Abstract
Sudden cardiac death is a tragic event under any circumstance but is especially devastating when it occurs in youth and athletes. In the “paradox of sports,” exercise both promotes health and acutely increases the risk of sudden cardiac death (SCD) among those with underlying heart disorders such as HCM, arrhythmogenic right ventricular cardiomyopathy, or coronary artery anomalies. Developed societies agree that pre-participation screening is valuable and warranted to improve the safety of sports competition, but there remain significant differences in opinion regarding the best methods to employ. ECG screening in particular remains controversial, with European societies generally in favor of ECG and US guidelines against ECG inclusion. Athlete-specific ECG criteria decrease the false-positive rate and costs of screening, and new US guidelines state ECG screening can be considered in small cohorts of young people under the conditions of sufficient provider expertise and quality control. However, barriers to widespread use of ECG screening remain, including concerns about ethics, logistics, cost-effectiveness, and overall health outcomes.
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Questions
Questions
- 1.
The following are true about pre-participation athletic screening except:
- A.
The USA recommends the 14-question AHA questionnaire.
- B.
Italy recommends an ECG routinely.
- C.
The USA recommends a history and physical.
- D.
The UK recommends an echocardiography.
- E.
It has not definitively reduced incidence of SCD.
Answer: D. All of these are true except D. Currently, no society recommends echocardiography as a routine part of pre-participation screening, due to cost and false-positive rates.
- A.
- 2.
The upper limit of hypertrophy for physiologic remodeling is:
- A.
13 mm
- B.
15 mm
- C.
17 mm
- D.
19 mm
Answer: C. While experts generally consider 15 mm as a diagnosis of HCM, especially when asymmetric and in the absence of loading conditions that could otherwise produce this level of hypertrophy, general agreement is that up to 17 mm can be seen in the trained athlete. This represents a significant overlap area, especially for Black athletes, who typically may have higher degrees of hypertrophy.
- A.
- 3.
Etiologies of SCD in athletes include the following:
- A.
Hypertrophic cardiomyopathy
- B.
Commotio cordis
- C.
ARVC
- D.
Coronary anomalies
- E.
Myocarditis
- F.
Channelopathies
- G.
All of the above
Answer: G. All of the above can be associated with sudden cardiac death in athletes, although the frequency differs in different societies. These differences may be explained by genetic distribution of cardiac conditions in segregated populations. In the USA, the largest contributor is HCM, whereas in Italy it is ARVC.
- A.
- 4.
SCD in athletes has the following themes, except:
- A.
It is more common in males than females.
- B.
It is more common in Blacks than Caucasians.
- C.
It is more common in burst athletics than lower intensity athletics.
- D.
It is more common in weight lifting than in endurance athletics.
Answer: D. All of these are true with the exception of weight lifting, although weight lifting is not advisable in HCM due to the increased afterload that might stimulate further LVH.
- A.
- 5.
Challenges to screening include the following except:
- A.
Cost-effectiveness indicates routine population-wide screening even with ECG would be cost-prohibitive.
- B.
False-positive rates are high, leading to unnecessary testing and psychological and financial impact to the athlete or youth.
- C.
Homegrown screening initiatives focus on wealthier demographics, leaving many communities with disparities in care delivery.
- D.
There is a higher false-positive rate in Blacks than Caucasians.
- E.
All of the above.
Answer: E. All of the above are challenges to screening programs. Therefore, current guidelines recommend a focused history and physical examination and the AHA 14-point questionnaire in an attempt to screen all individuals prior to sports participation. Patients with concerning features move on to ECG and echocardiography, based on findings.
- A.
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Owens, D.S., Sharma, S. (2019). Youth and Athletic Screening: Rationale, Methods, and Outcome. In: Naidu, S. (eds) Hypertrophic Cardiomyopathy. Springer, Cham. https://doi.org/10.1007/978-3-319-92423-6_11
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DOI: https://doi.org/10.1007/978-3-319-92423-6_11
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