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Cardiovascular Screening of Athletes: Focused Exam, Electrocardiograms, and Limited Echocardiograms

  • Christine E. Lawless
Chapter

Abstract

The incidence of sudden cardiac death (SCD) in athletes is estimated to occur at a frequency of 1/200,000 athletes per year [.1]. It is postulated that intense exercise predisposes the competitive athlete with previously undetected cardiac disease to lethal rhythm disturbances, and that the risk can be diminished if the athlete is withheld from sports participation.

Keywords

Sudden Cardiac Death Team Physician Physician Workforce Anomalous Coronary Artery Underlying Heart Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation. 2006;114:1633–44.CrossRefPubMedGoogle Scholar
  2. 2.
    Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA. 1996;276:199–204.CrossRefPubMedGoogle Scholar
  3. 3.
    Baggish AL, Hutter AM Jr, Wang F, et al. Cardiovascular screening in college athletes with and without electrocardiography: a cross-sectional study. Ann Intern Med. 2010;152:269–75.PubMedGoogle Scholar
  4. 4.
    Le VV, Wheeler MT, Mandic S, et al. Addition of the electrocardiogram to the preparticipation examination of college athletes. Clin J Sport Med. 2010;20:98–105.CrossRefPubMedGoogle Scholar
  5. 5.
    Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation. 2007;115:1643–455.CrossRefPubMedGoogle Scholar
  6. 6.
    Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation. 2009;119:1085–92.CrossRefPubMedGoogle Scholar
  7. 7.
    Fuller CM, McNulty CM, Spring DA, et al. Prospective screening of 5,615 high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc. 1997;29:1131–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Corrado D, Pelliccia A, Bjornstad HH, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26:516–24.CrossRefPubMedGoogle Scholar
  9. 9.
    Wyman RA, Chiu RY, Rahko PS. The 5-minute screening echocardiogram for athletes. J Am Soc Echocardiogr. 2008;21:786–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296:1593–601.CrossRefPubMedGoogle Scholar
  11. 11.
    Harris KM, Sponsel A, Hutter AM Jr, Maron BJ. Brief communication: cardiovascular screening practices of major North American professional sports teams. Ann Intern Med. 2006;145:507–11.PubMedGoogle Scholar
  12. 12.
    Maron BJ, Zipes DP. Introduction: eligibility recommendations for competitive athletes with cardiovascular abnormalities-general considerations. J Am Coll Cardiol. 2005;45:1318–21.CrossRefPubMedGoogle Scholar
  13. 13.
    Lawless CE, Winicur ZM, Bellande BJ. Preparedness of US physician workforce to screen competitive athletes for sports participation. American Heart Association, 2009 Annual Meeting: Orlando, Florida, 2009.Google Scholar
  14. 14.
    Pelliccia A, Zipes DP, Maron BJ. Bethesda Conference #36 and the European Society of Cardiology Consensus Recommendations revisited a comparison of U.S. and European criteria for eligibility and disqualification of competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol. 2008;52:1990–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Singh AM, McGregor RS. Differential diagnosis of chest symptoms in the athlete. Clin Rev Allergy Immunol. 2005;29:87–96.CrossRefPubMedGoogle Scholar
  16. 16.
    Link MS, Estes NA 3rd. How to manage athletes with syncope. Cardiol Clin. 2007;25:457– 66, vii.CrossRefPubMedGoogle Scholar
  17. 17.
    Lawless CE, Lampert R, Olshansky B, Cannom D. Safety and efficacy of implantable defibrillators and automatic external defibrillators in athletes: results of a nationwide survey among AMSSM members. Clin J Sports Med. 2005;15:386–91.CrossRefGoogle Scholar
  18. 18.
    Lawless CE, Briner W. Palpitations in athletes. Sports Med. 2008;38:687–702.CrossRefPubMedGoogle Scholar
  19. 19.
    Biffi A, Pelliccia A, Verdile L, et al. Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol. 2002;40:446–52.CrossRefPubMedGoogle Scholar
  20. 20.
    Estes NA 3rd, Link MS, Cannom D, et al. Report of the NASPE policy conference on arrhythmias and the athlete. J Cardiovasc Electrophysiol. 2001;12:1208–19.CrossRefPubMedGoogle Scholar
  21. 21.
    Morey SS. AHA assesses the impact of genotyping on diagnosis of genetic cardiac disease. American Heart Association. Am Fam Physician. 1999;59:2915–6, 2918.PubMedGoogle Scholar
  22. 22.
    Goldschmidt-Clermont PJ, Shear WS, Schwartzberg J, Varga CF, Bray PF. Clues to the death of an Olympic champion. Lancet. 1996;347:1833.CrossRefPubMedGoogle Scholar
  23. 23.
    Bille K, Figueiras D, Schamasch P, et al. Sudden cardiac death in athletes: the Lausanne recommendations. Eur J Cardiovasc Prev Rehabil. 2006;13:859–75.CrossRefPubMedGoogle Scholar
  24. 24.
    Pelliccia A, Maron BJ, Culasso F, et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation. 2000;102:278–84.CrossRefPubMedGoogle Scholar
  25. 25.
    Pelliccia A, Culasso F, Di Paolo FM, et al. Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening. Eur Heart J. 2007;28:2006–10.CrossRefPubMedGoogle Scholar
  26. 26.
    Pelliccia A, Di Paolo FM, Quattrini FM, et al. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med. 2008;358:152–61.CrossRefPubMedGoogle Scholar
  27. 27.
    Sharma S, Whyte G, Elliott P, et al. Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med. 1999;33:319–24.CrossRefPubMedGoogle Scholar
  28. 28.
    Rao PS, Thapar MK, Harp RJ. Racial variations in electrocardiograms and vectorcardiograms between black and white children and their genesis. J Electrocardiol. 1984;17:239–52.CrossRefPubMedGoogle Scholar
  29. 29.
    Rao PS. Racial differences in electrocardiograms and vectorcardiograms between black and white adolescents. J Electrocardiol. 1985;18:309–13.CrossRefPubMedGoogle Scholar
  30. 30.
    Magalski A, Maron BJ, Main ML, et al. Relation of race to electrocardiographic patterns in elite American football players. J Am Coll Cardiol. 2008;51:2250–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Basavarajaiah S, Wilson M, Whyte G, Shah A, McKenna W, Sharma S. Prevalence of hypertrophic cardiomyopathy in highly trained athletes: relevance to pre-participation screening. J Am Coll Cardiol. 2008;51:1033–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Thompson PD, Levine BD. Protecting athletes from sudden cardiac death. JAMA. 2006;296:1648–50.CrossRefPubMedGoogle Scholar
  33. 33.
    Corrado D, Pelliccia A, Heidbuchel H, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J. 2010;31:243–59.CrossRefPubMedGoogle Scholar
  34. 34.
    Reiley MA, Su JJ, Guller B. Racial and sexual differences in the standard electrocardiogram of black vs white adolescents. Chest. 1979;75:474–80.CrossRefPubMedGoogle Scholar
  35. 35.
    Lawless CE, Best TM. Electrocardiograms in athletes: interpretation and diagnostic accuracy. Med Sci Sports Exerc. 2008;40:787–98.CrossRefPubMedGoogle Scholar
  36. 36.
    A Heart for Sports. 2207; Accessed May 7, 2010. Web Page. Available at: http://www.aheartforsports.org/.
  37. 37.
    Maron BJ. National electrocardiography screening for competitive athletes: feasible in the United States? Ann Intern Med. 2010;152:324–6.PubMedGoogle Scholar
  38. 38.
    Maron BJ, Haas TS, Doerer JJ, Thompson PD, Hodges JS. Comparison of U.S. and Italian experiences with sudden cardiac deaths in young competitive athletes and implications for preparticipation screening strategies. Am J Cardiol. 2009;104:276–80.CrossRefPubMedGoogle Scholar
  39. 39.
    Thunenkotter T, Schmied C, Dvorak J, Kindermann W. Benefits and limitations of cardiovascular pre-competition screening in international football. Clin Res Cardiol. 2010;99:29–35.CrossRefPubMedGoogle Scholar
  40. 40.
    Crouse SF, Meade T, Hansen BE, Green JS, Martin SE. Electrocardiograms of collegiate football athletes. Clin Cardiol. 2009;32:37–42.CrossRefPubMedGoogle Scholar
  41. 41.
    Sofi F, Capalbo A, Pucci N, et al. Cardiovascular evaluation, including resting and exercise electrocardiography, before participation in competitive sports: cross sectional study. BMJ. 2008;337:a346.CrossRefPubMedGoogle Scholar
  42. 42.
    Wilson MG, Basavarajaiah S, Whyte GP, Cox S, Loosemore M, Sharma S. Efficacy of personal symptom and family history questionnaires when screening for inherited cardiac pathologies: the role of electrocardiography. Br J Sports Med. 2008;42:207–11.CrossRefPubMedGoogle Scholar
  43. 43.
    Pelliccia A, Di Paolo FM, Corrado D, et al. Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J. 2006;27:2196–200.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Sports Cardiology Consultants, LLC, Clinical Associate Faculty, Major League Soccer Team Physician, US Figure Skating World TeamsUniversity of Chicago Consulting CardiologistChicagoUSA

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