Last update:
16-Jun-2006

Sudden cardiac death (SCD) in athletes is a rare yet devastating event, with social consequences. The etiology of exercise-related SCD differs with the age of athletes. In the mature athlete (>35 years), atherosclerotic disease is responsible for the majority of SCD cases. In contrast, a variety of cardiac diseases cause SCD in young athletes (<35 years old), with hypertrophic cardiomyopathy and congenital coronary artery anomalies representing the most common lesions. Several other diseases, including myocarditis, arrhythmogenic right ventricular cardiomyopathy, aortic rupture, mitral valve prolapse and electrical disorders, are less frequent causes. The frequency of SCD is lower in females, probably due to their lower overall participation level and intensity of training, different training adaptations, the lower incidence of structural cardiovascular diseases in women, or to a combined effect of these reasons. Aside from the underlying cardiovascular disease, the mechanisms involved in exercise-related SCD are related to hemodynamic and electrophysiological changes brought about by competition or training, with fatal arrhythmia being most common mechanism of death. Identification of athletes at risk for SCD and the application of preventive strategies are likely to help avoid such catastrophic events. Problems in the routine screening of athletes include limitations inherent in the low frequency of SCD, the poor predictive value of available diagnostic procedures and the cost of elaborate testing for large populations. Differentiating physiological from pathological hypertrophy can also be a challenge. According to the AHA recommendations, a complete and careful personal and family history and a physical examination designed to identify (or raise suspicion of) cardiovascular lesions known to cause sudden death or disease progression in young athletes, seem to comprise the best available and most practical approach to screening competitive athletes. For older athletes and high risk individuals a clinical exercise test, evaluation of exercise induced symptoms, awareness of these symptoms and especially those of cardiac ischemia are recommended.

Key words: Cardiovascular screening, Exercise, Pre-participation, Sudden cardiac death.