Sudden Cardiac Arrest in Athletes: Do not Miss Suspicious Details

Abstract

Introduction Sudden cardiac death (SCD) related to sports activities is an unexpected and rare event, usually occurring in young and apparently healthy athletes. The main cause of SCD in young athletes (< 35 years old) is ventricular arrhythmia (VA) associated with arrhythmogenic disorders (e.g. hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy – ARVC, channelopathies). Some of these conditions can be suspected by routine preparticipation clinical evaluation, while others remain undetectable even after careful screening.1-3 This paper presents the case of a professional athlete with undiagnosed ARVC, whose first manifestation was malignant VA and biventricular dysfunction. Case report A 19-year-old white male professional handball player participated in a regional league since he was 16. He had unremarkable medical or family history. His pre-season medical examination showed electrocardiogram (ECG) with sinus rhythm, inverted T wave in right precordial leads and occasional premature ventricular contractions (PVC) (Figure 1). For more information, his physician ordered 24-hour Holter monitoring, transthoracic echocardiography (TTE) and an exercise test. The 24-hour Holter monitoring revealed periods of sinus bradycardia and 3713 PVC occurring as isolated, pairs or triplets, independently of exertion. TTE and exercise test were described as normal and he was allowed to play.