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Screening of athletes

An electrocardiogram is not enough

Screening von Athleten

Das EKG reicht nicht aus

Abstract

Professional and amateur athletic training can cause tremendous overload of the cardiovascular system and thus become a trigger of serious and often fatal cardiac events in athletes with a previously undetected underlying cardiovascular disease. Therefore, every athlete should undergo a specialized diagnostic and qualification screening before a training program is prescribed or continued. However, it is still an unresolved issue which of the accessible diagnostic tools should be routinely applied in order to increase the safety of extreme physical training and reduce the risk of sudden cardiac death. Pre-participation athlete evaluation including a standard electrocardiogram (ECG), physical examination, and familial history of cardiovascular diseases is important, but does not always guarantee high diagnostic accuracy. Hence, the aim of this review article is to discuss the controversy over the usefulness of ECG for the detection of cardiovascular diseases in athletes as well as the views on athlete screening methods in Europe and the USA. Differential diagnostic options and screening schemes are also described in particular groups of athletes in reference to their age, cardiovascular risk factors, as well as intensity and type of sport discipline.

Zusammenfassung

Sowohl Profi- als auch Amateursport können eine erhebliche Belastung des Herz-Kreislauf-Systems darstellen und hierdurch z. T. lebensgefährliche kardiale Ereignisse bei Sportlern auslösen, bei denen bisher unerkannte Herz- oder Gefäßkrankheiten vorliegen. Deshalb sollte sich jeder Sportler vor Aufnahme eines Trainingsprogramms einem allgemeinen und für die gewählte Sportart speziellen diagnostischen „Screening“ unterziehen. Bisher wird kontrovers diskutiert, welche medizinische Diagnostik routinemäßig vor einer Trainingsaufnahme durchgeführt werden soll, um bei außerordentlichen Belastungen die Gesundheit nicht zu gefährden und einem plötzlichen Herztod vorzubeugen. Diese Eintrittsuntersuchung, inklusive Ruhe-EKG, körperlicher Untersuchung und Erhebung der Familienanamnese, ist elementar, garantiert aber nicht immer eine ausreichende diagnostische Sicherheit. In diesem Übersichtsbeitrag werden deshalb auch die unterschiedlichen Auffassungen in Europa und den USA zum Nutzen eines routinemäßig angefertigten EKG zur Erkennung kardiovaskulärer Erkrankungen aufgearbeitet und weitere differenzialdiagnostische Optionen und Screeningmodalitäten – bezogen auf Alter, kardiovaskuläre Risikofaktoren und gewählte Sportart sowie Intensität der sportlichen Aktivität – besprochen.

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Compliance with ethical guidelines

Conflict of interest. R. Skalik states that there is no conflict of interest. The accompanying manuscript does not include studies on humans or animals.

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Correspondence to R. Skalik MD, PhD.

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Skalik, R. Screening of athletes. Herz 40, 386–394 (2015). https://doi.org/10.1007/s00059-015-4214-6

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Keywords

  • Athlete screening
  • Electrocardiogram, ECG
  • Advanced cardiac diagnostics
  • Cardiovascular diseases
  • Sudden cardiac death

Schlüsselwörter

  • Screeninguntersuchung von Sportlern
  • EKG
  • Kardiale Spezialdiagnostik
  • Herz-Kreislauf-Erkrankungen
  • Plötzlicher Herztod