Skip to Main 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 be useful for detecting arrhythmias in symptomatic athletes

TREATMENT

...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.