Tips to Live By

Heart Health in Student Athletes: What to Know About Cardiac Arrest

July 26, 2023 - Katie McCallum

Sports do more than help your kid stay in shape. They provide structure and encourage beneficial character traits, like discipline and resilience. Sports also emphasize the importance of community, teamwork, leadership, being a gracious winner and more.

But for all the benefits, playing sports isn't without risks.

"As far as the biggest threats to athletes, we must remember the three H's," says Dr. William Zoghbi, chief of cardiology at Houston Methodist Hospital. "Head trauma, heat and heart."

The first two are perhaps the most obvious, most universal concerns. But it can be hard to fathom a young, otherwise healthy athlete experiencing something like sudden cardiac arrest. We often think of these events solely as concerns for older adults or people with known heart issues.

"Sudden cardiac death in young people is rare, but it's not unheard of either," says Dr. Zoghbi. "In the general adult population, the chances of experiencing cardiac arrest are around 1 in 1,000. In young people, it's around 1 in 80,000."

(Related: What Is Cardiac Arrest & How Is It Different From Heart Attack?)

While it may not be common in young people, cardiac arrest is still life-threatening. Even the small chance it could occur means prevention steps should be taken.

What causes cardiac arrest in a young, healthy athlete?

Exercise is a workout for the heart — beating faster and pumping harder to meet the body's increased metabolic needs. A healthy heart shouldn't have trouble meeting these demands, but exercise can worsen an underlying heart issue — one that, in a young athlete, might not be known.

The most common causes of cardiac arrest in young people include:

  • Cardiomyopathy – a disease of the heart muscle. Hypertrophic cardiomyopathy (HCM), a thickening of the heart muscle, is the most common example. Other changes, such as the breakdown of heart muscle in arrhythmogenic right ventricular cardiomyopathy (ARVC), are also possible.
  • Cardiac channelopathies – electrical issues with the heart, such as long QT syndrome (LQTS), which can lead to arrhythmia (irregular heartbeat)
  • Coronary artery anomaly – also called anomalous coronary artery, it occurs when the coronary arteries don't originate in their usual place and become squeezed between the two large arteries arising from the heart


The challenge, though, is knowing whether a young athlete might suffer from one of these issues.

"All of these heart conditions are inherited or new congenital disorders, which is why it's so important for young people, especially young athletes, to be asked about their family history," adds Dr. Zoghbi.

How a sports physical can help protect a young athlete's heart

It's important for athletes to listen to their body. But to reduce the risk of sudden cardiac arrest, Dr. Zoghbi says the most important thing a young athlete can do is have a physical exam that starts with their family health history.

The signs that something might be wrong with the heart include:

  • Stamina issues, such as being quick to feel fatigued while exercising
  • Shortness of breath, particularly early in a workout
  • Lightheadedness or chest pain during exercise
  • Near-fainting or fainting episodes


"Most of the time, a youngster with one of these heart conditions isn't going to notice these symptoms beforehand," explains Dr. Zoghbi.

Cue the sports physical, where a doctor checks vitals, can probe about subtle symptoms like fatigue or lightheadedness during exercise and asks questions about health conditions that run in the family. Dr. Zoghbi stresses that knowing a person's family health history is paramount since it guides further screening.

"The conditions that cause sudden cardiac arrest in young people are frequently hereditary," Dr. Zoghbi reiterates. "If there's history there, we have noninvasive ways — EKG and echocardiogram — of evaluating the function and structure of the heart to determine whether issues are present."

There's controversy around whether every student athlete needs such tests, regardless of their family history. The heart conditions that lead to sudden cardiac arrest in young people are rare, after all. And an athlete's heart — which may be significantly remodeled due to the amount of exercise — may not look "normal" on some tests.

"Access and resources are some of the issues, but it's also about not scaring people too much," adds Dr. Zoghbi. "It's a delicate balance. If family history indicates these tests are needed, we do them. But performing them on every young athlete can lead to overtesting and, with more false positives, potentially overtreating."

Still, if you have concerns about your kid's heart health, be sure to share them with your child's pediatrician or doctor.

More ways for young athletes to protect their heart health

Aside from periodic sports physicals and going through family health history, student athletes' heart health can also be protected by:

Staying hydrated. This might mean drinking more than just water when sweating a lot. When electrolytes, which are lost through sweat, become low, the heart can't function as well as it normally would. If you're sweating a lot, be sure to sip on a sports drink or another electrolyte beverage.

Avoiding stimulants, like energy drinks and pre-workout. Dr. Zoghbi says these products aren't healthy for the heart, particularly if used frequently and especially if an underlying issue is present.

Knowing that cardiac arrest is a life-threatening emergency that requires immediate intervention. If someone around you collapses and loses consciousness, call 911 immediately and perform CPR or use a defibrillator if one is available until help arrives.

"Time is of the essence," Dr. Zoghbi stresses. "If blood flow isn't restored within six minutes, cardiac arrest is fatal."

This means that everyone — from young athletes themselves to training staff and parents — need to know not only how serious sudden cardiac arrest is but how crucial it is to intervene immediately. (Related: How to Perform CPR — A Lifesaving Technique Everyone Should Know)

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