The risk, aetiology, clinical features, management, and prevention of exercise-related sudden cardiac death and acute cardiac events in adult athletes

Abstract

Regular physical activity reduces atherosclerotic coronary artery disease (CAD) events including acute myocardial infarction (AMI) and sudden cardiac death (SCD). Conversely, vigorous exercise acutely and transiently increases the risk of both these CAD events in adult athletes with known or occult CAD. CAD is the cause of most exercise-related SCDs in adult athletes. Exercise-related AMIs are typically caused by atherosclerotic plaque rupture and acute thrombosis, whereas exercise-related SCD can be caused by both plaque rupture and exercise-induce ischaemia. The management of athletes with CAD requires aggressive risk factor reduction plus an assessment of risk for an acute cardiac event based on exercise testing, ventricular function measurement, and an assessment of electrical stability. Whether or not an athlete should return to competition after a CAD event is a joint decision made by the athlete and the clinician based on the risks and benefits of athletic participation for that athlete.