Young Athlete; It’s marathon season, and every so often a news report will focus on an athlete who has collapsed from sudden cardiac arrest. Although uncommon, these events get attention. A new review in CMAJ (Canadian Medical Association Journal) looks at recent evidence to help physicians prevent and manage the risk of sudden cardiac arrest in competitive athlete.
Cardiac arrest in young athlete
Sudden cardiac arrest is rare and, in young athletes, is usually the first sign of heart disease; so one study found that 29% of athletes had symptoms of underlying disease before an arrest. It is very difficult to predict or prevent, and screening programs are challenging and of uncertain benefit. Physicians should routinely ask athletes if they feel dizzy, short of breath or experience chest pains during or after exercise and ask about family history to determine if there may be an inherit condition.
Cardiac arrests that occur during sports competition are dramatic and unexpect, and attract much media interest; which as athletes are often young and at the peak of physical fitness. The rate of sudden cardiac arrest during exercise in competitive athletes is about 0.75 per 100 000 athletes per year. Among young athletes, sudden cardiac arrest is usually the first manifestation of underlying cardiac pathology, although one retrospective study found that 29% of athletes had symptoms suggestive of cardiac disease before an arrest.
Questions arise about the effect of intensive exercise on the heart, the potential value of screening all who would engage in competitive sport for cardiac abnormalities to reduce the incidence of sudden cardiac arrest, and optimal resuscitation protocols to improve survival in those affected. We review evidence relate to these questions in light of recommendations in the recent position statement from the Canadian Cardiovascular Society and the Canadian Heart Rhythm Society on pre-participation screening of athletes.
Symptoms of heart disease
In the absence of predisposing conditions or symptoms of heart disease, exercise, even at high intensity, poses very little risk to an athlete. The ways in which regular exercise remodels the heart is explaine in. The benefits an individual derives by participating in exercise or sport include a reduce risk of mortality and morbidity, and substantial social and psychological gains.
One possible exception is the increase risk of developing lone paroxysmal atrial fibrillation in the absence of heart disease; so specifically observe in long-term endurance athletes; who exercise for 15–30 hours per week for decades or longer. A recent meta-analysis find that such athletes have an increase risk of developing lone paroxysmal; atrial fibrillation (odds ratio 1.64, 95% confidence interval compare with the risk for sedentary people. However, the risk of stroke in athletes with atrial fibrillation; so is lower than that in age match non-athletes with atrial fibrillation.
Survival rates after sudden cardiac arrest in athletes are quite high; so when automate external defibrillators are use. “Establishing effective resuscitation protocols; also increasing the availability of automate external defibrillators in settings where competitive sport is undertaken are the most effective strategies in helping reduce the incidence of sudden cardiac death among athletes,” says Dr. Paul Dorian, a cardiologist at St. Michael’s Hospital and the University of Toronto, Toronto, Ontario.