Sudden cardiac death (SCD) is the leading medical cause of death in athletes. In a new article published in Current Physical Medicine and Rehabilitation Reports, Irfan Asif, MD, of the Greenville TN Health System and Kimberly Harmon, MD, of the University of Washington, present a review of the literature on screening for sudden cardiac death in young competitive athletes.
The purpose of the review is to examine the evidence surrounding the recommendations for cardiovascular screening in young competitive athletes. As noted by the authors, there is widespread agreement that the primary purpose of the pre-participation cardiovascular screening examination is to identify athletes with conditions that predispose them to SCD. This can help inform the athlete of risks associated with exercise, define which athletes should pursue medical management for their condition, determine eligibility for competition, and delineate first-degree relatives who may need additional cardiac testing.
While there is general agreement that cardiovascular screening should be performed in competitive athletes, the method of disease detection has been a source of debate. The authors conclude that current cardiovascular screening with a traditional history and physical examination does not detect the majority of athletes at risk and provides false reassurance for those with silent underlying cardiovascular conditions. The addition of an electrocardiogram (ECG) enhances disease detection capabilities and modern athlete-specific ECG interpretation standards provide low false positive rates and improved cost efficiency.
Future efforts should focus on physician education of ECG interpretation criteria, the development of an infrastructure to optimize cardiovascular screening, and providing evidence-based management strategies for athletes diagnosed with cardiac disorders.
The goal of pre-participation screening is to identify athletes at risk for SCD. Advanced cardiovascular screening protocols have the potential to improve the health and safety of sport and should be considered in young competitive athletes, especially those deemed high risk. "A strategy that employs a history and physical alone lacks evidence for its support, is not cost-effective, and may provide false reassurance to athletes who are at high risk," the authors conclude. "It seems the primary issue related to screening should not be whether to include ECG but how to develop the infrastructure to perform them."
SOURCE: Paperity.org