Screening for Sudden Cardiac Death Risk in Athletes: A Critical Health Initiative

Introduction

Sudden cardiac death  (SCD) in athletes is a catastrophic event  with gargantuan impact on societies that raised concerns on the health and safety of young active individuals. Effective screening tests and tools for SCD risk in athletes is key in reducing the negative impact of this relatively rare disease to societies.

Understanding Sudden Cardiac Death

SCD is an unexpected natural death from cardiac cause within 1 hour of onset of symptoms in a previously healthy individual. SCD accounts for 300,000 to 400,000 death in the US alone. Age, race, sex and activity are some of the predisposing factors. One in 250,000 of young adults especially male die during exercise  commonly  basketball and rarely in competitive athletes. Vigorous exercises are associated with platelet adhesiveness and aggregability causing sudden cardiac death and myocardial infarction.

There are conditions that predispose an individual to SCD:

• Hypertrophic Cardiomyopathy (HCM): A genetic condition characterized by thickened heart muscles.
• Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A disorder affecting the heart’s muscle tissue, leading to arrhythmias.
• Congenital Coronary Artery Anomalies: Abnormalities in the heart’s blood vessels present from birth.
• Long QT Syndrome: A genetic condition that affects the heart’s electrical activity.
• Myocarditis: Inflammation of the heart muscle, often caused by viral infections.

The Importance of Screening

Early detection, early intervention and treatment are important in the prevention of SCD in predisposed individuals.

Current Screening Methods

1. Medical History and Physical Examination:

• Comprehensive personal and family history.
• Extensive physical examinations

1. Electrocardiogram:

• Identification of prolonged QT syndromes
• Incorporating Seattle criteria in the ECG interpretation ( program in the ECG machine).

1. Echocardiogram:

• Provides information on the anatomy  and function of the heart.
• Identifies HCM and congenital anomalies.

1. Exercise Stress Testing:

• Monitors heart during physical activity.

1. Advanced Imaging Techniques:

• visualization of coronary anatomy and cardiac structures

Recommendations for effective screening

• Balanced approach: use of medical history and physical examination with ECG and echocardiography
• Education and training: accurate ECG interpretation to reduce false positives and enhance accuracy of screening
• Awareness program: educating athletes, coaches, family members and bystanders about SCD
• Regular updates
• Policy Implementation: standardize screening procedures in regional and national levels to ensure widespread implementation

Conclusion

Screening  for SCD in athletes and active young individuals is an important health initiative that can save lives. We can foster a safer sporting environment by prioritizing athletes health and safety.

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References:

1. Corrado, D., et al. (2010). Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. European Heart Journal, 31(21), 2431-2443.
2. Maron, B. J., et al. (2007). Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes. Circulation, 115(12), 1643-1655.
3. Harmon, K. G., et al. (2015). Incidence and etiology of sudden cardiac arrest and death in high school athletes in the United States. Mayo Clinic Proceedings, 90(11), 1480-1481.
4. Zipes, D., Wellens H. (24Nov1996). Sudden Cardiac Death. Circulation. 1998;98:2334–2351.
5. Lisman, KA. (2016). Electrocardiographic Evaluation in Athletes and Use of the Seattle Criteria to Improve Specificity. Methodist Debakey Cardiovascular Journal. 12(2): 81-85.