Preparticipation Evaluation

Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 Years of Age): a scientific statement from the American Heart Association and the American College of Cardiology.

Sudden Cardiac Death in Young Athletes

Physical activity is an invaluable tool to fight cardiovascular disease, but physical activity may trigger sudden death (SD) in athletes, especially if they are unknown with an underlying condition. Although the incidence of SD remains rather low in athletes (estimated at 0.5–2 events per 100,000 participants), some data suggest that the overall SD risk is higher in athletes than in sedentary individuals. Most athletes who die suddenly present with a silent cardiac condition, most commonly hypertrophic cardiomyopathy in American series or arrhythmogenic right ventricular cardiomyopathy in European data sets. Other causes of SD include coronary congenital abnormalities, valve disease, channelopathies, or commotio cordis. Based on these data, efforts have been undertaken to reduce the impact of SD in athletes. First, preparticipation screening programmes, including a clinical history, physical examination, and an electrocardiogram (ECG), interpreted through standardized criteria, aim at an early detection of cardiac conditions predisposing to SD. Second, a quick response to a cardiac arrest may save lives; training sports personnel in cardiac resuscitation, readily available automated external defibrillators, and sport medical action plans may critically influence outcomes.

Sudden cardiac death is the second most common cause of athletic mortality in both elite human and equine athletes. Racehorses perform at extremely high exercise intensities with maximal heart rates and aerobic capacities exceeding those of human athletes. A predisposition to life-threatening arrhythmias unmasked by athletic activity, is suspected to underlie sudden cardiac death in both species and predicting risk is critical for the health and safety of athletes. Cardiac restitution ratio (CRR) is used as a measure of arrhythmia risk at rest in humans and represents the ability of cardiomyocytes to recover between successive action potentials. CRR can be calculated as QT/TQ on an electrocardiogram (ECG) and has never been investigated during high intensity exercise. The objectives are to characterize changes in the QT interval and CRR in normal racehorses to establish a risk threshold and to identify unique ion channels in the equine myocardium that may be involved in accommodation of the cardiac action potential to changes in heart rate. It is hypothesized that CRR will be highest during exercise periods when sudden cardiac death most frequently occurs, and that the horse will exhibit differences in myocardial ion channel expression. Over 3800 cardiac cycles obtained from ECGs of 42 racehorses were analysed using custom software to calculate RR interval, QT interval, and CRR. Instantaneous heart rate ranged from 26 beats per minute at rest to 293 during racing. Interquartile ranges (median) of QT interval and CRR during maximal effort were 176-198 ms (186 ms) and 2.1-3.3 (2.5), respectively. CRR was highest during race exercise; the first 30 seconds of cardiac deceleration following the race; and sporadically during non-race exercise, corresponding to periods when sudden death most frequently occurs. Preliminary multivariable regression analyses revealed numerous significant associations for both QT interval and CRR, including with exercise period, RR interval, racing gait, sex, and age. Apparently healthy horses during exercise routinely displayed CRRs exceeding the described arrhythmogenic threshold of 1, established in humans. Left ventricular free wall myocardium was obtained from horses of typical racing breeds. A combined proteomic approach using mass spectrometry and immunoblotting revealed presence of several ion channels not known or not known to be significant to the ventricular action potential in humans, including Kv1.5 and Kir6.2, and different primary isoforms of sodium and calcium channels. These findings identify unique aspects of myocardial electrophysiology in horses with potential implications for sudden cardiac death in human athletes. Funding graciously provided by Equine Guelph. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Sudden death in athletes

Sudden death (SD) in athletes represents a cardiac ‘earthquake’ affecting apparently healthy and highly trained individuals. This is not due to excessive demands on a normal heart, as occurred to...

Regular participation in intensive physical exercise is associated with electro-morphological changes in the heart. This benign process is called athlete’s heart. Athlete’s heart resembles few pathologic conditions in some aspects. So differentiation of these conditions is very important which otherwise may lead to a catastrophic event such as sudden death. The most common causes of sudden death in young athletes are cardiomyopathies, congenital coronary anomalies, and ion channelopathies. The appropriate screening strategy to prevent sudden cardiac death in athletes remains a challenging issue. The purpose of this review is to describe the characteristics of athlete’s heart and demonstrate how to differentiate it from pathologic conditions that can cause sudden death.

Sudden cardiac death in athletes is one of the most tragic health events seen both in our country and all over the world. In some of those athletes, there is no obvious structural abnormality. Dynamic changes in intracardiac hemodynamics during exercise may be a cause for sudden death in these athletes, the impact of exercise on intracardiac gradient and cardiac hemodynamic parameters in athletes was compared with healthy controls. A total of 21 professional male athletes and 21 healthy male controls were included in the study. Transthoracic echocardiography was performed in all participants both at rest and maximal exercise level to assess the intraventricular gradient (IVG) and cardiac systolic and diastolic functions. Abnormal IVG was defined as gradient of >30 mm Hg at peak exercise level. Both groups reached the level of predicted maximum exercise. There was no exercise limiting symptom among participants during exercise test. The athletes revealed a higher maximum peak systolic IVG at baseline and after exercise in comparison with the control group. None of the participants showed an abnormal IVG level. Our results showed that there was no dynamic intraventricular obstruction with aerobic exercise in subjects with a structurally normal heart.

/n summer 2012 I had the opportunity to death in athletes. In 1993, Dr. Maron brought the work as a research intern at the MinneapNational Registry of Sudden Death in Young olis Heart Institute Foundation (MHIF). Athletes to MHIF. The Registry is an autopsy MHIF is a nonprofit organization with the based database that records athlete deaths meeting mission of improving cardiovascular health five criteria: the athlete must have been related to through research and education. The internship the USA in some capacity, such as an American they offer is an effective extension of this athlete or a foreign athlete on American soil; a mission: future physicians (the interns) are victim of sports-related sudden death-, under the educated about healthcare through a collection age Qfforty, working towards improvement and of diverse experiences, and in return the interns excellence in their sport; and they must have died work with physicians to advance clinical in 1980 or later (Maron et al., 2009). The research projects. The internship program at database currently holds about 2300 cases of MHIF is primarily designed for pre-medical athlete deaths, and an additional 225 cases of students in the latter stages of undergraduate aborted death, which is defined as a sudden education (juniors, seniors, and graduated cardiac arrest that would have resulted in death if students). In existence since 2002, the program nQt for cardiopUlmonaiy resuscitation (CPR) or has three main purposes for participating automated external defibrillator (AED) use. Since interns: to gain experience with clinical rethere is no mandatory reporting of athlete deaths search, to learn more about cardiovascular h the USA, the Registiy is responsible for many healthcare, and to develop an accurate understatistics ()n ^ |ssue of sudden aftlete deaths and standing of medicine as a career (Willenbring et . r . , r , 1 20081 1S ore an imPortant resource for physicians, administrators, and public health officials. The most recent statistical analysis of the Clinical research Registry was published in 2009, and this analysis is still considered accurate (the per The most valuable part of the internship was centages do not change much over time). This gaining exposure to clinical research. I was analysis offers many useful figures conceming assigned to work under Dr. Bany J. Maron, who the demographics of sudden death in athletes, holds a special interest in researching sudden For example% the most recent years of the database suggest a sudden death incidence rate in athletes of 99 deaths per year (Maron et al., Correspondence to: cjmurphy2@students.nwc.edu 2009). The age of these athletes at death was

Asthma-related sudden death in athletes: a retrospective analysis of the US NCCSIR database (1982-2018).

Sudden cardiac death (SCD) is the leading cause of fatalities in competitive athletes during sports and exercise. These tragic events often receive intense public attention and stimulate debate regarding the most appropriate prevention strategies. A precise understanding of SCD incidence is needed to guide effective screening programmes and proper emergency preparations at athletic events. However, published estimates of SCD incidence vary widely, and are strongly influenced by the methodology used for case identification (numerator) and calculations of the population at risk (denominator). Studies searching only media reports or catastrophic insurance claims tend to underestimate SCD risk. Few studies with mandatory reporting of SCD are available, leaving significant knowledge gaps in our understanding of SCD in competitive athletes. In general, SCD is more common in males, black athletes, and male basketball players. This chapter reviews the incidence of SCD in athletes and examines differences based on gender, race, sport, and geographic region.

Exceeding 300,000 cases annually, sudden cardiac death (SCD) is the leading cause of death in the United StatesUSA [1, 2]. [1, 2] SCD is also the leading cause of death in athletes [3].[ 3] Defined as occurring within one 1 hour of participation in sports [4],[4] exercise-related SCD occurs in 1-5 one to five cases per one million athletes per year. Of the approximately 25 million competitive athletes in the USAUnited States, there are 25-125 documented cases of SCD per year, likely a significant underestimation.[5].

Long‐lasting athletic training induces an overload on the heart that leads to structural, functional, and electrical adaptive changes known as the “athlete's heart.” The amount of this heart remodeling has been traditionally considered balanced between the left and the right heart chambers. However, during intense exercise, the right heart is exposed to a disproportional afterload and wall stress which over a long period of time could lead to more pronounced exercise‐induced changes. Highly trained athletes, especially those involved in endurance sport disciplines, can develop marked right ventricular (RV) remodeling that could raise the suspicion of an underlying RV pathology including arrhythmogenic cardiomyopathy (ACM). The distinction between physiological and pathological RV remodeling is essential as ACM is a common cause of sudden cardiac death in athletes, and high‐intensity exercise training has demonstrated to accelerate its phenotypic expression and worsen its prognosis. The distinction between physiological and pathological RV remodeling is essential since ACM is a common cause of sudden cardiac death in athletes, and high‐intensity exercise training has demonstrated to accelerate the phenotypic expression and worsen the prognosis. This article outlines the physiological adaptation of the RV to acute exercise, the subsequent physiological structural and functional changes induced by athletic training and provides useful tips of how to differentiate between physiological RV remodeling and a cardiomyopathy phenotype.

The benefits of exercise for cardiovascular and general health are many. However, sudden cardiac death (SCD) may occur in apparently healthy athletes who perform at the highest levels. A diverse spectrum of diseases is implicated in SCD in athletes, and while atherosclerotic coronary artery disease predominates in individuals of >35 years of age, primary cardiomyopathies and ion channelopathies are prevalent in young individuals. Prevention of SCD in athletes relies on the implementation of health policies aimed at the early identification of arrhythmogenic diseases (such as cardiac screening) and successful resuscitation (such as widespread utilization of automatic external defibrillators and training members of the public on cardiopulmonary resuscitation). This review will focus on the epidemiology and aetiologies of SCD in athletes, and examine fallacies in the approach to this controversial field. Furthermore, potential strategies to prevent these tragic events will be discussed, analysing current practice, gaps in knowledge and future directions.

Competitive sports activity is associated with an increase in the risk of sudden cardiovascular death (SCD) in susceptible adolescents and young adults with clinically silent cardiovascular disorders. Screening including 12-lead electrocardiogram (ECG) has been demonstrated to allow identification of athletes affected by malignant heart muscle diseases at a pre-symptomatic stage and lead to substantial reduction of the risk of SCD during sports. The use of modern criteria for interpretation of the ECG in the athlete significantly improves the screening accuracy by reducing the false positive rate (increased specificity), with the important requisite of maintaining the ability for detection of life-threatening heart diseases (preserved sensitivity). Screening including ECG has a more favorable cost-benefit ratio than that based on history and physical examination alone, with cost estimates per year of life saved below the threshold to consider a health intervention as cost-effective. Screening with exercise testing middle aged/senior athletes engaged in leisure sports activity is likely to be cost-effective in older patients with coronary risk factors, while it is not justified in low-risk subgroups.