Skip to main content

Cardiovascular Screening of Athletes: Focused Exam, Electrocardiograms, and Limited Echocardiograms

  • Chapter
  • First Online:
Sports Cardiology Essentials

Abstract

The incidence of sudden cardiac death (SCD) in athletes is estimated to occur at a frequency of 1/200,000 athletes per year [.1]. It is postulated that intense exercise predisposes the competitive athlete with previously undetected cardiac disease to lethal rhythm disturbances, and that the risk can be diminished if the athlete is withheld from sports participation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation. 2006;114:1633–44.

    Article  PubMed  Google Scholar 

  2. Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA. 1996;276:199–204.

    Article  CAS  PubMed  Google Scholar 

  3. Baggish AL, Hutter AM Jr, Wang F, et al. Cardiovascular screening in college athletes with and without electrocardiography: a cross-sectional study. Ann Intern Med. 2010;152:269–75.

    PubMed  Google Scholar 

  4. Le VV, Wheeler MT, Mandic S, et al. Addition of the electrocardiogram to the preparticipation examination of college athletes. Clin J Sport Med. 2010;20:98–105.

    Article  PubMed  Google Scholar 

  5. Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation. 2007;115:1643–455.

    Article  PubMed  Google Scholar 

  6. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation. 2009;119:1085–92.

    Article  PubMed  Google Scholar 

  7. Fuller CM, McNulty CM, Spring DA, et al. Prospective screening of 5,615 high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc. 1997;29:1131–8.

    Article  CAS  PubMed  Google Scholar 

  8. Corrado D, Pelliccia A, Bjornstad HH, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26:516–24.

    Article  PubMed  Google Scholar 

  9. Wyman RA, Chiu RY, Rahko PS. The 5-minute screening echocardiogram for athletes. J Am Soc Echocardiogr. 2008;21:786–8.

    Article  PubMed  Google Scholar 

  10. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296:1593–601.

    Article  CAS  PubMed  Google Scholar 

  11. Harris KM, Sponsel A, Hutter AM Jr, Maron BJ. Brief communication: cardiovascular screening practices of major North American professional sports teams. Ann Intern Med. 2006;145:507–11.

    PubMed  Google Scholar 

  12. Maron BJ, Zipes DP. Introduction: eligibility recommendations for competitive athletes with cardiovascular abnormalities-general considerations. J Am Coll Cardiol. 2005;45:1318–21.

    Article  PubMed  Google Scholar 

  13. Lawless CE, Winicur ZM, Bellande BJ. Preparedness of US physician workforce to screen competitive athletes for sports participation. American Heart Association, 2009 Annual Meeting: Orlando, Florida, 2009.

    Google Scholar 

  14. Pelliccia A, Zipes DP, Maron BJ. Bethesda Conference #36 and the European Society of Cardiology Consensus Recommendations revisited a comparison of U.S. and European criteria for eligibility and disqualification of competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol. 2008;52:1990–6.

    Article  PubMed  Google Scholar 

  15. Singh AM, McGregor RS. Differential diagnosis of chest symptoms in the athlete. Clin Rev Allergy Immunol. 2005;29:87–96.

    Article  PubMed  Google Scholar 

  16. Link MS, Estes NA 3rd. How to manage athletes with syncope. Cardiol Clin. 2007;25:457– 66, vii.

    Article  PubMed  Google Scholar 

  17. Lawless CE, Lampert R, Olshansky B, Cannom D. Safety and efficacy of implantable defibrillators and automatic external defibrillators in athletes: results of a nationwide survey among AMSSM members. Clin J Sports Med. 2005;15:386–91.

    Article  Google Scholar 

  18. Lawless CE, Briner W. Palpitations in athletes. Sports Med. 2008;38:687–702.

    Article  PubMed  Google Scholar 

  19. Biffi A, Pelliccia A, Verdile L, et al. Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol. 2002;40:446–52.

    Article  PubMed  Google Scholar 

  20. Estes NA 3rd, Link MS, Cannom D, et al. Report of the NASPE policy conference on arrhythmias and the athlete. J Cardiovasc Electrophysiol. 2001;12:1208–19.

    Article  PubMed  Google Scholar 

  21. Morey SS. AHA assesses the impact of genotyping on diagnosis of genetic cardiac disease. American Heart Association. Am Fam Physician. 1999;59:2915–6, 2918.

    CAS  PubMed  Google Scholar 

  22. Goldschmidt-Clermont PJ, Shear WS, Schwartzberg J, Varga CF, Bray PF. Clues to the death of an Olympic champion. Lancet. 1996;347:1833.

    Article  CAS  PubMed  Google Scholar 

  23. Bille K, Figueiras D, Schamasch P, et al. Sudden cardiac death in athletes: the Lausanne recommendations. Eur J Cardiovasc Prev Rehabil. 2006;13:859–75.

    Article  PubMed  Google Scholar 

  24. Pelliccia A, Maron BJ, Culasso F, et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation. 2000;102:278–84.

    Article  CAS  PubMed  Google Scholar 

  25. Pelliccia A, Culasso F, Di Paolo FM, et al. Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening. Eur Heart J. 2007;28:2006–10.

    Article  PubMed  Google Scholar 

  26. Pelliccia A, Di Paolo FM, Quattrini FM, et al. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med. 2008;358:152–61.

    Article  CAS  PubMed  Google Scholar 

  27. Sharma S, Whyte G, Elliott P, et al. Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med. 1999;33:319–24.

    Article  CAS  PubMed  Google Scholar 

  28. Rao PS, Thapar MK, Harp RJ. Racial variations in electrocardiograms and vectorcardiograms between black and white children and their genesis. J Electrocardiol. 1984;17:239–52.

    Article  CAS  PubMed  Google Scholar 

  29. Rao PS. Racial differences in electrocardiograms and vectorcardiograms between black and white adolescents. J Electrocardiol. 1985;18:309–13.

    Article  CAS  PubMed  Google Scholar 

  30. Magalski A, Maron BJ, Main ML, et al. Relation of race to electrocardiographic patterns in elite American football players. J Am Coll Cardiol. 2008;51:2250–5.

    Article  PubMed  Google Scholar 

  31. Basavarajaiah S, Wilson M, Whyte G, Shah A, McKenna W, Sharma S. Prevalence of hypertrophic cardiomyopathy in highly trained athletes: relevance to pre-participation screening. J Am Coll Cardiol. 2008;51:1033–9.

    Article  PubMed  Google Scholar 

  32. Thompson PD, Levine BD. Protecting athletes from sudden cardiac death. JAMA. 2006;296:1648–50.

    Article  CAS  PubMed  Google Scholar 

  33. Corrado D, Pelliccia A, Heidbuchel H, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J. 2010;31:243–59.

    Article  PubMed  Google Scholar 

  34. Reiley MA, Su JJ, Guller B. Racial and sexual differences in the standard electrocardiogram of black vs white adolescents. Chest. 1979;75:474–80.

    Article  CAS  PubMed  Google Scholar 

  35. Lawless CE, Best TM. Electrocardiograms in athletes: interpretation and diagnostic accuracy. Med Sci Sports Exerc. 2008;40:787–98.

    Article  PubMed  Google Scholar 

  36. A Heart for Sports. 2207; Accessed May 7, 2010. Web Page. Available at: http://www.aheartforsports.org/.

  37. Maron BJ. National electrocardiography screening for competitive athletes: feasible in the United States? Ann Intern Med. 2010;152:324–6.

    PubMed  Google Scholar 

  38. Maron BJ, Haas TS, Doerer JJ, Thompson PD, Hodges JS. Comparison of U.S. and Italian experiences with sudden cardiac deaths in young competitive athletes and implications for preparticipation screening strategies. Am J Cardiol. 2009;104:276–80.

    Article  PubMed  Google Scholar 

  39. Thunenkotter T, Schmied C, Dvorak J, Kindermann W. Benefits and limitations of cardiovascular pre-competition screening in international football. Clin Res Cardiol. 2010;99:29–35.

    Article  PubMed  Google Scholar 

  40. Crouse SF, Meade T, Hansen BE, Green JS, Martin SE. Electrocardiograms of collegiate football athletes. Clin Cardiol. 2009;32:37–42.

    Article  PubMed  Google Scholar 

  41. Sofi F, Capalbo A, Pucci N, et al. Cardiovascular evaluation, including resting and exercise electrocardiography, before participation in competitive sports: cross sectional study. BMJ. 2008;337:a346.

    Article  PubMed  Google Scholar 

  42. Wilson MG, Basavarajaiah S, Whyte GP, Cox S, Loosemore M, Sharma S. Efficacy of personal symptom and family history questionnaires when screening for inherited cardiac pathologies: the role of electrocardiography. Br J Sports Med. 2008;42:207–11.

    Article  CAS  PubMed  Google Scholar 

  43. Pelliccia A, Di Paolo FM, Corrado D, et al. Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J. 2006;27:2196–200.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christine E. Lawless .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Lawless, C.E. (2011). Cardiovascular Screening of Athletes: Focused Exam, Electrocardiograms, and Limited Echocardiograms. In: Lawless, C. (eds) Sports Cardiology Essentials. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92775-6_2

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-92775-6_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-92774-9

  • Online ISBN: 978-0-387-92775-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics