2. 80-90% of SCD in young athletes occur during or
shortly after exercise
Sex and sport related predilection
Male to female ratio = 9:1
Mean age ranges from 17-23 years of age
Soccer and basketball = largest number
3.
4.
5.
6.
7.
8.
9. Most common cause of sudden death in
young “healthy” individuals
Characterized by thickened heart
muscle
Inherited usually as autosomal
dominant in older children and adults
Approximately 1 in 500 adults have HCM
10. Clinical presentation varies depending on age of
onset (may be asymptomatic)
Syncope
Sudden death
Heart failure
Sudden death risk similar in adolescents versus
adults
EKG abnormal in 70-90% of patients
Should evaluate all 1st
degree relatives for HCM
11. Arrhythmogenic Right Ventricular
Dysplasia (ARVD)
Incidence unknown, but estimated to affect
1:1000.
Mean age of diagnosis is 30
Principle symptoms1
Palpitations – 67%
Syncope – 32%
Atypical chest pain – 27%
Short of breath – 11%
Circulation 2004 Oct 5;110:1879-84.
12. 30% of cases are familial (probably
underestimate)
Diagnosis of ARVD is based on clinical findings
but this can be difficult and ambiguous,
particularly in young family members
Genetic testing can be used to help clarify
difficult diagnoses earlier in life
Important implications for both the patient and family
members
13.
14. Physical exam: The
conditions that cause
SCD may be subtle and
not apparent on routine
exam.
History: Symptoms
may not be present
prior to SCD
The relative frequency
of these conditions is
low in the population
The impact is HIGH
Sports Illustrated
December 10 2007
15. American Heart Association (AHA) recommends
health questionnaire and physical examination
onlyonly
16. A mandatory careful, detailed history and
physical examination
To identify abnormalities known to cause SCD
Every TWO years an interim history is recommended
By “qualified” care providers
17. There is none
Inconsistent forms: Only 3 states use ALL 12 AHA
elements
Nonmedical evaluations account for about 35%
Consensus of expert opinion
There are limitations to current system
More false positives and false negatives with pre-
participation examination forms
18. Prior occurrence of
exertional chest pain
Syncope with exercise
Shortness of breath or
fatigue with exercise
History of a heart murmur
History of hypertension
Family history of premature
death, sudden or otherwise
(age <50)
Specific knowledge of
family history of HCM,
LQTS, Marfan, DCM,
arrhythmias
Disability from heart
disease in close relative <50
years old
Parents need to be
responsible for ensuring
accuracy of historical data
HCM – Hypertrophic cardiomyopathy; LQTS – long QT
syndrome; DCM – dilated cardiomyopathy
19. Listen to heart in both
lying and standing
position to identify
murmurs associated
with outflow tract
obstruction (HCM, etc)
Assess femoral artery
pulses (pulse in groin)
Recognize physical
stigmata of Marfan
syndrome
Blood pressure
measurement while
sitting
20. Recent analysis of high school pre-participation
screening - 2004
80% of states ≥9 of AHA items
2% of states ≤4 of AHA items
However, states in which non-physician
examiners are permitted to perform screening
examinations has increased from 22% to 35%
21. General ProblemsGeneral Problems
Some not doing them AT ALL
Non-uniform approach, correct questions are not
asked
Who administers or performs evaluations?
Questions not answered truthfully
AND not helpful if symptoms are not present, family
history negative and examination “normal”
22. Uniform comprehensive questionnaire – “a
national standard”
Questionnaire and examination should be
administered by individuals with knowledge and
training
Parents need to be involved
Still will miss cases, but may find some too
23.
24.
25.
26.
27.
28.
29. Corrado, D. et al. J Am Coll Cardiol 2008;52:1981-1989
Flow Chart of the Italian Protocol of Cardiovascular Pre-
Participation Screening
39. Exertional chest pain/discomfort
Unexplained syncope/near syncope – especially
when related to exertion
Prior recognition of heart murmur - should assess
standing and sitting (outflow tract obstruction)
Elevated systemic blood pressure
Family history of sudden and unexpected premature
death (<50 years old)
Family history of HCM, ARVD, long QT, Marfans or
congenital arrhythmia disorders (Brugada
syndrome, etc)
40. SCD is the leading cause of death in young
athletes
Pre-participation screening strategies are of help
to identify athletes of risk for SCD
Parents, get involved when they go for pre-
participation physical
Establishing emergency action plan at ALL
athletic venues is needed
