The Young Competitive Athlete with Heart Disease

Abstract

Over the past several years, there has been heightened awareness that highly trained young individuals participating in competitive sporting activities can harbor underlying structural cardiovascular disease. A broad spectrum of disease has been incriminated encompassing virtually all lesions known to cause sudden death in young individuals. The most common single cardiovascular abnormality among these is hypertrophic cardiomyopathy, usually in the nonobstructive form, which is responsible for about 35% of athletic field deaths. Second in importance and frequency to hypertrophic cardiomyopathy is a spectrum of congenital vascular malformations of the coronary arterial tree (responsible for about 20% of the deaths), the most common of which appears to be anomalous origin of the left main coronary artery from the right sinus of Valsalva. Other lesions occur with lesser (and relatively low) frequency, including Marian's syndrome, myocarditis, dilated cardiomyopathy, aortic valve stenosis, mitral valve prolapse, sarcoidosis, and arrhythmogenic right ventricular dysplasia. In about 2% of cases, the standard medical examiner autopsy examination fails to show a cardiovascular lesion that could account for sudden death. Preparticipation cardiovascular screening of high school-and college-aged athletes traditionally has been performed in the context of a standard personal and family-history and physical examination. Such standard evaluations very frequently fail to identify cardiovascular abnormalities in those competitive athletes who ultimately die of underlying diseases. An American Heart. Association expert panel recently has recommended that a more focused and standardized history and physical preparticipation screening process, and more systematic implementation is most likely to enhance identification of many potentially lethal abnormalities. The consensus guidelines of the 26th Bethesda Conference provide unbiased recommendations for clinical decision-making regarding disqualification from competitive sports for the purpose of reducing risk, which can be useful when cardiovascular abnormalities are identified in competitive athletes.