Screening to prevent sudden cardiac death in athletes
- Mark S Link, MD
Mark S Link, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Tufts Medical School
- Antonio Pelliccia, MD
Antonio Pelliccia, MD
- Chief of Cardiology
- Institute of Sport Medicine and Science, Rome, Italy
- Section Editors
- Peter J Zimetbaum, MD
Peter J Zimetbaum, MD
- Section Editor — Cardiac Arrhythmias
- Associate Professor of Medicine
- Harvard Medical School
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Francis G O'Connor, MD, MPH, FACSM
Francis G O'Connor, MD, MPH, FACSM
- Section Editor — Sports-Related Injuries; Symptom Assessment and Physical Examination; Medical Issues Related to Sports and Exercise
- Professor of Military and Emergency Medicine
- Uniformed Services University of the Health Sciences
Sudden cardiac death (SCD) associated with athletic activity is a rare but devastating event. Victims are usually young and apparently healthy, and while many of these deaths are unexplained, a substantial number harbor underlying undiagnosed cardiovascular disease. As a result, there is great interest in early identification of at-risk individuals for whom appropriate activity restrictions can be implemented to minimize the risk of SCD.
The majority of SCD events in athletes are due to malignant arrhythmias, usually ventricular tachycardia (VT) or ventricular fibrillation (VF). In individuals with certain cardiac disorders (eg, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, etc), athletics may increase the likelihood of VT/VF in two ways:
●Prolonged physical training induces changes in cardiac structure (eg, interstitial fibrosis, disruption of normal myocardial architecture, dilation of right and left ventricle) in susceptible individuals that may create pathologic arrhythmogenic substrate.
●The immediate physiologic demands of intense athletics (eg, hemodynamic overload, catecholamine release, electrolyte imbalance) may trigger malignant arrhythmias in susceptible individuals with underlying cardiac abnormalities.
As with screening for any condition, the primary purpose of screening athletes for cardiac pathology is to identify patients at higher risk of SCD whose prognosis could be improved with an intervention (in this case, activity restriction or modification, or other specific therapy targeted at the underlying pathology). The approach to screening athletes depends, in part, upon the age of the athlete along with the anticipated level of activity (ie, competitive versus recreational athletics).
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- WHICH ATHLETES ARE AT RISK?
- RECOMMENDATIONS FOR SCREENING BY EXPERT GROUPS
- North American recommendations
- - Younger athletes (NA)
- - Masters athletes (NA)
- European recommendations
- - Younger athletes (European)
- - Masters athletes (European)
- Frequency of repeat screening
- Efficacy of screening programs to detect cardiovascular disease
- Impact of screening program on the outcome
- CHALLENGES TO WIDESPREAD SCREENING
- OUR APPROACH TO SCREENING
- FOLLOW-UP OF DETECTED ABNORMALITIES
- SUMMARY AND RECOMMENDATIONS