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Sudden death in athletes
1Department of Medicine, University of Miami School of Medicine, FL 33101, USA.
Insights
Sudden cardiac death (SCD) in young athletes is often caused by hypertrophic cardiomyopathy (HCM). Current risk stratification methods are insufficient, leading to disqualification from sports for athletes with HCM.
Area of Science:
- Cardiology
- Sports Medicine
- Sudden Cardiac Death
Background:
- Hypertrophic cardiomyopathy (HCM) and other cardiac abnormalities are leading causes of sudden cardiac death (SCD) in young athletes.
- Fatal arrhythmia is the most common mechanism of death in these cases.
- Current data are insufficient to reliably stratify SCD risk in athletes with HCM.
Observation:
- Screening is impractical and not cost-effective due to population size and disease rarity.
- Risk factors for SCD in athletes with HCM are not fully understood.
- Individual risk varies significantly among athletes with HCM.
Findings:
- A thorough history and physical exam are crucial for identifying potential risk factors.
- Research is ongoing to define hemodynamic and electrical instability variables for risk stratification.
- Current recommendations advise disqualifying athletes with confirmed HCM from moderate- to high-intensity sports, regardless of symptoms or obstruction.
Implications:
- Until reliable risk stratification is available, a conservative approach is necessary to prevent SCD.
- Individual assessment may be appropriate for older athletes due to decreased SCD risk.
- Athletes with myocarditis or tachyarrhythmia require thorough cardiac evaluation before returning to sports.
Abstract:
HCM, as well as coronary and myocardial structural abnormalities, is the most common pathology leading to SCD in young athletes. Furthermore, SCD from fatal arrhythmia seems to be the most common mechanism of death. In this population, however, data are insufficient to support either invasive or noninvasive approaches to clarify risk stratification for SCD. Because of the large population, variants of normal found within the athletic population, and the rarity of the disease, screening for individuals at risk is neither practical nor cost-effective. Not all athletes with HCM are at the same risk for SCD; a thorough history and physical examination should alert the health professional to potential risk factors. Efforts are under way to stratify athletes at risk for SCD to determine who can participate in competitive sports and who should not. However, until research can accurately define variables of hemodynamic and electrical instability that permit reliable identification of athletes with HCM who are at risk for SCD, the recommendation is to disqualify athletes with confirmed HCM from moderate- to high-intensity competitive sports. This recommendation includes athletes with or without symptoms or left ventricular outflow obstruction. Due to the decreased risk of SCD in older athletes, individual judgment of eligibility may be used. Athletes thought to have had myocarditis should be withdrawn from all competitive sports for a convalescent period of approximately 6 months, with thorough cardiac assessment and testing performed before returning to training. Athletes with atrial or ventricular tachyarrhythmia must be screened for structural abnormality, heart response during exercise, and the frequency and duration of the arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)