Screening of Athletes
Screening of athletes prior to participating in strenuous activities is important to reduce the incidence of sudden death in young individuals. Causes of sudden cardiac death in individuals younger than thirty-five years of age include: hypertrophic cardiomyopathy with or without outflow tract obstruction, congenital anomalies of the coronary arteries, arrhythmogenic right ventricular cardiomyopathy, Brugada's syndrome, premature atherosclerotic coronary artery disease, certain patients with Wolff-Parkinson-White syndrome and atrial fibrillation, aortic rupture from a connective tissue disorder, such as Marfan's syndrome, prolonged QT syndrome and myocarditis.
Screening of athletes must be practical and cost effective. Current recommendations include a careful history for effort related symptoms of syncope, angina, excessive dyspnea, fatigue or palpitations; a careful family history for sudden death or disability from cardiovascular disease before age fifty, or known family history of conditions previously mentioned as causes of sudden death in young individuals; and a careful cardiovascular physical examination to detect hypertension, abnormal arterial and precordial impulses, murmurs or fourth heart sounds or physical stigmata of Marfan's syndrome. The exam should include auscultation with the patient performing several maneuvers. Fortunately, sudden death in athletes is a relatively uncommon occurrence, but still occurs due to undetected cardiac disorders, despite screening protocols.
When screening athletes, the use of laboratory studies is not routinely recommended. However, if specific conditions are suggested by the history and physical examination, studies may include measurement of serum cholesterol, electrocardiogram, exercise stress testing, echocardiography, magnetic resonance imaging or even coronary angiography. Patients with suspected of having hypertrophic obstructive cardiomyopathy should have an electrocardiogram and an echocardiogram.