Cardiovascular Screening in Athletes

Abstract

Physical activity increases life expectancy and has a strong impact on the prevention and treatment of different chronic diseases and risk factors. Thus, physical exercise and sport should a priori not be considered as potentially harmful but rather as essential for people, society and the healthcare system. However, intensive exercise training and competitive sports participation, in predisposed individuals, is associated with a higher risk of incidental adverse cardiovascular events, including sudden cardiac death (SCD). SCD in sports is a rare but devastating event, causing a strong emotional and social impact within the community, especially when young apparently healthy athletes are involved. Almost invariably, the victims carry an underlying, frequently undiagnosed, predisposing and potentially detectable cardiovascular disease. In young athletes (<35 years of age) most deaths are attributed to inherited or congenital, structural or electrical disorders of the heart, which predispose to malignant ventricular arrhythmias, while in master athletes (>35 years of age), almost 80% of these tragic events can be ascribed to latent coronary artery disease. Accordingly, the aim of a medical pre-participation evaluation is to detect potentially life-threatening conditions, which, if timely identified, can be appropriately managed through lifestyle modifications, physical activity adaptations, pharmacotherapy and/or implantable cardioverter defibrillators (ICDs), thereby minimizing the risk of major cardiovascular adverse events. Thus, before participation in sports, every athlete may benefit from a cardiovascular screening, which in baseline consists of a focused family and personal medical history, physical examination and, according to the European Society of Cardiology Guidelines, a resting ECG. Moreover, an additional incremental exercise testing might be useful, particularly in subjects performing high-intensity exercise or those with higher cardiovascular risk. Pre-competition evaluation for safe sport activities has diverse ethical and socio-economic implications, which is the reason why medical guidelines and recommendations differ widely between countries. Despite the most accurate pre-participation evaluation, SCD on the playing field may still happen. Therefore, exercise professionals who supervise exercise and fitness programs should engage in training of basic and/or advanced cardiac life support and other emergency procedures. Moreover, appropriate resuscitation equipment and an automated external defibrillator (AED) should always be promptly available.