Sudden death syndrome: Gerry Thornley talks to two doctors about sudden death in sport and possible ways of preventing tragedy

The recent deaths of the Tyrone gaelic football captain Cormac McAnallen and the Royal School Armagh, Ulster Schools and Irish under-19 flanker John McCall highlights how little is known about the phenomenon of sports and sudden death syndrome. And how much more could be done to potentially save lives.

Nor are the deaths of McCall and McAnallen isolated cases, for there have been a number of other unspecified incidents, including that of a man in his early 20s who died while playing one of the major team field sports in Ireland in the past few months at a strictly amateur level. However, as in other such cases, the family concerned did not want their son's death to be divulged to the media.

"It's an incredibly sensitive area," admits Dr Conor O'Brien, a sports medicine consultant in Blackrock Clinic. "Because, while it doesn't happen frequently, when it does happen it causes extraordinary pain. It's a complete disaster for all these families. It's devastation beyond belief, but there are a lot of facts around this that you could say: 'could we make this better?' Of course we could make it better and there are things going that we could change to make this better. Simple things and complicated things."

There is, however, little data available on the issue. "The second thing is that the reported research, mainly from America, says that it's a rare bird. The numbers that are reported are four per million exercisers per year," says O'Brien, but he is citing a report from 1992 and agrees with Dr David Keane, a cardiac arrhythmia specialist and consultant cardiologist based in St James's Hospital, Dublin, who believes that those numbers "considerably underestimate the problem".

Exercise and sporting activity has been consistently proven to reduce the overall risk of heart disease. "The daily risk of sudden cardiac death is lower in people who exercise regularly," says Keane. "Paradoxically, the very low risk of sudden cardiac death in people who exercise regularly peaks during the period of exercise, but falls to an extremely low level throughout the remainder of the day," explains Keane. "As a result the overall risk of sudden cardiac death is greatly reduced by regular exercise."

O'Brien adds: "The research suggests that you've got to do a lot of screening to pick these cases up but that it's worth doing it and according to the sports medicine literature, in certain countries such as Italy, they screen everybody. You can't run across the road without being screened. It's in their schools."

"It's the same with any sports scholarship to any University in the States as well as turning pro," adds Keane, who has recently returned to this country after eight years in the US, where many of the studies on sudden cardiac death have been done.

There are two ways of helping to prevent cases from happening, what O'Brien terms non-intervention and intervention, an example of the former being questionnaire screening. Important questions include whether a player has ever had a "black out" or loss of consciousness or significant dizzy spells on exercise or whether there is a family history of sudden death at a young age.

Depending on the responses to questionnaire screening, this method "may be a way to pick up somebody who could have an underlying disorder of the heart rhythm or a congenital abnormality who should then be evaluated by a cardiologist," explains O'Brien .

Another question, taken from a "Sample Questionnaire for Cardiac Screening of Athletes," in The Physician and Sports Medicine journal, asks: "Do you use, or have you ever used, cocaine or anabolic steroids? and has a physician ever disqualified you from athletic competition?"

This relates to the instances, sometimes high profile, in the United States of athletes who have suffered heart attacks while taking cocaine or anabolic steroids. O'Brien, who is also chairman of the anti-doping committee of the Irish Sports Council, explains that some of the older, more established anabolic steroids have been linked to brain tumours "but as for the newer ones, the THGs and so forth, we've no idea what they're causing because they didn't come through mainstream pharmacology."

Athletes can either be born with, or acquire, heart disease. Some can be picked up by an ECG, or Electrocardiograph. "An ECG is very cheap, is very quick to do, and is non-invasive, so there is no pain or risk to the patient," says Keane. "An ECG can pick up primary electrical problems which predispose to the development of fatal rhythm disorders and there's also echo, an ultrasound examination of the heart, which can show problems with the heart muscle or valves."

Of course, there is the expense. Should, or could, it be funded by the state and/or sports bodies and schools? "If an individual goes to a cardiac clinic for an ECG it may cost €80, but if a mass routine screening programme was set up for children participating in competitive school sports, it could be performed more cost effectively," says Keane.

Another aspect to all of this are AEDs, or Automatic External Defibrillators, a device which can be used in an emergency by, effectively 'jump-starting' the heart back into action. "They are cheap, and can be easily applied with minimal training by members of the public," says Keane, who adds "I do think they should be made available not only at all sports facilities, but at all public facilities."

AEDs cost about €3,500, but as Keane puts it, "what is cost effective? If it comes down to your own child, cost effectiveness goes out the door. I mean, we invest the same in airbags and ABS brakes in cars."