiomyopathy. Chagas' disease is caused by a parasite spread by the Kissing bug. At first, it was thought that it was confined to South America, but has been found in Central America and the Southern United States. Many who are infected may not realise that they have the disease because it mimics influenza, with fever, headache, etc. Later, it causes severe cardiac problems. It is now thought that many unexplained cardiac deaths were infected by this parasite.
- Hypertrophic cardiomyopathy - causes the cardiac muscle to thicken but not to contract properly. The electrical system of the heart controls the heartbeat. Alterations in the initiation and conducting of the electrical impulses may cause cardiac arrest or arrhythmia. The heart would either stop contracting or contract irregularly and so cannot pump the blood.
Occasionally, there is an aneurysm of an artery in the brain that ruptures. Much rarer is the aortic dissection and pulmonary embolus.
Reducing the possibility of sudden death will be more than the usual school medical at the start of the year. In many cases, it consists of ticking off the questionnaire without examining the student. The result is that many potential problems are missed.
It must be remembered that many students take part in physical education classes. They, too, are at risk. If any potential problems are identified, then an ECG may be warranted. It may require a trained cardiologist to distinguish between the athlete's heart, which may be larger because of the changes that occur when they are fit, and that from mild cardiomyopathy.
Echocardiac assessments would be the next investigation. However, a word of caution. The fact that many wealthy professional athletes have also suffered sudden death is indicative of the difficulty in diagnosing the potential causes.
HAVE POOR DIETS
The indiscriminate use of energy drinks to boost performance is an ever-present danger. The stimulus to the brain and heart may cause arrhythmia in those susceptible to them.
Compounding this, many athletes are not fully hydrated before the competition. Playing in hot and humid conditions will cause water and electrolyte problems. The proper balance of water and salts is vital for optimum performance. Drinking water to have clear urine is the best guide to the status of hydration. It should be mandatory to drink water and electrolyte solutions during physical activity. In addition, you have those athletes who need to make weight in sports like karate, and sometimes starve themselves or take weight-loss medicines. This can result in serious water and electrolyte imbalances.
Many students have poor diets. They, like most of the population, don't have enough fruits and vegetables. Instead, they go for fast food, which, while tasty and convenient, does not provide all nutritional needs for a healthy life. Compounding the danger is the adrenaline rush of competition. This may cause the athletes to ignore warning signs of potential danger. Many push themselves beyond the limits that their fitness could take them.
It is, therefore, up to coaches, teachers and parents to observe any indications of potential danger.
Given the complexities of situation, it is vital that a thorough investigation be done as to the causes of the recent deaths of the students and teachers. If there is a definite pattern, then we must convene a panel of experts to study the findings and then take the appropriate action. Once we partake in strenuous physical activity there are risks, but the benefits outweigh the potential dangers.
However, we have to have a policy which is affordable and implementable. Having ambulances at every match is impossible, given the number of events and the shortage of these vehicles. Teaching basic cardiopulmonary resuscitation to as many people as possible may reduce the number of deaths.
It is impossible to predict where the next event will occur, but taking the necessary precautions and encouraging the population to exercise and being active will improve the health of the nation and reduce the number of sudden deaths.
- Dr Winston Dawes, CD, MB, BS, FRCSE, is a consultant general surgeon, pain management consultant. Email: email@example.com