The Perfect Electrical Storm

Why basketball players are more susceptible to sudden cardiac death than other athletes

The “perfect storm” is a set of conditions ideal for catastrophe. In the case of basketball players, there are a range of conditions which lead them to be more susceptible to sudden cardiac arrest at a young age both on and off the court. In other words, a perfect electrical storm in the heart.  

1. While many might think football is the most demanding sport on a player’s body, basketball is one of the most physically demanding from a cardiovascular standpoint.  Football plays typically average around 6 seconds each, while basketball plays can continue on for minutes at a time with the players moving the entire time – running, jumping, dribbling. And the limited space on a basketball court means players have little time to decelerate.
2. Basketball players tend to be tall and elongated (“lanky”). This physicality lends itself to conditions such as Marfan syndrome which can result in sudden cardiac arrest.
3. African-American males are more likely to die from sudden cardiac arrest^[1], regardless whether they are an athlete or not. Since the majority of college basketball players fall into this category, they are typically at a higher risk on the court as well.
4. Without the threat of adverse weather conditions resulting in cancelled practices, basketball players tend to spend more time at their sport. Their season is also much longer and there are far more basketball games (27 – 31 depending on the team) than Football games (10 – 13 in a season).
5. When it comes to college athletes, a 2014 article in the New Yorker pointed out basketball players in Division I schools see higher rates of cardiac events than the other divisions. The theory here is Division I schools push their players harder, and their seasons tend to be longer with the addition of high-stakes playoffs. This puts a larger toll on hearts which may have undiagnosed conditions. Alternatively, the reason we may see higher numbers of Division I cardiac events is simply that we SEE them. Division one has much higher profile schools and media outlets are more likely to cover them.

Hypertrophic Cardiomyopathy (HCM) has long been held as the number one cardiac killer of college age athletes. (It is estimated 1 in 500 people in this country have the condition but are unaware they do and never have symptoms).  Based on those facts, original estimates put college athletes at a risk of approximately 1 in 200,000 to 250,000. However, the number of cardiac deaths on college basketball courts may be even HIGHER than originally thought because many are reported on death certificates as “autopsy-negative sudden unexplained death with no structural abnormality.” In other words, they may have had a cardiac arrest, but not HCM and their condition was not diagnosable via autopsy. When other factors are taken into consideration, studies have shown the numbers are probably closer to 1 in 5,000 at risk.

So let’s do some math. There are 351 Division I schools. Each college basketball team has around 15 players, which means we will lose approximately one NCAA Division I player per year. One per year. Doesn’t seem like a lot – until you are the parents of that one player. Or the sibling. Or the coach. Or the school that now wonders what else it could have done to prevent that death.  And that’s just Division I. Add in Division II and III, which have roughly the same number of players each, and we are looking at another 2 deaths per year, and that’s just basketball. In fact, when you look across all sports, approximately every 72 hours a young athlete dies from sudden cardiac arrest.

What’s the answer? Recently more high schools have been taking advantage of free or low-cost ECG heart screenings sponsored by cardiac arrest awareness foundations which can identify risk-factors not found during standard physicals and by taking family histories. Finding these conditions early could literally mean the difference between life and death. For years college athletic departments have fought against ECGs as part of college pre-participation requirements stating the false-positive rate was too high. Their argument was the student could be side-lined while awaiting further testing, and the additional medical work-up could be cost-prohibitive to families. But now, with a better understanding of a condition known as “athlete’s heart” where the heart is slightly enlarged due to years of conditioning, and ECGs that compensate for the physical changes of an athlete’s heart, the false-positive rate has dropped dramatically. In fact, there is an ECG device on the market right now, CardeaScreen, which claims a less than 3% false-negative rate by using the Seattle Criteria which includes athlete’s heart compensation. So that argument no longer holds water. Could it be colleges are more concerned about their playoff rankings than the athletes themselves and the biggest motivator is a potentially sidelined star? Hopefully, there will be more consideration given to the potential for the loss of an athlete.

1. ^[1]https://www.cedars-sinai.edu/About-Us/News/News-Releases-2015/African-Americans-Face-Twice-the-Rate-of-Sudden-Cardiac-Arrest-Compared-to-Caucasians.aspx↩