Young athletes should be routinely tested for heart abnormalities to prevent sudden cardiac death triggered by vigorous exercise, using a simple protocol, which includes a heart trace (electrocardiogram or ECG).
This is the conclusion of several studies in the first of a series of quarterly partnership issues between the British Journal of Sports Medicine and the International Olympic Committee (IOC), which are dedicated to injury prevention in elite sports.
Sudden cardiac death is the most common cause of death in young athletes, but exactly how common is unknown as figures vary considerably and there is no mandatory reporting.
Screening for silent but potentially deadly heart abnormalities in athletes before they embark on a career in competitive sports, known as preparticipation cardiovascular screening or PPS for short, has been the subject of considerable debate.
This was re-ignited in 2005, with the publication of a common European protocol – the Lausanne recommendations – which advocate taking a personal and medical history, a physical examination and an ECG for every young competitive athlete.
But critics claim that there are too many population differences between countries for these recommendations to be universally relevant and that ECGs pick up too many ‘normal irregularities’ induced by the body’s adaptation to the demands of competitive sports – sparking unnecessary alarm and needless investigations.
Unfortunately, the vast majority of “irregularities” detected by ECG do not amount to anything concerning. Follow-up testing with echocardiography and / or exercise stress testing also has limitations – sensitivity and specificity are nowhere near 100%, and there are no established guidelines by cardiology organizations that can clearly differentiate between “abnormalities” that are normal in athletes’ hearts and true life-threatening “abnormalities.” I do agree with the critics, but I share the concern held by many that sudden cardiac death in young athletes is tragic and we should continue to research ways we can prevent this.
For now, the best preventive measure is a careful pre-participation history and physical exam by a physician, with attention paid to family history of sudden death in young relatives and the patient’s cardiac exam (looking for a murmur that gets louder with Valsalva maneuver or upon standing after squatting).