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Cardiac issues in the young athlete

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Current Sports Medicine Reports

Abstract

Young athletes are disproportionately plagued with congenital cardiac disease. Many of these diseases predispose to sudden cardiac death (SCD), a dramatic and tragic outcome for any young athlete. In many cases, conditions that predispose to SCD do not cause symptoms or show signs on examination, making diagnosis of cardiac disease and prevention of SCD difficult. Clinicians should be familiar with common causes of SCD and their symptoms, perform careful evaluations, refer athletes in whom there are concerns, and make sure any concerning findings receive thorough evaluation. Clinicians should also be familiar with and follow recent guidelines on return to play. Unfortunately, most preparticipation examinations are inadequate, due in part to use of inadequate forms. Better forms are available and should replace inadequate ones.

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References and Recommended Reading

  1. DiVasta AD, Alexander ME: Fainting freshmen and sinking sophomores: cardiovascular issues of the adolescent. Curr Opin Pediatr 2004, 16:350–356.

    Article  PubMed  Google Scholar 

  2. Trusty JM, Beinborn DS, Jahangir A: Dysrhythmias and the athlete. AACN Clin Issues 2004, 15:432–448. This paper involves a detailed description of arrhythmias and related cardiac pathologies in athletes.

    Article  PubMed  Google Scholar 

  3. Wight JN, Salem D: Sudden cardiac death and the "athlete’s heart". Arch Intern Med 1995, 155:1473–1480.

    Article  PubMed  Google Scholar 

  4. Bader RS, Goldberg L, Sahn DJ: Risk of sudden cardiac death in young athletes: which screening strategies are appropriate? Pediatr Clin North Am 2004, 51:1421–1441.

    Article  PubMed  Google Scholar 

  5. Berger S, Kugler JD, Thomas JA, Friedberg DZ: Sudden cardiac death in children and adolescents: introduction and overview. Pediatr Clin North Am 2004, 51:1201–1209.

    Article  PubMed  Google Scholar 

  6. Mick TM, Dimeff RJ: What kind of physical examination does a young athlete need before participating in sports? Cleve Clin J Med 2004, 71:587–597. This paper offers a concise review of preparticipation evaluation in athletes.

    Article  PubMed  Google Scholar 

  7. Maron BJ, Thompson PD, Puffer JC, et al.: Cardiovascular preparticipation screening of competitive athletes: a statement for health professionals from the sudden death committee and congenital cardiac defects committee, american heart association. Circulation 1996, 94:850–856 (addendum published in Circulation 1998, 97:2294).

    Article  CAS  PubMed  Google Scholar 

  8. Preparticipation Physical Evaluation, edn 3. The Physician and Sports Medicine. Minneapolis: McGraw-Hill; 2005. The six authoring medical societies for this manuscript represent sports medicine and primary care, and make recommendations to guide screening evaluation of athletes. This manuscript is easy to read and offers a thorough description of all issues pertinent to the preparticipation evaluation, forms that comply with current guidelines, and useful information for the clinician.

  9. Glover DW, Maron BJ: Profile of preparticipation cardiovascular screening for high school athletes. JAMA 1998, 279:1817–1819.

    Article  CAS  PubMed  Google Scholar 

  10. Fuller CM: Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc 2000, 32:887–890.

    Article  CAS  PubMed  Google Scholar 

  11. Pfister GC, Puffer JC, Maron BJ: Preparticipation cardiovascular screening for US collegiate student-athletes. JAMA 2000, 283:1597–1599.

    Article  CAS  PubMed  Google Scholar 

  12. Wigle ED, Rakowski H, Kimball BP, et al.: Hypertrophic cardiomyopathy: clinical spectrum and treatment. Circulation 1995, 92:1680–1692.

    Article  CAS  PubMed  Google Scholar 

  13. Maron BJ, Bonow RO, Cannon RO, et al.: Hypertrophic cardiomyopathy: interrelation of clinical manifestations, pathophysiology and therapy. N Engl J Med 1987, 316:780–789; 844–852.

    Article  CAS  PubMed  Google Scholar 

  14. Maron BJ, Bonow R, Cannon R, et al.: Hypertrophic cardiomyopathy. N Engl J Med 1987, 316:780–852.

    Article  CAS  PubMed  Google Scholar 

  15. Maron BJ, McKenna WJ, Danielson GK, et al.: American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2003, 42:1687–1713.

    Article  PubMed  Google Scholar 

  16. Wigle ED, Sasson Z, Henderson MA, et al.: Hypertrophic cardiomyopathy: the importance of the site and extent of hypertrophy. A review. Prog Cardiovasc Dis 1985, 28:1–83.

    Article  CAS  PubMed  Google Scholar 

  17. Spirito P, Seidman CE, McKenna WJ, et al.: Management of Hypertrophic Cardiomyopathy. N Engl J Med 1997, 30:775–785.

    Article  Google Scholar 

  18. Maron BJ, Gottdiener JS, Epstein SE: Patterns and significance of distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy: a wide-angle, two dimensional echocardiographic study of 125 patients. Am J Cardiol 1981, 48:418–428.

    Article  CAS  PubMed  Google Scholar 

  19. Maron BJ: Hypertrophic cardiomyopathy in childhood. Pediatr Clin North Am 2004, 51:1305–1346.

    Article  PubMed  Google Scholar 

  20. Maron BJ, Shen WK, Link MS, et al.: Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy. N Engl J Med 2000, 342:365–373.

    Article  CAS  PubMed  Google Scholar 

  21. Burke AP, Farb A, Virmiani R: Causes of sudden death in athletes. Cardiol Clin 1992, 10:303–317.

    CAS  PubMed  Google Scholar 

  22. Drezner JA: Sudden cardiac death in young athletes. Postgrad Med 2000, 108:37–50.

    Article  CAS  PubMed  Google Scholar 

  23. Futterman LG, Myerburg RJ: Sudden death in athletes: an update. Sports Med 1998, 26:335–350.

    Article  CAS  PubMed  Google Scholar 

  24. Maron BJ, Shirani J, Poliac LC, et al.: Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA 1996, 276:199–204.

    Article  CAS  PubMed  Google Scholar 

  25. Schoepf UJ, Becker CR, Ohnesorge BM, et al.: CT of coronary artery disease. Radiology 2004, 232:18–37.

    Article  PubMed  Google Scholar 

  26. van Geuns RJ, Wielopolski PA, de Bruin HG, et al.: Magnetic resonance imaging of the coronary arteries: techniques and results. Prog Cardiovasc Dis 1999, 42:157–166.

    Article  PubMed  Google Scholar 

  27. Batra AS, Lewis AB: Acute myocarditis. Curr Opin Pediatr 2001, 13:234–239.

    Article  CAS  PubMed  Google Scholar 

  28. Maron BJ, Epstein SE, Roberts WC: Causes of sudden death in competitive athletes. J Am Coll Cardiol 1986, 7:204–214.

    Article  CAS  PubMed  Google Scholar 

  29. McGrew CA: Sudden cardiac death in competitive athletes. J Orthop Sports Phys Ther 2003, 33:589–593.

    Article  PubMed  Google Scholar 

  30. Maron BJ, Chaitman BR, Ackerman MJ, et al.: Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation 2004, 109:2807–2816. This American Heart Association statement is helpful in addressing recommendations for the competitive athlete limited from intense sport or recreational athlete found to have significant cardiac disease.

    Article  PubMed  Google Scholar 

  31. Klein GJ, Bashore TM, Sellers TD, et al.: Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med 1979, 301:1080 -1085.

    Article  CAS  PubMed  Google Scholar 

  32. Maron BJ, Mitten MJ, Greene Burnett C: Criminal consequences of commotio cordis. Am J Cardiol 2002, 89:210–213.

    Article  PubMed  Google Scholar 

  33. Wu J, Stork TL, Perron AD, Brady WJ: The athlete’s electrocardiogram. Am J Emerg Med 2006, 24:77–86. This paper is a thoughtful discussion on interpreting ECGs in athletes.

    Article  PubMed  Google Scholar 

  34. Oakley D: The athlete’s heart. Heart 2001, 86:722–726.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Pellicia A, Maron BJ, Culasso F, et al.: Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 2000, 102:278–284.

    Article  Google Scholar 

  36. Brady WJ: Benign early repolarization: electrocardiographic manifestations and differentiation from other ST-segment elevation syndromes. Am J Emerg Med 1998, 16:592–597.

    Article  CAS  PubMed  Google Scholar 

  37. Brady WJ, Chan TC: Electrocardiographic manifestations: benign early repolarization. J Emerg Med 1999, 17:473–478.

    Article  CAS  PubMed  Google Scholar 

  38. McKenna WJ, Thiene G, Nava A, et al.: Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Br Heart J 1994, 71:215–218.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Nava A, Bauce B, Basso C, et al.: Clinical profile and long-term follow-up of 37 families with arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol 2000, 36:2226–2233.

    Article  CAS  PubMed  Google Scholar 

  40. Ackerman MJ: The long QT syndrome: ion channel diseases of the heart. Mayo Clin Proc 1998, 73:250–269.

    Article  CAS  PubMed  Google Scholar 

  41. Priori SG, Schwarts PJ, Napolitano C, et al.: Risk stratification in the long-QT syndrome. N Engl J Med 2003, 348:1866–1874.

    Article  PubMed  Google Scholar 

  42. Brugada J, Brugada P, Brugada R: The ajmaline challenge in Brugada syndrome: a useful tool or misleading information? Eur Heart J 2003, 24:1104–1102.

    Article  Google Scholar 

  43. Brugada J, Brugada R, Antzelevitch C, et al.: Long-term follow-up of individuals with the electrocardiographic pattern of right bundle-branch block and ST-segment elevation in precordial leads V1 to V3. Circulation 2002, 105:73–78.

    Article  PubMed  Google Scholar 

  44. Estes NAI, Link MS, Cannom D, et al.: Report of the NASPE policy conference on the arrhythmias and the athlete. J Cardiovasc Electrophysiol 2001, 12:1208–1219.

    Article  PubMed  Google Scholar 

  45. Zipes DP, Garson AJ: 26th Bethesda Conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. Task Force 6: Arrhythmias. J Am Coll Cardiol 1994, 24:892–899.

    Article  CAS  PubMed  Google Scholar 

  46. Update on the 1987 task force report on high blood pressure in children and adolescents: a working group report from the national high blood pressure education program. Pediatrics 1996, 98:649–658.

  47. Report of the second task force on blood pressure control in children. Pediatrics 1987, 79:1–25.

  48. Barlow SE, Dietz WH: Obesity evaluation and treatment: expert committee recommendations. Pediatrics 1998, 102:1–11.

    Article  Google Scholar 

  49. Maron BJ, Mitten MJ, Quandt EK, Zipes DP: Competitive athletes with cardiovascular disease--the case of Nicholas Knapp. N Engl J Med 1998, 339:1632–1635.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Susan Cochella MD, MPH.

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Cochella, S., Johnson, C. Cardiac issues in the young athlete. Curr Sports Med Rep 5, 309–314 (2006). https://doi.org/10.1007/s11932-006-0058-4

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