How can elite athletes also be at risk of heart attacks?

Tamim Iqbal was admitted to hospital today (24 March) after suffering a heart attack. 

Although he has since begun recovering, a heart attack of an elite athlete sent shockwaves. 

Athletes suffering from heart attacks is surprising because they are generally considered the fittest individuals, but it does happen. 

Cameroonian footballer Marc-Vivien Foe tragically died on the pitch during a 2003 FIFA Confederations Cup semi-final match against Colombia, succumbing to a heart attack.

It wasn't the first or the last, but it became a talking point for the years to come. 

Tamim Iqbal regains consciousness, responding to calls

A positive result of Foe's death has been huge improvements in both the testing of footballers for heart problems and the treatment they receive during matches.   

Though sudden cardiac arrests are more common in sports like football and basketball due to the high-intensity running involved, cricketers can still be at risk, especially in extreme weather conditions or with pre-existing heart conditions.

An example that springs to mind is of James Taylor, who played for England in 2016. He was diagnosed with a serious heart condition, forcing him to retire at 26.

Research shows that some athletes may inherit a higher risk of heart disease, even if they appear fit.

Tamim Iqbal's brother, former cricketer Nafees Iqbal, for instance, suffered a brain stroke in June last year.  

While genetic factors can be reasons, there are others as well. 
Many athletes have underlying genetic or structural heart diseases that go unnoticed until a triggering event occurs.
Intense exercise also puts extra stress on the heart, especially in endurance sports like marathon running or football.

Tamim’s condition now stable after heart attack, one stent placed in coronary artery

Strenuous activity can trigger abnormal heart rhythms (arrhythmias), leading to cardiac arrest.

Then there is the loss of fluids and essential salts (like potassium and magnesium) can disturb the heart's electrical activity, leading to arrhythmias and heart failure.

Furthermore, playing in extreme heat causes the body to work harder to cool down, which puts stress on the heart.

Some athletes also take steroids, stimulants, or energy boosters that increase heart rate and blood pressure, raising the risk of a heart attack.

Another can be a blow to the chest (eg, from a cricket ball, football, or punch) at the wrong moment in the heart's cycle can cause cardiac arrest.
One factor that came to fore recently is the post-viral cardiac issues.

Viral infections like COVID-19 or flu can inflame the heart muscles (myocarditis), increasing the risk of heart complications, even in young athletes.