In the 42nd minute of a 2020 European Championship match in Copenhagen, 29-year-old Danish soccer player Christian Eriksen collapsed to the ground as he received a throw-in.

The medical staff rushed to the field to perform defibrillation, and teammates gathered around to protect him from the view of the fans.

Prompt emergency medical attention likely saved Eriksen’s life. Studies consistently show that more than half the number of athletes who experience sudden cardiac arrest, often erroneously called a heart attack, die before they reach or are discharged from the hospital.

Sudden cardiac arrest isn’t unique to soccer. Despite being rare, every year there are reports of amateur or professional athletes in sports like hockey, basketball, or football dying suddenly. In most cases, sudden cardiac death is linked to heart defects present from birth.

We will explore why athletes develop cardiac arrest and what they can do to lower their risk.

It’s rare for athletes to develop cardiac arrest. Congenital heart conditions, or heart conditions present from birth, are the most common cause in athletes under 35 years. In older athletes, most sudden cardiac deaths are due to coronary artery disease.

Congenital conditions

Researchers believe the most common congenital heart conditions that lead to cardiac arrest in athletes in the United States are:

  • Hypertrophic cardiomyopathy (HCM): a thickening of the walls in the left ventricle. HCM is thought to be the most common cause of sudden cardiac death in athletes and affects about 1 in 500 people in the general population.
  • Anomalous origin of a coronary artery: an improper placement of one of the coronary arteries that supply the heart with blood.

Some people disagree on whether or not HCM is the most common cause.

A 2015 study looked at autopsies of National Collegiate Athletic Association (NCAA) athletes who died of sudden cardiac arrest from 2003 to 2013. One in four athletes had structurally normal hearts, implying that arrhythmias or electrical disorders may have been the most common cause of death.

The researchers only found definitive evidence in 8 percent of cases, compared to 30 to 40 percent in previous studies.

Other heart anomalies can contribute to sudden cardiac death.

Dilated cardiomyopathy and The syndrome is called Brugada syndrome. can also be acquired conditions.

Acquired conditions

Acquired conditions are the things that develop in your life.

The most common cause of sudden cardiac arrest in athletes over the age of 35 is atherosclerosis, which is the buildup of plaque in the wall of your arteries. Risk factors for atherosclerosis include:

Other acquired conditions can lead to cardiac arrest.

Signs of sudden cardiac arrest

Cardiac arrest is often referred to as a heart attack.

  • sudden collapse
  • There was no pulse.
  • There was no breath.
  • Loss of consciousness.

Cardiac arrest can be preceded by:

If you develop any signs of a cardiac arrest, you need to get help.

Estimates on how often athletes experience sudden cardiac arrest vary based on the definition of athlete and whether studies include cardiac events away from sport. They range anywhere from 1 in 3,000 to 1 in 1 million.

A 2016 study estimates that the risk of sudden cardiac death among Division 1 NCAA athletes is 1 in 53,703 athletes per year. Some groups of people, such as Black athletes, basketball players, and males, seem to be at a heightened risk.

Risk factor Higher risk Lower risk
Sex 1 in 37,790 for males 1 in 121,593 for females
Race 1 in 21,491 for Black athletes 1 in 56,254 for Hispanic athletes
1 in 68,354 for white athletes
Sport Men’s basketball: 1 in 8,978
Men’s soccer: 1 in 23,689
Men’s (American) football: 1 in 35,951

In a 2020 study, researchers looked at how common sudden cardiac arrest was in middle school to professional athletes using a national surveillance program in the United States.

They identified 74 cases of sudden cardiac arrest with survival, and 105 that resulted in death. More than 80 percent of people were male, and the average age was 16.6 years.

Cardiac arrest by sport

In a 2021 study, researchers looked at the incidence of sudden cardiac arrest in athletes ages 11 to 29 in the United States over 4 years. They identified 331 total cases.

Sport Number (%)
Basketball 95 (28.7)
Football 84 (25.4)
Soccer 39 (11.8)
Track and field/cross country 31 (9.4)
Baseball 21 (6.3)
Swimming 11 (3.3)
Lacrosse 9 (2.7)
Ice hockey 8 (2.4)
Wrestling 7 (2.1)
Softball 6 (1.8)
Volleyball 5 (1.5)
Dance 4 (1.2)
Tennis 4 (1.2)
Cheerleading 3 (0.9)
Boxing 1 (0.3)
Crew 1 (0.3)
Freestyle skiing 1 (0.3)
Flag football 1 (0.3)

How to best prevent sudden cardiac arrest in athletes is still a matter of considerable debate. Guidelines and laws vary between countries.

The American College of Cardiology and American Heart Association (AHA) recommend screening by examining your medical history and performing a physical exam.

Researchers continue to debate the implementation of screening with an electrocardiogram (ECG), as is done in some countries. An ECG is a device that measures the activity of your heart.

Since 1982, Italian law has required pre-participation screening with an ECG for competitive sports practice. But this screening hasn’t been uniformly accepted by the international scientific community.

In Italy, the most common cause of sudden cardiac death in athletes is arrhythmogenic right ventricular cardiomyopathy. Some researchers argue that ECG isn’t necessary in the United States, where HCM may be the most common cause of sudden cardiac death.

Researchers are continuing to examine the potential usefulness of genetic tests.

Eating a balanced diet may help reduce the risk of coronary heart disease, especially for older athletes. Foods that lower your risk of heart disease are also likely to support athletic performance and overall health.

Benefits of having an athletic training and defibrillator on-site

A certified athletic trainer and a defibrillar on-site can help save lives after a sudden cardiac arrest.

In a 2019 study, researchers found overall survival among athletes who had sudden cardiac arrest was 48 percent. However, if a certified athletic trainer was present and involved in resuscitation, survival rose to 83 percent. It increased to 89 percent with the use of an on-site automated external defibrillator.

Careful evaluation from a medical professional is needed before you can return to sport. A study by the AHA found evidence that athletes with genetic heart disease can remain competitive with a reasonably low incidence of cardiac events.

It might not be possible to return safely. Your team or institution may disqualify you from being involved in liability concerns.

Eriksen returned to football 8 months after his sudden cardiac arrest. Doctors fitted him with an implantable cardioverter defibrillator. However, Italian medical authorities banned him from playing in Italy with his club team Inter Milan, leading him to sign with Brentford in the United Kingdom’s Premier League.

Congenital heart disease is the most common cause of sudden cardiac death in young athletes. It is a disease in older athletes.

There is still debate on how to best screen for risk factors in athletes.

If you have a known heart problem, you can talk to your doctor about whether you should be participating in sports or undergo further testing.