The purpose of preparticipation cardiovascular screening is to diagnose the pathological conditions that can lead to sudden cardiac death during exercise. Although many of the tragic deaths of young people remain unexplained, many could have been avoided.
Sudden cardiac death due to exercise is defined as the sudden and unexpected death that occurs during or shortly after exercise and occurs in a person who was otherwise healthy. The incidence of sudden cardiac death in athletes is 2.1 per 100,000 compared to 0.7 per 100,000 in the general population.
The main causes of sudden cardiac death in athletes:
A.Under 35 years old:
- Hypertrophic cardiomyopathy
- Congenital abnormalities of the coronary arteries
- Long QT syndrome
- Brugada Syndrome
- Short QT syndrome
- Catecholaminergic ventricular tachycardia
- Myocarditis
- Arrhythmogenic Cardiomyopathy of the Right Ventricle
B. Over 35 years old:
- Coronary artery disease
- Congenital abnormalities of the coronary arteries
- Myocarditis
- Dilated cardiomyopathy
- Mitral valve prolapse
- Aortic valve stenosis
It is important to emphasize that people of all ages, who are amateur or professional athletes should undergo a preventive cardiological examination at least once. The initial stage of the test involves a comprehensive history taking with targeted questions such as the presence of symptoms during exercise (chest pain, dizziness, unusual tachycardia, seizures). It is also necessary to obtain a detailed family history and search for cases of sudden cardiac death in the family in people under 50 years of age and / or the presence of young people with some type of heart disease.
A complete clinical examination is then performed, which includes, among other things, proper listening of the heart and palpitations of peripheral pulses. Next is the electrocardiogram whose findings will determine the further investigation of the patient (FIGURE 1).
It should be understood that the diagnosis of a pathology is not at the same time prohibitive for any sports activity. Proper further investigation with imaging or even genetic testing enables the doctor to properly advise the athlete on how and what type of exercise to participate. For example, an athlete with myocarditis should abstain from exercise for at least 6 months and return to action only if all laboratory and imaging findings return to normal. At the same wavelength, an athlete with a positive hypertrophic cardiomyopathy gene but with normal echo examination can participate in all sports with frequent follo ups.
The goal of an effective preventive cardiology screening in professional or amateur athletes is to find people at increased risk early and dramatically reduce the incidence of sudden cardiac death.
References:
1. Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Brugada Terradellas J, Carré F, Guasch E, Heidbuchel H, La Gerche A, Lampert R, McKenna W, Papadakis M, Priori S, Scanavacca M et al. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. European Journal of Preventive Cardiology. 2016;24(1):41-69.
2. Η. Σανίδας, Α. Αναστασάκης, Μ. Βέλλιου, Κ. Τσιούφης, Ι. Μπαρμπετσέας. Καρδιολογικός Προαγωνιστικός Έλεγχος Αθλητών Ελληνική Καρδιολογική Επιθεώρηση.
3. 2. Sharma S, Drezner J, Baggish A, Papadakis M, Wilson M, Prutkin J, La Gerche A, Ackerman M, Borjesson M, Salerno J, Asif I, Owens D, Chung E, Emery M, Froelicher V et al. International recommendations for electrocardiographic interpretation in athletes. European Heart Journal. 2017;39(16):1466-1480.
