Preparticipation screening and electrocardiograms in athletes

Background

Sudden cardiac arrest occurs in 1 per 50,000 to 80,000 people per year. Preparticipation screening may identify athletes who may be at risk for developing sudden cardiac arrest.

Aim of review

The purpose of this article is to review the etiologies of sudden cardiac arrest, preparticipation screening, and use of electrocardiograms in screening athletes for cardiac problems.

Key scientific concepts of review

Sudden cardiac arrest may occur in young athletes who have hypertrophic cardiomyopathy, anomalous origin of a coronary artery, arrhythmogenic right ventricular cardiomyopathy, dilated cardiomyopathy, aortic dissection, myocarditis, Wolff-Parkinson-White syndrome, long QT syndrome, Brugada syndrome, commotio cordis, aortic valve stenosis, coarctation of the aorta, congenital heart block, short QT syndrome, or coronary artery disease. Preparticipation screening may include history, physical examination, and an electrocardiogram. Several guidelines for screening are available. The American Heart Association 14-element screening protocol includes seven questions about personal history, three questions about family history, and four physical examination findings. The electrocardiogram may identify cardiac conditions such as cardiomyopathy, Wolff-Parkinson-White syndrome, and long QT syndrome that may not manifest on physical examination. Widespread use of an electrocardiogram in screening may be limited by cost and practitioner training. Successful implementation of the use of an electrocardiogram in screening may depend on specific training for practitioners in interpreting the electrocardiogram in young athletes. It is important to identify specialists who may help with further evaluation of any findings consistent with critical cardiovascular disease.