Abstract
Underlying cardiac abnormalities are the main cause of unexpected death in athletes on field. These abnormalities have been associated with a previous history of syncope, a family history of sudden cardiac arrest (SCA), cardiac murmur, a history of over-exhaustion post exercise and ventricular tachyarrhythmia during physical activity. The timely diagnosis of susceptible athletes may assist with an appropriate management plan for these individuals, and allow for the prevention of premature death in sport. A young football player was screened for SCA risk using the fundamental components of the pre-participation examination (PPE) – essentially, a medical history, a resting and stress electrocardiogram, and an echocardiogram to support clinical findings. The case is submitted with consideration of the applicable literature to accentuate the importance of using PPE to prevent SCA in young athletes.
Highlights
Case A 23-year-old South African male football player, involved in amateurlevel football, was referred for examination
sudden cardiac arrest (SCA) prevalence is relatively low in the global adult athletic community (1/65 000 - 1/200 000), it represents a large majority (75%) of deaths during exercise. [1,2] The Fédération Internationale de Football Association (FIFA) is leading the drive to ensure that the pre-participation examination (PPE) – the template of which is available on the FIFA website – becomes a mandatory component of a football player’s career.[1,3]
The main objectives of this study were to emphasise the importance of such risk stratification, using a case study focused on an asymptomatic athlete at risk of SCA as an example
Summary
Case A 23-year-old South African male football player, involved in amateurlevel football, was referred for examination. Arterial pulses at all sites of examination were present and he had normal characteristics, with no delays His heart rate (HR) in the supine position was 42 beats per min (bpm) and irregular. His HR in the standing position was 74 bpm and regular His resting blood pressure was 110/68 mmHg. His resting blood pressure was 110/68 mmHg His first heart sound (S1) was normal and there was a short ejection systolic murmur (ESM) of 1 - 2/6. Stress ECG When undergoing an effort ECG, the participant reached peak exercise levels at the fifth stage of the Bruce protocol when the test was terminated, at 14:37 min of exercise, corresponding to 17.1 metabolic equivalnts His peak HR was 193 bpm (98% of predicted maximum) and he exhibited no chest pain, ischaemic ECG changes, conduction abnormalities or early repolarisation during the exercise stress test
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