Athlete Screening

Athlete Screening

The purpose of the athlete screening program is motivated by occurrences of sudden death, which has an incidence ranging from 1/65,000 to 1/200,000. There are many causes of sudden death in young people with cardiac causes accounting for more than 50%. Athletes are vulnerable to sudden cardiac death because there is increased oxygen demand to the heart muscle and increased level of adrenaline during exercise, which can potentially unmask dormant heart diseases. The causes of sudden cardiac death in athletes can categorized into structural or electrical heart diseases.

Structural heart diseases:
· Heart muscle diseases, i.e. hypertrophic or dilated cardiomyopathy
· Congenital coronary anomalies or coronary artery disease
· Severe heart valve narrowing, i.e. aortic valve stenosis from bicuspid aortic valve
· Aortic rupture / dissection, i.e. Marfan Syndrome
· Infection of the heart, i.e. myocarditis

Electrical heart diseases:
· Long QT Syndrome
· Wolff-Parkinson-White Syndrome
· Brugada Syndrome
· Arrhythmogenic Right Ventricular Cardiomyopathy
· Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)   

A few of the red-flags for athletes

Symptoms of the dormant heart diseases can be subtle and variable. Here are a few of red-flags that should be concerning:
· Syncope occurred, especially during intense physical activity
· Chest pain, especially during intense physical activity
· Excessive / persistently elevated heart rate, especially during intense exercise
· Unexplained loud murmurs

Cardiac evaluation of athletes with chest pain who have red-flags include a comprehensive cardiac evaluation, which can include, but not limited to, a detailed history and cardiac examination, a screening electrocardiogram (ECG), a heart ultrasound, heart rhythm monitor, stress / exercise test or cardiac MRI. 

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