Screening Athletes For Heart Defects

Almost weekly we read of another young athlete that suddenly collapses and in far too many cases dies of a "heart attack". The following are excerpts are from various articles including:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994446/

Example: "Shane del Rosario has died, nearly two weeks after suffering a heart attack, the UFC announced Monday. The 30-year-old Del Rosario, a professional MMA fighter since 2006. Official Statement: Shane Del Rosario had a catastrophic cardiovascular collapse at home on Tuesday morning. He was brought to the hospital in full cardiac arrest. Del Rosario’s management team released a statement saying doctors were looking at the potential that the fighter had a rare heart condition known as Long QT Syndrome that typically goes undetected until there’s a problem.

The goals of evaluating individuals for exercise and sports participation is crucial. The most important reason to screen for heart disease is to prevent sudden, unexpected death. Heart disease may also lead to sudden incapacity which may result in injuries, and pre-existing heart disease may be exacerbated by exercise. It has been estimated that there are 5 million active athletes at the high school, university, professional and master's levels in the United States.1 The sudden death rate among high school athletes is 1:100–200 000; among marathon runners 1:50 000; and among recreational joggers 1:15 000.2 Thus, athletic sudden cardiac death is a rare event.

“Sudden cardiac deaths in competitive athletes continue to be highly visible, compelling emotional events with significant liability concerns. These catastrophes are frequently subjected to intense public scrutiny largely because of their occurrence in young otherwise healthy-appearing individuals, including elite participants in collegiate and professional sports”

CAUSES OF SUDDEN DEATH IN ATHLETES
In athletes above the age of 35, especially men, the most common cause of sudden death is atherosclerotic coronary artery disease. In younger individuals atherosclerotic coronary artery disease is much less common and other diseases predominate. The most common cause of sudden death in young athletes is hypertrophic cardiomyopathy. The second most common is coronary artery anomalies, and the third is abnormal left ventricular hypertrophy.

RECOMMENDATIONS FOR SCREENING
Ideally screening should be done pre-participation by a physician trained in this activity, but other well-trained healthcare workers are acceptable as long as they do not have a conflict of interest. Screening should be done yearly just before training for the sports activity begins. The evaluation should include a history of symptoms suggestive of heart disease, a family history of premature death or specific cardiac diseases, and questions about substance abuse. The physical examination should include blood pressure, femoral pulses, auscultation of the heart in the standing position and inspection for Marfan syndrome features. There should be a low threshold for delaying clearance to play to evaluate further suspected cardiovascular disease.

I currently suggest and strongly recommend that each patient/athlete consult with a cardiologist regarding the above concerns. The heart matter can only be found with the special testing. One day all athletes will be required to comply with examinations including ECG, echocardiography and referral to a cardiologist.

Better to be healthy and safe ... than to ignore a hidden problem.