The very sad death at the age of 44 of former England footballer Ugo Ehiogu has led many people to believe he died of a heart attack. In fact, it appears he died of a sudden cardiac arrest and, although it may seem that these two things are the same, they are in fact very different.
A heart attack typically occurs when there is a blockage in one or more of the coronary arteries, preventing the heart from receiving blood and oxygen. When this happens the affected heart muscle dies, leading to a heart attack or myocardial infarction.
However, in someone suffering a sudden cardiac arrest the coronary arteries are usually completely normal and the problem is caused when the electrical system of the heart malfunctions or suddenly misfires, causing it to beat dangerously fast and irregularly. Most cases start without any prior symptoms — although dizziness, palpitations and feeling faint can all occur briefly before collapse — and, because blood is not pumped around the body as it should be, death typically occurs quickly unless emergency treatment is begun immediately.
Sudden cardiac death in athletes or young fit people is often caused by an underlying heart condition such as hypertrophic cardiomyopathy (where the heart is abnormally enlarged), but up to half of all sudden cardiac deaths are found to have a completely normal heart at post-mortem examination and are classified as ‘autopsy negative sudden unexplained deaths’.
Other possible causes for sudden cardiac death in the young include genetic coronary heart abnormalities, where the heart arteries become compressed during exercise, or an inherited condition called long QT syndrome, which can cause fast chaotic heartbeats and can lead to fainting and cardiac shock. In my experience, autopsy negative deaths often deepen the distress for the families left behind as they have no clear explanation as to why their loved one has died so young.
Coroners usually define sudden cardiac death as an unexpected death occurring within one hour from the onset of symptoms in cases where the death is witnessed, and in unwitnessed cases within 24 hours of the individual last being seen alive and well. Sudden cardiac death in athletes is the leading cause of death in this group of people. There is a wide range of estimated incidences, but it is probably about one in 50,000 to one in 80,000 athletes a year, being more common in men and those of African-Caribbean origin.
There is much debate about screening young athletes for potential heart defects even if they appear totally fit and healthy and I confess to being on the side that agrees with this view. The main issue is about the balance between the number of potential lives saved and the economic cost. Even if no national screening programme exists currently, increased awareness about sudden cardiac death is vital. More training in cardiopulmonary resuscitation is part of this, along with access to the automated external defibrillators that are vital in such cases.
Some countries such as Italy already screen young athletes using electrocardiograms (ECGs) that record the electrical activity of the heart. However, this type of screening can produce false-positive results (meaning they indicate a problem is present when it is not) and I would suggest a better screening tool along with this is an echocardiogram ultrasound heart scan that would pick up abnormal heart enlargement long before any symptoms occurred.
There is very little evidence that physical exercise is actively detrimental to the heart in the general population — we should all be exercising regularly and to the best of our ability as this promotes better health in many ways. However, tragic sudden death in young fit people will always occur whatever we do to try to identify people at risk. Last week the dice decided to roll against Ugo Ehiogu. It is a sobering thought that nature always ultimately has the final say — in all of us, whatever our age.