Common Medical Conditions: Epilepsy & Sudden Cardiac Arrest

Two Serious Conditions in Sport

Epilepsy and sudden cardiac arrest (SCA) are two of the most serious medical conditions a coach or sports practitioner may encounter. Both can be life-threatening in a sporting context. Understanding the causes, recognising the symptoms and knowing the correct response can make the difference between life and death. This lesson covers both conditions in the depth required by the specification.

Epilepsy: Overview and Causes

Epilepsy is a neurological condition in which abnormal bursts of electrical activity in the brain cause recurrent seizures. Not all seizures are the dramatic convulsions often associated with epilepsy — they range from brief lapses in consciousness to full body shaking. Three key triggers are listed in the specification: severe head injuries (which can damage brain tissue and disrupt normal electrical patterns), anxiety or stress (psychological states that can lower the seizure threshold in susceptible individuals) and tiredness or lack of sleep (fatigue reduces the brain's resilience to abnormal electrical activity). In sport, these triggers are all plausible — contact sport carries head injury risk, competition brings stress, and overtrained athletes may be sleep-deprived.

Epilepsy: Symptoms of Seizures

Seizure symptoms affect different parts of the body. In the eyes, a performer may stare blankly or show flickering/fluttering of the eyelids — this may look like a brief lapse of attention or a temporary absence. In the mouth, symptoms include biting the tongue, making random involuntary noises or vocalisation, or producing excessive saliva. In the limbs, seizures may cause stiffness (tonic phase) followed by rhythmic jerking movements of the arms and legs (clonic phase), or sudden loss of muscle tone causing the performer to collapse to the ground.

Epilepsy: Treatment

The two main treatments for epilepsy are anti-epileptic drugs (AEDs) — medication taken regularly to reduce the frequency and severity of seizures by stabilising the brain's electrical activity — and the ketogenic diet, a high-fat, very low-carbohydrate diet that has been shown to reduce seizure frequency in some patients, particularly children, when medication is not fully effective. In a sporting context, if a performer has a seizure, the immediate response is to protect them from injury (move hard objects away, cushion the head), do not restrain them, place them in the recovery position once convulsions stop, stay with them and call 999 if the seizure lasts more than 5 minutes or they do not regain consciousness.

Sudden Cardiac Arrest: Overview and Causes

Sudden cardiac arrest (SCA) occurs when the heart's electrical system malfunctions, causing it to stop pumping blood. Without immediate treatment, brain damage begins within 4–6 minutes and death within 10 minutes. Three causes are listed in the specification: underlying genetic heart conditions — such as hypertrophic cardiomyopathy (HCM), an inherited thickening of the heart muscle that is the most common cause of SCA in young athletes; intense physical activity — which can trigger SCA in those with undetected heart conditions by placing extreme demand on an already abnormal heart; and sudden trauma — a severe blow to the chest at a specific moment in the cardiac cycle (called commotio cordis) can trigger ventricular fibrillation.

SCA vs Heart Attack: A Critical Distinction

The specification requires you to know the difference between cardiac arrest and a heart attack. A heart attack (myocardial infarction) is caused by a blockage in a coronary artery — the heart muscle is starved of blood but continues to beat. The performer is typically conscious, may experience crushing chest pain, breathlessness and pain radiating to the arm or jaw, and can often speak. A sudden cardiac arrest is an electrical failure — the heart stops beating effectively. The performer is unconscious and not breathing normally. Both are emergencies requiring 999, but SCA additionally requires immediate CPR and defibrillation to have any chance of survival.

SCA Treatment: CPR and Defibrillation

The symptoms of SCA are: unconsciousness (sudden collapse with no response) and breathing difficulties (agonal breathing — irregular gasping — or complete absence of breathing). Treatment follows the DRABC protocol. Once SCA is suspected, call 999 immediately and begin CPR — 30 chest compressions to 2 rescue breaths, at a rate of 100–120 compressions per minute, pushing down 5–6 cm on the centre of the chest. A defibrillator (AED) should be retrieved and used as soon as possible — the AED analyses the heart rhythm and delivers a controlled electric shock if ventricular fibrillation is detected, which can restore a normal rhythm. Every minute without defibrillation reduces survival chances by approximately 10%. Lifestyle changes — including maintaining a healthy weight, not smoking, and regular cardiovascular exercise — reduce the long-term risk of cardiac events.