Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Sudden unexplained death or cardiovascular arrest in a trained athlete is rare Incidence increases with age because of concomitant coronary artery disease Occurrence is unrelated to athletic performance or level of training Incidence is higher if the athlete has symptoms or a family history of sudden death at a young age +++ GENERAL CONSIDERATIONS ++ Sudden death in athletes is usually due to underlying cardiovascular disease The most common underlying cardiac disease in young athletes is hypertrophic cardiomyopathy, followed by congenital coronary anomalies, Marfan’s syndrome, aortic stenosis, arrhythmogenic right ventricular cardiomyopathy, preexcitation, and prolonged QT interval syndrome Coronary artery disease predominates in older athletes Athletic sudden death generally occurs during or shortly after exercise Sudden death in athletes is rare (about 1 per year for every 18,000 to 750,000 male athletes, depending on age [range, 18–75 years]) Little data exist on women athletes, but in general, the risk is believed to be less +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ A family history of sudden death or congenital heart disease is important Symptoms are related to the underlying disease: chest pain, dyspnea, syncope, palpitations Signs of importance would be those of Marfan’s syndrome or those of other syndromes known to have cardiovascular disease +++ PHYSICAL EXAM FINDINGS ++ A systolic murmur heard in the upright position (standing) is of critical importance because an innocent flow murmur (common in athletes when supine) would be expected to disappear in the upright position when venous return is less An ejection sound suggests aortic valve abnormalities S4 suggests left ventricular hypertrophy, but some highly trained athletes have an S4 +++ DIFFERENTIAL DIAGNOSIS ++ Distinguish congenital and acquired heart disease from cardiac trauma, which can result in arrhythmias (commotio cordis), rupture of cardiac structures, or dissection of great vessels Heat stroke +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Those pertinent to underlying condition (eg, genetic testing) +++ ELECTROCARDIOGRAPHY ++ Extensive physical training can lead to ECG evidence of chamber hypertrophy and even myocardial infarction patterns Prolonged QT interval and preexcitation are important findings not caused by training +++ IMAGING STUDIES ++ Echocardiography is important for detecting structural abnormalities of the heart such as hypertrophic cardiomyopathy and valvular disease – Transesophageal echo can help evaluate suspected diseases of the aorta CT or MRI may be needed to further evaluate conditions such as arrhythmogenic right ventricular dysplasia, anomalies of the great vessels, and suspected myocarditis +++ DIAGNOSTIC PROCEDURES ++ Exercise testing is useful for evaluating symptoms that occur during exercise Ambulatory ECG monitoring, event recorders, or implanted loop recorders may ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.