Preventing Sudden Death

Some inborn heart diseases progress silently for many years. Intense exercise may then suddenly unbalance the sick heart muscle, causing a heart arrest. Regular medical checks may save lives.

Time and time again, a young player dies on the pitch because their heart suddenly and unexpectedly stops beating - this is called “Sudden Cardiac Death” (SCD). Fortunately, this is extremely rare: SCD occurs in about 1 of 100,000 athletes. The vast majority of them suffered from an inborn disease of the heart. These diseases progress unnoticed for a long time until one day some additional demand on the heart causes the compensation mechanisms of the body sufficient at rest to fail. Intense physical effort may act in this way.

This is what you can do to avoid exposing yourself to an undue risk when playing:

1) Go for regular medical checks: A careful heart examination (physical, ECG) by your doctor may raise suspicion of disease making further investigations by specialists (for example ultrasound) necessary. These may unveil a harmless or more severe problem that may or may not require treatment before you can continue to play.

  • Be aware: The following questions aim to detect subtle signs of an underlying heart disease that may otherwise get unnoticed:
  • Have you currently or recently had any flu-like symptoms or suffered from infections caused by a virus? Have you ever had rheumatic fever?
  • Have you ever, either at rest or when exercising, had any of the following: chest pain or tightness, shortness of breath, cough or bronchitis?
  • Have you ever, either at rest or when exercising, felt your heart beating irregularly, skipped heartbeats or racing?
  • Have you ever had other heart problems?
  • Have you ever, either at rest or when exercising, felt dizzy or fainted?
  • Do you tire more quickly than your team-mates?
  • Do you take any medication?
  • Do you have an allergy?
  • Has your doctor ever told you that you have a heart murmur or high blood pressure?
  • Has your doctor ever told you that you have epilepsy?
  • Have you ever been advised to give up sport?
  • Have any of your family members died from Sudden Cardiac Death?
  • Have any of your family members high blood pressure, a heart disease or a pacemaker implanted?
  • Have any of your family members undergone heart surgery?
  • Have any of your family members had a stroke?
  • Have any of your family members suffered from unexplained drowning or a car accident?

2) Never play when you are sick: There are viruses that usually cause only a cold but sometimes an acute inflammation of the heart muscle, particularly with intense exercise. That is why you must never train or play when you have a cold with fever or aching joints. The “above-collar” rule says that any symptoms below your neck are a strict NO to exercise. That means a running nose is OK, but a productive cough is not.

What causes Sudden Cardiac Death?

In players under 35 years of age

  • Hypertrophic cardiomyopathy – continuous enlargement of the heart muscle that progresses over many years. Different from an “athlete’s heart”, this muscle is not fully functional.
  • Arrhythmogenic Right Ventricular Dysplasia – fat replaces muscle cells especially in the right ventricle.
  • Further common causes include other inborn heart muscle diseases or coronary artery anomalies.
  • Medications, drugs: Stimulants, certain medication against allergies. Cocaine carries a considerable risk of SCD when exercising!
  • Myocarditis: viruses causing flu symptoms or other diseases may affect the heart muscle causing an acute inflammation. This might only manifest itself with exercise.

In players over 35 years of age, coronary artery disease is the most frequent cause of SCD.

  • Hit to the chest wall - contusio cordis (all ages): very rarely, heart arrest is caused by an object (e.g. ball) hitting the chest in a specific location at a particularly vulnerable time of the heart cycle.


- Dvorak J. A lion never dies: pro memoria of Marc-Vivien Foe. Br J Sports Med 2009;43(9):628.

- Dvorak J, Grimm K, Schmied C, Junge A. Development and implementation of a standardized precompetition medical assessment of international elite football players--2006 FIFA World Cup Germany. Clin J Sport Med 2009;19(4):316-321.

- Schmied C, Zerguini Y, Junge A, Tscholl P, Pelliccia A, Mayosi BM, Dvorak J. Cardiac findings in the precompetition medical assessment of football players participating in the 2009 African Under-17 Championships in Algeria. Br J Sports Med 2009;43(9):716-721.

- Thünenkötter T, Schmied C, Grimm K, Dvorak J, Kindermann W. Precompetition cardiac assessment of football players participating in the 2006 FIFA World Cup Germany. Clin J Sport Med 2009;19(4):322-325.