[Cardiac risk assessment for athletic training]

Regular physical activity has unequivocal health benefits: however, cardiac complications and sudden death do occur during physical activity, particularly in unfit persons. In younger individuals these are predominantly due to congenital anomalies of the conduction system or the coronary arteries and to left ventricular outflow tract obstruction (aortic stenosis, hypertrophic cardiomyopathy). In persons above the age of 40 the predominant cause is coronary artery disease. A further common cause in all age groups seems to be a silent myocarditis occurring during an otherwise uncomplicated viral illness; therefore, the physician is confronted with the difficult task to generally advise increased physical activity but to recognize individuals at increased risk for cardiac complications. A careful history is of key importance in the assessment of the aptitude for physical training. It may reveal a history or current symptoms of heart disease as well as individual and familial risk factors. Physical examination may show abnormal findings on palpation, auscultation or exercise testing. In selected cases, an echocardiogram or another, more thorough investigation is indicated. An individual risk assessment and recommendations for physical activity even for persons at increased risk can be derived from these methods.