Sudden Cardiac Death in Athletes: What Sport-Rehabilitation Specialists Need to Know

Abstract

Objective: To describe the underlying conditions that predispose athletes to sudden cardiac death (SCD) and review signs and symptoms that indicate an athlete is at risk. Data Sources: MEDLINE, the Los Angeles Times and Triathlon Times archives, and other sources identified in the references of articles initially located therein. A total of 43 references were included. Conclusions: Most cases of SCD in younger athletes (≤35 years) are attributable to multiple hereditary conditions, with familial hypertrophic cardiomyopathy being the primary cause, whereas the major cause of SCD in older athletes (>35 years) is coronary artery disease. Health-care professionals evaluating athletes should pay particular attention to past medical and family history. Items in an athlete's screening that suggest increased risk include a history of chest pain, syncope, excessive shortness of breath, irregular heart rate or murmur, or a history of SCD in an immediate family member. Key Words: familial hypertrophic cardiomyopathy, cardiovascular screening Evans CC, Cassady SL. Sudden cardiac death in athletes: what sport-rehabilitation specialists need to know. J Sport Rehabil. 2003;12:259-271.

Screening for Heart Disease in Athletes by Athletic Trainers and Sports Physical Therapists

“…For a thorough review of screening of the CV system in an athlete, see Evans and Cassidy, Lyznicki et al, or Maron. 8,15,19 Regarding the return rate for both e-mailed and postal surveys in this study, the response was suboptimal. The outcome of the study must be interpreted cautiously since the low response rate may have biased the results in several ways.…”

“…The question of whether consistent screening for heart disease in athletes during routine evaluation by a PT or AT might actually result in fewer fatalities, timelier referral or better treatment cannot be definitively answered. Few studies have looked at the effectiveness of formal preparticipation screening of athletes specifically for heart disease 2,27-29 and many have estimated that at best, screening will identify only a fraction of those at risk for SCD, 5,19,30 since the underlying defects are difficult to detect; however, if including the CV system during the routine evaluation of an athlete yields even a few positive cases, these may represent lives saved. Moreover, there are other reasons beyond identifying people at risk for SCD to include the CV system when performing a routine evaluation on an athlete.…”

“…Older athletes most often succumb to a coronary event or myocardial infarction, similar to cardiac death in the general population, whereas younger athletes are more likely to succumb to a genetically-linked or congenital cardiac defect. [19][20] Currently, over 20 genetic or acquired conditions have been found to contribute to SCD in younger athletes with no single cause accounting for greater than 30 to 40% of cases. 4,12,18,19 Taking into consideration the many causes of SCD in athletes and the overlap in clinical presentation of "athlete's heart" compared with pathological cardiac hypertrophy, identifying athletes at risk for SCD is a daunting job for a clinician unless they are specifically educated about these conditions.…”

“…[19][20] Currently, over 20 genetic or acquired conditions have been found to contribute to SCD in younger athletes with no single cause accounting for greater than 30 to 40% of cases. 4,12,18,19 Taking into consideration the many causes of SCD in athletes and the overlap in clinical presentation of "athlete's heart" compared with pathological cardiac hypertrophy, identifying athletes at risk for SCD is a daunting job for a clinician unless they are specifically educated about these conditions. 8,[19][20][21] Because of differences in the pathophysiology of SCD, young athletes may present with different markers or signs and symptoms compared with older athletes at risk.…”

“…4,12,18,19 Taking into consideration the many causes of SCD in athletes and the overlap in clinical presentation of "athlete's heart" compared with pathological cardiac hypertrophy, identifying athletes at risk for SCD is a daunting job for a clinician unless they are specifically educated about these conditions. 8,[19][20][21] Because of differences in the pathophysiology of SCD, young athletes may present with different markers or signs and symptoms compared with older athletes at risk. An uninformed clinician or healthcare worker who is not trained in what to look for may not be alert to findings or to an athlete's complaint that indicates a serious underlying condition.…”