Sudden Arrhythmia Death Syndrome?

Hi

I'm an 18 year old soccer player who has been an extremely active boy for his entire life (started playing when i was 5). I have never had problems with my heart, and I had done sports every single day. I had done all kinds of intense sports like soccer, swimming, basketball etc. It wasn't until the age of 16 when i started having a weird heartbeat. The heart did not skip a beat, nor did it beat too fast or too slow, it just had a STRONGER beat. The rhythm was perfect, but some beats were stronger. I had no chest pain, no palpitations (unless you consider that a palpitation), no fainting, lightheadedness or syncope, and a resting pulse of 50. I became so aware of my heart and read so much about heart diseases, i can clearly identify everything. Lately, however, and it's been a year, I started getting a skipped beat once in a while. It became frequent for the last 3 months, every day I had 1-5 skipped beats. One night I became anxious and I had a run of 3 beats and more skipped beats. Again no symptoms. I did get anxious countless times thinking my heart was gonna stop. And now my sports life is at stake because I can't exercise without worrying :(... I have done all the tests, (echo, ecg, holter, blood work, but NO STRESS TEST) and the cardiologist said im perfectly fine! No history of heart disease in my family, i got all grandparents alive all older than 70.

All I am suspecting is Long QT, Catecholaminergic Polymorphic V-Tach, Brugada, or any other SADS... Cardiologist said I had none of these...

Any ideas? Or am I just worrying too much?

[lmuenchen]

Hi,

sudden cardiac death can happen extremely in young active people who never felt sick before. The most frequent causes are hypertrophic obstructive cardiomyopathy and long-QT syndrome, both of with are rare / very rare diseases. Long-QT syndrome usually occurs hereditary / in the family.

What is important: long-qt syndrome can usually be diagnosed on the ECG and HOCM can easily be diagnosed on an echo.
The best test to rule out the risk of sudden cardiac death CLEARLY is the cardiologist telling you you are fine. There is no better test yet.

Many Professional guidelines suggest to do no test at all:
"Consequently, we conclude that a complete and careful personal and family history and physical examination designed to identify (or raise suspicion of) those cardiovascular lesions known to cause sudden death or disease progression in young athletes is the best available and most practical approach to screening populations of competitive sports participants, regardless of age. Such cardiovascular screening is an obtainable objective and should be mandatory for all athletes. We recommend that both a history and a physical examination be performed before participation in organized high school (grades 9 through 12) and collegiate sports. Screening should then be repeated every 2 years. In intervening years an interim history should be obtained. Indeed, this recommendation is consistent with procedures that are customary for most high school and collegiate athletes in the United States."
(http://circ.ahajournals.org/cgi/content/full/94/4/850)

Others just do an ECG:
http://www.nejm.org/doi/full/10.1056/NEJM199808063390602

In your case: a resting pulse of 50 is common in young, well trained athletes and no reason for concern at all. Many young athletes DO have a very long PQ-interval (the time it takes the electric current to travel from the atria to the ventricles), that sometimes even qualifies as an AV-block, type I; which however is NO reason for concern. It can happen that sometimes individual heart beats are skipped (also 3 in a row; some patients have 5 skipped beats per hour) which also is no reason for concern.

It can be very difficult to get more relaxed on matters of the heart (particularly when its your own) but in your case I think it is the thing to do.

Bye,

F.Schwarz