The Higher Risk of Sudden Cardiac Arrest Among Young Black Athletes: One Survivor's Story

Omar Carter has a fuzzy memory of the day he collapsed during his basketball game on July 9, 2013. His memory of the incident is mainly composed of witness accounts and a recorded video of the horrific moment his heart ceased to function.

In the video, we can see Carter, then a 25-year-old professional basketball player, navigating the court, passing the ball to his teammate, and then suddenly collapsing on his back.

The incident was not like any other cardiac arrests that Carter had previously seen in movies or other videos. "I have a vague memory of attempting to cushion my fall, which felt unusual," Carter, now 36, disclosed in an interview with Health. "When I watch other cardiac arrest videos, the victims simply collapse instantly. It almost felt like I was conscious of what was happening to me."

At first, onlookers and his teammates assumed Carter had fainted, but two women on the scene—Kelly Thomas, a cardiac ICU nurse, and Claudia Ward, who would later become Carter's mother-in-law—realized the severity of the situation.

While waiting for medical assistance to arrive, the duo performed CPR on Carter and used the automated external defibrillator (AED) machine at the facility. Carter gasped for breath after Thomas shocked him for the third time—his heart had stopped for an unnerving 13 minutes in total.

"I was informed that I drew a dramatic, movie-like breath back to life," Carter recollected. He was soon medically induced into a coma by the EMTs who arrived shortly and was transported to Carolina Medical Center for further treatment.

Carter regained consciousness a few days later, completely coherent and responsive. As he recalled, his primary concerns were whether he had prayed yet, what day it was, and whether he could continue playing basketball. However, he was confronted with the bitter truth that his basketball career was finished due to the cardiac arrest.

Basketball had been a huge part of Carter's life ever since he was a child, playing with his good friend and NBA star Steph Curry back in their hometown Charlotte, North Carolina. He was a college athlete and an elite basketball player, competing both domestically and overseas at the time of his cardiac arrest.

Despite having been diagnosed with an "athlete's heart"—a term referring to structural, functional, or electrical changes that comes with high-level athletic training—at 16, Carter had a clean bill of health. It was after he started experiencing a disconcerting pain in his left side during workouts that the condition was discovered. This led to a series of medical tests and examinations. Carter was relieved when doctors concluded that his condition was unlikely to be hypertrophic cardiomyopathy (HCM)—a cardiac disorder where the left ventricle of the heart thickens and stiffens, impairing blood flow. However, less than half a year later, Carter experienced a cardiac arrest on the court.

Since the incident, Carter has been diagnosed with hypertrophic cardiomyopathy. "According to my medical charts, I possibly experienced a bout of atrial fibrillation or AFib, and HCM," reveals Carter.

Notably, this occurrence isn't exclusive to Carter, with others such as professional athletes Damar Hamlin of Buffalo Bills, USC Trojans' Bronny James, and Keyontae Johnson of Oklahoma City Thunder having similar experiences. This has triggered extensive research backed by the National Heart, Lung, and Blood Institute (NHLBI) into the alleged increased susceptibility of young, black male athletes to sudden cardiac arrests.

"Black athletes are shown to be two to three times more at risk of Sudden Cardiac Arrest (SCA) than their white counterparts," reports Jonathan Drezner, MD, the director of the UW Medicine Center for Sports Cardiology.

SCA is a major cause of sports-related deaths for competitive athletes in the U.S. Black male NCAA Division I basketball players have been identified as the group most at risk, according to research published in 2020 in the British Journal of Sports Medicine (BJSM). The study revealed that compared to the average high-school athlete, these players are up to 21 times more likely to suffer from a major cardiovascular event. 

Various factors cause SCA, and they often differ depending on age. However, a significant number of SCA cases among college and professional athletes are due to cardiomyopathies, disorders that affect the heart muscle. Hypertrophic cardiomyopathy (HCM) is often responsible, causing just over 20% of SCAs, according to the same BJSM study. While HCM does not appear to be more prevalent among Black athletes, high-intensity exercise, which they often partake in, may trigger it.

Current research suggests that the increased risk among Black athletes is related to the social, economic, and physical conditions in the communities they come from. "It most probably relates to factors such as social determinants of health, and psychosocial stressors, including discrimination and racism," said Merije T. Chukumerije, MD, the director of sports cardiology for the Smidt Heart Institute at Cedars-Sinai Medical Group and team cardiologist for the LA Galaxy and LA Clippers.

Drezner, the primary author of the BJSM study, notes that Black athletes who experience SCA often come from zones with more significant socioeconomic deprivation compared to white athletes facing SCA. Ultimately, access to healthcare, quality screening, attention to heart symptoms and family medical history play a role in early condition detection that could provoke SCA.

Carter commented on the higher risk saying that it mirrors the struggles Black and brown people face relating to school and health disparities, as well as lack of access to resources; for instance, the lack of fresh nutritious food in many disadvantaged communities, and how heavily processed meals has tied to poorer health results.

Despite his cardiac arrest and brain injury from a fall on the court, Carter experienced relatively uncomplicated physical recuperation shocking his medical team and family. Shortly after hospital discharge, he received an implantable cardioverter-defibrillator (ICD) as a safety measure against potential heart rhythm complications.

However, the mental recovery was arduous. His basketball career was gone, leaving him lost. It wasn't until his mother proposed he start a foundation that he found a new purpose.

The Omar Carter Foundation was established in 2014 and obtained 501(c)(3) nonprofit status in 2015. It aspires to raise awareness about SCA, train athletes and families in CPR and AED usage, and educate on all aspects of heart health.

The trajectory of the organization has evolved over the years to not only train in CPR but also emphasize AED placement and utilization. The aim is to increase the bystanders at sporting events both capable and willing to intervene to save a life. The foundation also prides itself in supporting others as they navigate their experience following a cardiac arrest or career-ending injury.

After his cardiac arrest. Carter felt "invincible," and although his lifestyle did not immediately change following the incident, a benign episode of AFib in 2019 spurred him to adopt healthier habits.

Carter now follows a plant-based diet for the heart-health benefits, and prioritizes drinking enough water, keeping his stress levels in check, and exercising in a way that’s safe for him, as a cardiac arrest survivor (this means keeping track of his heart rate during physical activity to make sure it doesn’t go above 150 beats per minute).

Though his life may not have turned out the way he planned at 25 years old, he believes he’s still fulfilling his mission through the work of his foundation and sharing his story. “It’s helped me because I’m effectively doing what I thought I would do...just in a different way,” Carter said. “I may not be on the basketball court, but I’ve always had a passion to touch lives and give back.”