Why athlete cardiac arrests shock us

Athletes are often viewed as the pinnacle of physical health — strong, fast, and full of energy. That’s why cardiac arrest in athletes often feels so unexpected and alarming. When a seemingly healthy young player collapses on the field, it captures global attention and raises pressing questions: What causes it? Could it have been prevented? What can we learn?

Sudden cardiac arrest (SCA) is the leading cause of death in young athletes during sports. While rare, its impact is devastating. By understanding the causes, risk factors, warning signs, and prevention strategies, we can protect athletes and change the outcome of future collapse cases.

What is cardiac arrest?

Cardiac arrest is a sudden loss of heart function caused by a disruption in the heart’s electrical system. This prevents blood from circulating to the brain and body. Within seconds, the person becomes unresponsive, and without immediate CPR and defibrillation, death occurs within minutes.

It is different from a heart attack, which involves a blockage in the coronary arteries. Cardiac arrest is primarily an electrical problem — especially in younger, active individuals.

How common is it in athletes?

While cardiac arrest is relatively rare in athletes, it’s not unheard of. Estimates suggest:

  • 1 in 50,000 to 1 in 80,000 young athletes experiences sudden cardiac arrest annually.

  • It is the leading cause of death in young athletes during sports activities.

  • Male athletes, particularly African American males, are at higher risk.

  • Most cases occur during or immediately after intense physical activity.

The actual numbers may be higher due to underreporting or misclassification of cause of death.

Notable collapse cases

Several high-profile incidents have brought global attention to the risk of cardiac arrest in sports:

  • Christian Eriksen, a Danish soccer player, collapsed during a Euro 2020 match. Immediate CPR and defibrillation saved his life.

  • Damar Hamlin, an NFL player, collapsed mid-game from suspected commotio cordis — a rare cause of cardiac arrest from chest impact.

  • Hank Gathers, a college basketball player, died on court in 1990 due to hypertrophic cardiomyopathy.

  • Numerous high school athletes have also collapsed suddenly during practice or games, often with fatal outcomes.

These stories are heartbreaking, but they have sparked critical awareness and policy changes in sports medicine.

Key causes in athletes

Cardiac arrest in athletes is most often linked to undiagnosed heart conditions. The most common include:

  • Hypertrophic cardiomyopathy (HCM): Thickened heart muscle that disrupts electrical signals and blood flow.

  • Arrhythmogenic right ventricular cardiomyopathy (ARVC): A genetic condition causing heart muscle replacement with fatty tissue.

  • Congenital coronary artery anomalies: Abnormal positioning of arteries supplying the heart.

  • Long QT syndrome: A genetic electrical disorder that causes dangerous arrhythmias.

  • Brugada syndrome: Another electrical disorder with risk of fatal rhythms, often during rest.

  • Commotio cordis: Sudden cardiac arrest from a blunt chest impact at a specific moment in the cardiac cycle.

Often, these conditions have no symptoms — which is why early detection is so challenging and vital.

Warning signs to recognize

While many athletes show no symptoms before collapse, some may experience subtle signs that are overlooked or dismissed.

Symptoms to watch for:

  • Chest pain during or after exercise

  • Unexplained fainting or dizziness

  • Shortness of breath not explained by effort

  • Palpitations or fluttering heartbeat

  • Family history of sudden cardiac death

  • Seizure-like episodes during physical activity

These signs should always be evaluated by a sports cardiologist or electrophysiologist before returning to competition.

The role of screening

Pre-participation screening has become a central strategy to detect at-risk athletes before tragedy strikes.

Basic screening tools:

  • Personal and family medical history

  • Physical examination

  • Resting electrocardiogram (ECG or EKG)

  • Echocardiogram (in some cases)

Countries like Italy require mandatory ECGs for athletes and have seen a dramatic reduction in SCA deaths. In contrast, the U.S. has varied policies, with many high school programs lacking mandatory screenings.

The debate continues over balancing cost, false positives, and accessibility — but most experts agree: doing more screening saves lives.

Emergency response in sports

Survival after cardiac arrest depends heavily on immediate response. The “Chain of Survival” includes:

  1. Early recognition and calling emergency services

  2. Immediate CPR to restore blood flow

  3. Early defibrillation using an automated external defibrillator (AED)

  4. Advanced medical support

  5. Post-arrest care in the hospital

For athletes, having trained personnel and readily accessible AEDs at games and practices is non-negotiable.

Best practices:

  • All coaches and staff trained in CPR and AED use

  • AED placed within 1–2 minutes of any playing area

  • Emergency action plan (EAP) reviewed and rehearsed annually

  • Rapid response drills conducted regularly

CPR and AED success stories

Many athletes have survived cardiac arrest thanks to swift bystander action:

  • Christian Eriksen was revived with CPR and an AED on the field and returned to professional soccer.

  • Several high school athletes have been saved by athletic trainers or coaches trained in emergency response.

  • In one study, athletes who collapsed with an AED on-site had a 3x higher survival rate compared to those without.

These outcomes prove the power of preparedness — and the critical importance of AED access at all sports venues.

Post-collapse care and return to sport

Survivors of cardiac arrest require extensive evaluation before considering a return to competition.

Key assessments include:

  • Cardiac imaging (echocardiogram, MRI)

  • Electrophysiological studies

  • Genetic testing (if a heritable condition is suspected)

  • Neurological evaluations

  • Mental health support

Some athletes may be cleared to return to sport with medical management or after ICD (implantable cardioverter-defibrillator) implantation. Others may need to retire from competitive athletics for their safety.

Return decisions should always involve a team of specialists, including a sports cardiologist.

Psychological impact

Cardiac arrest doesn’t only affect the body — it shakes the mind. Both survivors and their teammates often experience emotional trauma.

Common challenges:

  • Post-traumatic stress

  • Anxiety about exercising or competing

  • Fear of recurrence

  • Guilt or helplessness among bystanders

Psychological support, including therapy and peer groups, is crucial for long-term recovery and confidence.

Role of governing bodies

Sports organizations have a major role to play in protecting athletes from SCA. In recent years, progress has been made:

  • FIFA, NCAA, and many high schools now require AEDs at sporting events.

  • The National Athletic Trainers’ Association promotes emergency action plans and CPR training.

  • Some professional leagues conduct advanced cardiac screening for all players.

Still, disparities exist between elite and youth or amateur levels. Equal access to lifesaving tools should be a universal standard.

Prevention strategies

To reduce the risk of cardiac arrest in athletes, a combination of personal and institutional strategies is necessary:

  • Encourage honest symptom reporting without fear of disqualification.

  • Implement mandatory CPR and AED training in schools and sports programs.

  • Ensure AED availability at all sports facilities.

  • Conduct routine screenings for high school and college athletes.

  • Create and practice emergency action plans regularly.

  • Increase public education on recognizing and responding to SCA.

Education, access, and swift response are the pillars of prevention.

Conclusion

Cardiac arrest in athletes may be rare, but its consequences are immediate and tragic. Each high-profile collapse reminds us that no one — not even the strongest among us — is immune.

But these cases also teach us valuable lessons: the importance of screening, the power of CPR and AEDs, and the need for emergency preparedness in every gym, field, and court.

By staying informed, acting quickly, and prioritizing prevention, we can ensure that more athletes survive — and thrive — after a sudden cardiac event.