Understanding Cardiac Arrest in Female Athletes

Date: April 12, 2023 Reference: Weizmann et al. Incidence of Cardiac Arrest During Sports Among Women in the European Union. JACC November 2022 Guest Skeptic: Dr. Susanne (Susy) DeMeester is an Emergency Physician practicing at St Charles Medical Center in Bend, Oregon. She has been very involved with EMRAP’s CorePendium as the cardiovascular section editor. Last time Susy was on the SGEM it was for an SGEM Xtra episode discussing gender issues related to cardiovascular disease. Here are five of the highlights from that episode: The leading cause for morbidity and mortality in both males and females is cardiovascular disease (CVD) Females are often excluded from being subjects in medical research, included CVD research Most male and female patients with myocardial infarctions still present with chest pain. However, women are more likely to have atypical presentations compared to men (shortness of breath, weakness, and fatigue). In addition to the usual cardiac risk factors, females also have other things that increase risk like pregnancy, hormone replacement therapy and autoimmune diseases Females diagnosed with acute coronary syndrome are less likely to receive timely therapies Case: You are reading through your social media feed and see a story that jumps out at you. It is a report of a seemingly invincible athlete who collapses on the field and dies of sudden cardiac death. It reminds you of the recent case of football player Damar Hamlin, who has thankfully recovered well. This story makes you wonder: when was the last time you heard of a sudden cardiac death in the female athlete? Background: Sudden cardiac arrest (SCA) is a rare but serious event that can occur in athletes during training or competition. While it can occur in both male and female athletes, the incidence is reported to be higher in male athletes. There are several reasons why SCA may be more common in male athletes than in female athletes. One reason is that male athletes tend to participate in sports that involve more physical contact and higher levels of exertion, which can put more strain on the heart. Additionally, male athletes are more likely to have certain genetic predispositions to heart conditions that can increase their risk of SCA. However, it is important to note that SCA can occur in female athletes as well, and it should not be ignored or overlooked. Females who participate in high-intensity sports should undergo appropriate cardiovascular screening to identify any underlying heart conditions that could increase their risk of SCA. Females are increasingly competing in recreational and professional sports.  Little seems to be heard about SCA in these athletes. In fact, not surprisingly, there is a paucity of data on the subject.  However, currently available evidence suggests we can improve our understanding of SCA in all athletes by examining sex-based differences. Clinical Question: What are the sex-based differences in sports related SCA? Reference: Weizmann et al. Incidence of Cardiac Arrest During Sports Among Women in the European Union. JACC November 2022 Population: Three large European registries that prospectively collect data on every case of SCA between 2006-2017. Sports-related (Sr) SCA was defined as occurring <=1 hour after ending a sports activity. Excluded: Patients not referred to registry and patients with SCA greater than one hour after cessation of sport. Intervention: There was no intervention as this was a prospective data analysis Comparison: Sr-SCA in men vs women Outcome: Incidence, characteristics, and outcomes in women vs men after episode of Sr-SCA Type of Study: Prospective observational registry study Authors’ Conclusions: “These findings emphasize the dramatically lower risk of Sr-SCA in women compared with men, despite similar subject characteristics. This should be considered in designing preparticipation screening strategie...