A Review of Sudden Cardiac Death in Young Athletes and Strategies for Preparticipation Cardiovascular Screening

Abstract

OBJECTIVES: To provide the reader with an overview of the many causes of sudden cardiac death in young athletes and to present various strategies for preparticipation cardiovascular screening. DATA SOURCE: A MEDLINE search using the phrase sudden cardiac death and the key word athlete for the years 1980 to 2000. DATA SYNTHESIS: Sudden cardiac death is a rare event in athletics. More than 20 different causes have been described, but most cases result from a few distinct entities. Most afflicted athletes have no symptoms before death. Many attempts have been made to detect those at risk for sudden cardiac death before athletic participation. At this time, a thorough history and physical examination are the most efficient screening methods for detecting cardiovascular abnormalities. Studies show that the current status of preparticipation cardiovascular screening of high school and college athletes nationwide is poor. CONCLUSIONS AND RECOMMENDATIONS: The use of diagnostic tests to screen for cardiovascular abnormalities is ineffective and inefficient. The most prudent and effective methods of preparticipation screening for cardiovascular abnormalities at this time are a history and physical examination in accordance with the American Heart Association guidelines. Athletic trainers must ensure that their institutions comply with these minimum standards.

Figure 1

Cross-sectional views. A, Normal ventricular septal anatomy. B, Asymmetric septal hypertrophy found in hypertrophic cardiomyopathy. RV indicates right ventricle; LV, left ventricle.

Figure 2

A, Normal coronary artery anatomy. B, Most common congenital cardiac artery anomaly with left main (LM) coronary artery arising from the right sinus of Valsalva and coursing between the aorta (Ao) and pulmonary artery (PA). This anatomic variation also results in the right coronary artery's (RC) originating in a different region than normal, but its function is not affected. LC indicates left coronary artery; LAD, left anterior descending artery.