Frequency and Causes of Sudden Death in Young Adults and Athletes
Sudden cardiac (heart-related) deaths in young adults and athletes, although rare, are tragic events that cause great sorrow and concern in society. Although they are often labeled as a "heart attack" in the media, the underlying causes in people under 35 are usually very different from heart attacks at older ages.
Why Do Young People Have Problems Other Than
Heart Attacks?
Prof. Dr. Mehdi Zoghi
Sudden deaths over the age of 35 are usually caused by heart attacks due to blocked arteries (atherosclerosis). However, in young people and athletes under 35, the cause is usually genetic or structural. Many are problems present from birth that are "triggered" during intense sports activity.
Main Causes:
Hypertrophic Cardiomyopathy (HCM): This is abnormal thickening of the heart muscle. It is one of the most common causes of sudden death in young athletes. In normal heart muscle, the cells are arranged in an orderly, parallel row. In HCM, however, these cells are arranged in a "disorganized and chaotic" structure. As the electrical current travels through this chaotic structure, it slows down, splits, and folds back on itself. This disorder, like electrical signals losing their way in a maze, triggers circular rhythm disturbances in the heart. These circuits lead to ventricular tachycardia or ventricular fibrillation, which are very fast and chaotic rhythms, completely stopping the heart's ability to pump blood.
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Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): This is a genetic disease in which the muscle tissue in the right ventricle of the heart turns into fatty tissue. This condition can disrupt the heart's electrical system and trigger rhythm crises. Conduction System Diseases (Channelopathies): These are congenital disorders of the heart's "electrical wiring" (e.g., Long QT Syndrome). An electrical short circuit can occur even if there is no structural abnormality in the heart. Coronary Artery Anomalies: This is when the arteries that supply the heart arise from the wrong places or follow an abnormal course from birth. During intense exercise, these arteries can become compressed and blood flow to the heart muscle can be cut off. Myocarditis (Inflammation of the Heart Muscle): This is inflammation that usually develops after viral infections. It poses a risk especially for people who return to strenuous sports before fully recovering. Commotio Cordis: Very rare; this is when a sudden, hard blow to the chest (for example, from a baseball or a boxing punch) coincides with a sensitive split second in the heart's rhythm cycle and stops the heart.
Which Signals Should Be Taken Seriously?
In many young people, these diseases can progress without causing any symptoms. However, the following "red flags" should never be ignored:
- Fainting Related to Exertion: Fainting that occurs especially during or right after exercise
should never be dismissed as "just a simple drop in blood pressure."
- Unexplained Chest Pain: Pressure or severe pain in the chest during sports.
- Palpitations: The heart beating very fast or irregularly, out of proportion to the exercise.
- Family History: If there is a family history of sudden and unexplained death under age 50 (sudden cardiac arrest at a young age, or sudden deaths that appeared to be drowning or accidents), that person must undergo cardiac screening.
How Can It Be Prevented?
Pre-Participation Screening: Detailed physical examinations and ECG (electrocardiogram) screenings, which are standard for professional athletes, can reveal many hidden risks. Medication and Substance Use: Performance-enhancing drugs (steroids), excessive use of energy drinks, and illegal substances can directly trigger fatal rhythm disorders in young hearts. Managing Infections: After a severe viral infection (such as the flu), returning to intense sports without fully resting can put serious strain on the heart. Awareness: Especially if there is a similar case in the family, genetic tests and detailed heart imaging (Echo, Cardiac MRI) can be lifesaving.
Remember
Being very physically "fit" or doing intense sports does not "cure" a structural problem that may exist in your heart; on the contrary, when you push your limits, it can cause these problems to surface sooner. Listening to the signals your body gives you during exercise, and especially taking unexplained fainting seriously, is the most important protective step.
Sudden cardiac death in athletes is a rare but high-impact event in society. Data from studies on this subject show the risk profile and its relationship with different sports more clearly.
How Common Is It?
Although research on the frequency of sudden cardiac death varies depending on the methods used, the generally accepted data are as follows:
- Overall Rate: Sudden cardiac arrest among young athletes may be somewhat more common
- than previously thought. For many years, scientific sources accepted that it occurred in 1 to 3
out of 100,000 athletes. Today, however, thanks to advances in health technologies, our ability to perform more detailed examinations, and better recording of all data, we see that this rate can actually be as high as 5 per 100,000. Risk Comparison: The risk of sudden death in athletes is about 2.5 times higher than in their peers who do not play sports. This is because sports can trigger an existing heart disease more quickly, or intense physical activity can push the heart to its limits.
Sex Difference: Male athletes are at much greater risk than female athletes. Nearly 90% of sudden cardiac death cases occur in male athletes. The higher incidence in males is a combination of factors such as more frequent genetic predisposition, greater participation in high-risk sports, and a higher tendency to use performance-enhancing substances.
Which Athletes/Sports Are at Higher Risk?
The risk of sudden cardiac death varies depending on the type and intensity
of the sport. The highest-risk group is sports that require intense cardiovascular effort. High-Risk Sports: Soccer and basketball are the sports in which sudden cardiac events are most frequently reported worldwide. The main reason is that these sports require both intense effort and sudden changes in speed (stop-and-go), which can put more strain on the heart's electrical system. Ethnic Origin as a Risk Factor: Some research presents findings suggesting that the risk of sudden death may be higher in Black athletes than in other ethnic groups. "New" Athletes: The risk is known to increase in people who return to sports after a long break or with irregular, intense exercise. Low-Risk Sports: Although swimming, baseball, and other low-exertion sports are statistically considered "safer," no sport is completely free of risk.
Why Is It More Common in Some Sports?
Sudden death in athletes is not just a "heart problem"; it is the combination of "heart + intense exertion."
- Increase in Adrenaline and Catecholamines: The intense stress of competition and physical activity raise adrenaline (catecholamine) levels in the body excessively. If the athlete has a hidden genetic disorder in the heart (such as a predisposition to rhythm irregularities), this rise in adrenaline
can act as a "trigger" and cause the heart to stop with a fatal rhythm (ventricular fibrillation).
- Structural and Electrical Differences: In sports that require intense running, such as soccer and basketball, the athlete reaches the limits of maximal oxygen consumption. If there is a coronary artery anomaly (an abnormality in the structure of the artery) or hidden thickening of the heart muscle
(HCM), the heart's need for blood cannot be met during exertion, and the system fails.
Important Note
Most professional athletes undergo periodic cardiac screenings (ECG, Echo, etc.). The main purpose of these screenings is to protect athletes by detecting these hidden diseases, which cause no symptoms, before competition. If you do strenuous exercise, even at an amateur level, and especially if there is a family history of sudden death at an early age, the safest approach is to have a detailed screening by a sports cardiology specialist.
Despite these health checks for professional athletes, why can't sudden deaths
be prevented? Many genetic heart diseases are still developing. In a screening done on an athlete at age 18, everything may look normal, but the disease may begin to show itself at age 22.
- It is not that professional athletes are "not checked," but the current standard methods we use have a certain detection capacity (sensitivity). These methods are very successful, but unfortunately they are not enough to detect 100% of all risks.
To prevent this, rather than simply taking an ECG and moving on, "very detailed questioning of the family history" (is there sudden death at a young age?) and the use of more advanced imaging methods such as Cardiac MRI in suspicious cases is the safest approach accepted worldwide today. •
Prominent professional athletes who have died from sudden cardiac events in the sports world over the last 10 years include cases that resonated widely in the sports community and usually occurred on the field or during training:
Athlete
Patrick Ekeng
Ben Idrissa
Dermé Gilbert Bulawan Cheick Tioté Davide Astori
Sport
Soccer
Year
Notes 2016 Due to heart failure during a Dinamo Bucharest match.
Soccer
2016 Heart attack during a cup match in France.
Basketball
Soccer Soccer
Zeke Upshaw
2016 Heart attack during training. 2017 Heart attack during training in China. 2018 Sudden cardiac arrest in his sleep in a hotel room. Collapsed during a G-League game and died two days
later.
Michael
Cycling 2018 Cardiac arrest during the Paris-Roubaix race. Goolaerts Ekundayo Soccer 2018 Fell ill and died during a match in Turkey. Mawoyeka Raphael Soccer 2023 Collapsed during a match in Albania. Dwamena The sudden cardiac events and deaths on sports fields or during training in Turkey in recent years that have been reported to the public present a very sad picture. These cases have prompted important discussions in Turkey about reviewing athlete health and on-field emergency response protocols (defibrillator use, CPR training). Some cases in Turkey:
- Ekundayo Mawoyeka (2018): A Nigerian soccer player competing in an amateur league in Turkey
fell ill during a match and died.
- Ahmet Çalık (2022): Although this national team soccer player, who played for Konyaspor, died in a traffic accident, his death sharply increased awareness in Turkey about general health screenings in the sports world and the monitoring of post-traumatic cardiac conditions.
- Muhammed Eren (2024): It was reported in the press that some young athletes competing in youth age categories in Turkey experienced sudden cardiac arrest during competition due to undiagnosed heart conditions.
An Important "Comeback" Case: Christian Eriksen
Although it was not a death case directly in Turkey, the Christian Eriksen incident at the European Championship (2021) had a major impact on the sports medicine and cardiology community in Turkey.
Eriksen suffering cardiac arrest on the field and being brought back to life with successful emergency
intervention reinforced the requirement for all professional clubs in Turkey to keep AED (Automated External Defibrillator) devices at their stadiums and training grounds, and for health personnel to receive periodic training on this subject.
In Conclusion: Sudden cardiac death is not "fate" but a biological risk. The modern discipline of cardiology has powerful tools to prevent these tragic deaths through genetic screening and rapid on-field emergency response protocols. The most important task is to identify at-risk individuals before they show symptoms and to increase public awareness.
References
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Meagan M Wasfy ,Adolph M Hutter, Rory B Weiner. Sudden Cardiac Death in Athletes. Methodist Debakey Cardiovasc J. 2016 Apr-Jun;12(2):76–80. Ala W Abdallah et al. Cardiac Screening in Young Athletes: The Role of Diagnostics in Preventing Sudden Cardiac Death and Exploring Clearance Protocols. Clin Med. 2026 Mar 2;15(5):1895. Khashayar Farzam; Venkat Rajasurya; Thaer Ahmad. Sudden Death in Athletes. StatPearls Keerthana Prakash et. al. Sudden Cardiac Arrest in Athletes: A Primary Level of Prevention. Cureus. 2022 Oct 20;14(10):e30517. Farioli A, et al Incidence of sudden cardiac death in a young active population. J Am Heart Assoc. 2015.
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Kim JH, et al. A contemporary review of sudden cardiac arrest and death in competitive and recreational athletes. American College of Cardiology Sports & Exercise Leadership Council. Lancet. 2024 Nov 30;404(10468):2209-2222. Patel MA, et al. Sudden cardiac death in the adolescent population: a narrative review. Egypt J Intern Med. 2023;35(1):36. Salzillo C, Sansone V, Napolitano F. Cardiac Death in the Young: State-of-the-Art Review in Molecular Autopsy. Curr Issues Mol Biol. 2024 Apr 10;46(4):3313-3327.
Abbas R, et. al. Sudden Cardiac Death in Young Individuals: A Current Review of
Evaluation, Screening and Prevention. J Clin Med Res. 2023 Jan;15(1):1-9. van den Heuvel L, et al. Sudden cardiac death in the young: A qualitative study of experiences of family members with cardiogenetic evaluation. J Genet Couns. 2024 Apr;33(2):361-369. Cordeiro FP, Cainé L. Viral infection and sudden non-cardiac death: A systematic review. J Forensic Leg Med. 2024 Aug; 106:102727. Bohm P, et al. Sports-related sudden cardiac arrest in young adults. Europace. 2023 Feb 16;25(2):627-633.