Cause Of Death In Athletes Research Articles

Diagnostic dilemma of deep T-wave inversion for sports participation: Two contrasting case reports

Sudden cardiac death (SCD) is the leading cause of death in athletes. Among which, cardiomyopathy is the most common in young asymptomatic sportsperson. The electrocardiogram (ECG) is used as a primary screening and diagnostic tool for detecting underlying conditions associated with SCD. However, providing medical clearance for an asymptomatic athlete without any positive personal or family history is especially challenging when the athlete demonstrates abnormal ECG, particularly repolarization patterns, highly suggestive of an inherited cardiomyopathy, or ion channelopathy. This paper presents two such cases of contrasting diagnostic conundrum which may help sports physicians and cardiologists working with athletes.

Incidence and Etiology of Sudden Cardiac Death: New Updates for Athletic Departments.

Context:Sudden cardiac death (SCD) in a young athlete is a tragic event and is the leading medical cause of death in this population. The precise incidence of SCD in young athletes has been subject of debate, with studies reporting drastically different rates (1:917,000 athlete-years (AYs) to 1:3000 AYs) depending on the methodological design of the investigation or the targeted population.Evidence Acquisition:A literature search was performed in PubMed using the terms: incidence, sudden cardiac death, sudden death, sudden cardiac arrest, etiology, pathology, registry, athlete, young, children, and adolescents. Articles were reviewed for relevance and included if they contained information on the incidence of SCD in athletes or young persons up to the age of 35 years.Study Design:Clinical review.Level of Evidence:Level 5.Results:Studies of high quality and rigor consistently yield an incidence of 1:50,000 AYs in college athletes and between 1:50,000 and 1:80,000 AYs for high school athletes, with certain subgroups that appear to be at particularly high risk, including the following: men, basketball players, and African Americans. Initial reports suggest that the most common cause of SCD is hypertrophic cardiomyopathy (HCM). However, more comprehensive investigations in the United States and international populations—athletes, nonathletes, and military—support that the most common finding on autopsy in young individuals with SCD is actually a structurally normal heart (autopsy-negative sudden unexplained death).Conclusion:SCD is the leading cause of death in athletes during exercise and usually results from intrinsic cardiac conditions that are triggered by the physiologic demands of vigorous exercise. Current rates of SCD appear to be at least 4 to 5 times higher than previously estimated, with men, African Americans, and male basketball players being at greatest risk. Emerging data suggest that the leading finding associated with SCD in athletes is actually a structurally normal heart (autopsy-negative sudden unexplained death).

Optimizing QT Interval Measurement for the Preparticipation Screening of Young Athletes

Sudden cardiac death is the leading cause of death in athletes. Long QT syndrome (LQTS) is one of the most common cardiogenetic diseases that can lead to sudden cardiac death and is identified by QT interval prolongation on an ECG. Recommendations for QT monitoring in athletes are adopted from nonathlete populations. To improve screening, ECG data of athletes are assessed to determine a more appropriate method for QT interval estimation. ECG (CardeaScreen) data were collected from June 2010 to March 2015. ECG data with HR greater than 100 bpm were excluded. Fiducial points of outliers were manually corrected if the QRS onset or the T wave offset was misidentified. A model of best fit was determined and compared across four QT correction factors. Classification analysis was used to compare the Bazett's corrected QT interval to the 99th percentile of uncorrected QT interval. High school (n = 597), college (n = 1207), and professional athletes (n = 273) (N = 2077) were analyzed. Mean age was 19 ± 3.5 yr. QT interval varied by cohort (HS = 388 ± 30, Col = 410 ± 33, Pro = 407 ± 27, p < 0.0001). A nonlinear power function with a cubic exponent of -0.349 fit the data the best (R = 0.64). Of the four common correction factors, Fridericia had the lowest residual dependence to HR (m = -0.10). With standard screening, 75% of athletes within the top 1% for QT interval were not identified for further investigation for LQTS. Up to 75% of athletes possessing an uncorrected QT interval greater than 99% of the population are not identified for investigation for LQTS using the recommended criteria. We propose a new method of risk stratification that replaces QT interval correction. Further study is needed to establish QT interval distributions and risk thresholds in athletes.

Should Cooling Vests Be Used to Treat Exertional Heatstroke? A Critically Appraised Topic.

Are TC cooling rates acceptable (ie, >0.08°C/min) when hyperthermic humans are treated with cooling vests postexercise? No significant differences in TC cooling rates occurred between cooling vests and no cooling vests. Cooling rates across all studies were ≤0.053°C/min. Clinical Bottom Line: Cooling vests do not provide acceptable cooling rates of hyperthermic humans postexercise and should not be used to treat EHS. Instead, EHS patients should be treated with cold-water immersion within 30 min of collapse to avoid central nervous system dysfunction and organ failure. Strength of Recommendation: Strong evidence (eg, level 2 studies with PEDro scores ≥5) suggests that cooling vests do not reduce TC quickly and thus should not be used in EHS scenarios.

The most common cause of sudden cardiac death in athletes

The positive impact of exercise on cardiovascular health is well known. Athletes, who are constantly physically active, are considered to be the healthiest members of our society. That is why their sudden death, during the training or competition, attracts the attention of the general public. Rarely, tragic events of sudden cardiac death (SCD) are the reason for questioning if by many positive there are also negative impact of physical exercise. The first case of SCD is recorded as far back as the year 490 BC, when the Greek soldier Pheidippides died after he conveyed news of the great victory of the Greeks over the Persians. Risk of SCD is recognized in the middle of the twentieth century. In our region, discussion about this issue began after the World Basketball Championship, which was held in Ljubljana in 1970, because of the sudden death of the national team member Trajko Rajkovic. One of the important goals of modern sports medicine is to reduce the risk of SCD in athletes to 'inevitable rarity'. Definition of SCD is considered to be any unexpected death due to sudden cardiac arrest. Pedo (Pedoe) has divided all causes of SCD in the sport into three categories: Commotio cordis (agitation of the heart), which results from blunt impact to the athletes chest with consequent fatal disorder of heart rhythm; SCD of athletes under the age of 35 because of structural, congenital and inflammatory heart disease, which includes hypertrophic cardiomyopathy as the most important cause of sudden cardiac death, congenital anomalies of the coronary arteries, arrhythmogenic right ventricular cardiomyopathy, myocarditis and other; SCD of athletes older than 35 years which is most common due coronary artery disease - atherosclerosis (the dominant risk in the marathon and half-marathon). .

Benign and pathological electrocardiographic changes in athletesBenign and pathological electrocardiographic changes in athletes

Sudden cardiac death is the leading cause of death in athletes during sport. It is a tragic event that generates significant media attention and discussion throughout society as to whether everything possible had been done to prevent it. Regular physical exercise causes cardiac remodeling at both the mechanical and electrical level, known as athlete's heart, resulting in an electrocardiogram (ECG) considered abnormal compared with the ECGs of the general population. Some of these electrocardiographic changes are considered normal or physiological in athletes, while others suggest underlying cardiac disease with the potential to cause sudden cardiac death. There is thus an urgent need to define the electrocardiographic patterns that allow or prohibit participation in sports, and to differentiate them in terms of gender, ethnicity and age. The purpose of this review is to present the latest data on the electrocardiographic changes considered benign or pathological that are typically found in athletes and to critically analyze the most recent criteria for classifying ECGs in this population (the Seattle criteria), comparing them with previous guidelines and with the latest studies on the subject. This article also examines the question of including ECGs in preparticipation screening programs, the US and European approaches to the subject, and the most up-to-date data on the sensitivity, specificity and cost-effectiveness of the ECG in athletes.

Alterações eletrocardiográficas benignas e patológicas em atletas

Sudden cardiac death is the leading cause of death in athletes during sport. It is a tragic event that generates significant media attention and discussion throughout society as to whether everything possible had been done to prevent it. Regular physical exercise causes cardiac remodeling at both the mechanical and electrical level, known as athlete's heart, resulting in an electrocardiogram (ECG) considered abnormal compared with the ECGs of the general population. Some of these electrocardiographic changes are considered normal or physiological in athletes, while others suggest underlying cardiac disease with the potential to cause sudden cardiac death. There is thus an urgent need to define the electrocardiographic patterns that allow or prohibit participation in sports, and to differentiate them in terms of gender, ethnicity and age. The purpose of this review is to present the latest data on the electrocardiographic changes considered benign or pathological that are typically found in athletes and to critically analyze the most recent criteria for classifying ECGs in this population (the Seattle criteria), comparing them with previous guidelines and with the latest studies on the subject. This article also examines the question of including ECGs in preparticipation screening programs, the US and European approaches to the subject, and the most up‐to‐date data on the sensitivity, specificity and cost‐effectiveness of the ECG in athletes.

Electrocardiography Findings in Iranian Premier League Football Players

Background: Sudden cardiac death (SCD) is the leading cause of death in athletes during sport. Electrocardiography (ECG) is a useful tool to detect underlying cardiovascular conditions that may increase the risk for SCD. The aim of the present study is to evaluate common ECG changes among professional football players. Materials and Methods: All football players of Iranian Premier League in season 2013-2014 participated in this descriptive study (258 football players). The standard 12-lead ECGs were evaluated and ECG analysis was performed according to previously described criteria. Results: Electrocardiogram evaluation showed that the percent of ECG changes was as follows; Inverted T (7.7%), Depression ST (2.3%), Bradycardia (0.3%), St Elevation (2.7%), Left ventricular hypertrophy (1.5%), Left bundle branch block (0.3%), Incomplete right bundle branch (0.3%), Incomplete left anterior bundle (0.8%), branch Incomplete left posterior bundle branch (1.1%), Wolf Parkinson white (0.3%), Left axis deviation (1.5), Right axis deviation (2.3%), ECG finding in favor of HCM (3.1%) and finally ECG finding in favor of IHD(10%). Conclusion: Most electrocardiographic variables in Iranian professional football players were lower than the worldwide football players that may be related to the lower level of physical fitness among Iranian football players.[GMJ.2015;4(4):151-58]

The Role of Screening for Sudden Cardiac Death in Young Competitive Athletes: A Critical Review

The purpose of this review is to examine the evidence surrounding the recommendations for cardiovascular screening in young competitive athletes. Sudden cardiac death (SCD) is the leading medical cause of death in athletes. There is widespread agreement that the primary purpose of the pre-participation cardiovascular screening examination is to identify athletes with conditions that predispose them to SCD. This can help inform the athlete of risks associated with exercise, define which athletes should pursue medical management for their condition, determine eligibility for competition, and delineate first-degree relatives who may need additional cardiac testing. Current cardiovascular screening with a traditional history and physical examination does not detect the majority of athletes at risk and provides false reassurance for those with silent underlying cardiovascular conditions. The addition of an electrocardiogram (ECG) enhances disease detection capabilities and modern athlete-specific ECG interpretation standards provide low false positive rates and improved cost efficiency. Future efforts should focus on physician education of ECG interpretation criteria, the development of an infrastructure to optimize cardiovascular screening, and providing evidence-based management strategies for athletes diagnosed with cardiac disorders. The goal of pre-participation screening is to identify athletes at risk for SCD. Advanced cardiovascular screening protocols have the potential to improve the health and safety of sport and should be considered in young competitive athletes, especially those deemed high risk.

The most common causes of sudden cardiac death in athletes

AbstractCompetitive sport causes physiological changes called athlete’s heart. In most cases echocardiographic parameters return to normal after cessation of career. Sudden cardiac death may occur in persons with previously diagnosed or undiagnosed heart disease. Mortality is 1-3 people/100,000. The main reasons for death is hypertrophic cardiomyopathy and commotio cordis. In cardiomyopathy coronary vasculature does not increase proportionately to heart mass. In the case of extreme physical effort areas of poor blood supply can cause dangerous arrhythmias. Commotio cordis is caused by by blunt trauma to the thorax, which induces ventricular fibrillation and cardiac arrest without structural damage.

Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED Use in Sports

BackgroundSudden cardiac arrest (SCA) is the leading cause of death in athletes during exercise. The effectiveness of school-based automated external defibrillator (AED) programmes has not been established through a prospective...

Sudden cardiac arrest risk in young athletes

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.

Sudden cardiac arrest risk in young athletes

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.

Electrocardiographic interpretation in athletes: the ‘Seattle Criteria’

Sudden cardiac death (SCD) is the leading cause of death in athletes during sport. Whether obtained for screening or diagnostic purposes, an ECG increases the ability to detect underlying cardiovascular...

Relevance of allergy testing in the screening of athletes

Dear Editor,The insightful article of Galanti and co-workers [1],published in a recent issue of IEM, calls attention to therelevance and benefits of the Italian medical screening forathletes, not only in the fitness assessment for competitivesports but also as a valuable screening program to promotewell-being and prevent diseases. The article also empha-sizes the potential impact of this particular clinical evalu-ation to gather relevant epidemiological information on thehealth status and lifestyle of a wide population sample.I would like to suggest here the opportunity to extendthe clinical assessment of both competitive and non-com-petitive athletes beyond the examinations mandatory bylaws, with special reference to diseases with a high prev-alence and impact on athletic performance and health, asthe case is for allergic diseases.It is well known that allergic diseases affect approxi-mately 25.0 % of the general population, particularly inthe youngest ages (WAO White Book on Allergy 2011,http://www.worldallergy.com). Recent data collected in theframework of an EU funded Network of Excellence inseveral national delegations taking part in the OlympicGames have shown that allergy and asthma have even anhigher prevalence in athletes (http://www.GA2LEN.net).In particular, in a 10-year study performed in 659 Italianelite athletes, participating in the Sydney (2000), Beijing(2008) and Vancouver (2010) Olympics, the presence of anallergic sensitization is detectable, by skin tests, in 49.0 %of athletes, with a prevalence of asthma in 14.7 % of thetotal population sample studied. Interestingly enough, bothallergy and asthma seem to be on a significant increase(p\0.01), since their prevalence was, respectively, 32.7and 11.3 % in 2000, compared to 56.5 and 17.3 % in 2008(Bonini et al. submitted).Allergic diseases and asthma certainly influence well-being and athletic performances. Furthermore, exercise-induced anaphylaxis and exacerbations of asthma arerecognized as major causes of sudden death in athletes,besides cardiovascular events.Since baseline pulmonary function testing, the onlymandatory examination for assessment of asthma andallergy in athletes is often not sufficient to detect mildasthma or exercise-induced bronchoconstriction [2], theItalian Federation of Sports Medicine has recently pub-lished standardized protocols to be considered as com-plementary parameters of good clinical practice in themedical assessment of these conditions in both competi-tive and non-competitive athletes [3]. In particular, asimple specific allergy questionnaire (AQUA, AllergyQuestionnaire for Athletes) has been produced and vali-dated to identify, with a very high specificity, subjects tobe addressed to further examinations to prove an allergicsensitization or disease [4]. International Guidelinesshould also be taken into consideration for an optimaldiagnosis and management of allergic diseases andasthma in exercisers [5].Physical activity is highly recommended to maintainhealth and prevent chronic diseases. Suffering from asthmaand allergy should not prevent this beneficial program,provided that adequate care is guaranteed to the millions ofallergic exercisers.

Evidence-Based Medicine and the Recognition and Treatment of Exertional Heat Stroke, Part II: A Perspective From the Clinical Athletic Trainer

Exertional heat stroke (EHS) is one of the leading causes of death in athletes. Certified athletic trainers (ATs) demonstrate strong knowledge of recommended practices with EHS but are apprehensive in implementing 2 basic procedures: rectal temperature assessment and cold water immersion. This apprehension might lead to deaths from EHS that could have been prevented. To investigate why collegiate and high school ATs do not implement best practices for the recognition and treatment of EHS. Qualitative study. In-person focus groups consisting of 3 to 6 collegiate or high school ATs. A total of 19 ATs (9 men, 10 women; age = 36 ± 10 years, length of certification = 12 ± 9 years) employed at either the collegiate (n = 10) or high school (n = 9) level participated in the study. Interviews were transcribed verbatim, and data were analyzed using deductive data analysis. Peer review and multiple-analyst data triangulation were conducted to establish trustworthiness of the data. Five emergent themes explained the lack of evidence-based practice (EBP) regarding recognition and treatment of EHS. Three themes (lack of knowledge, comfort level, lack of initiative) were common in both the collegiate and high school settings, and 2 separate themes (liability concerns, lack of resources) were present in the high school setting. Our findings are consistent with those in the literature on EBP and EHS. Regardless of clinical setting, ATs have basic information on recognition and treatment of EHS, but 5 themes act as barriers to implementing proper management in the clinical setting. Workshops or hands-on training sessions need to be made available to improve students' comfort levels so ATs will implement EBP into everyday settings.

Nutzen von kardiologischen Vorsorgeuntersuchungen beim Leistungssport

The sudden and unexpected death in young athletes is always a tragic event. At the age < 35 years distinct structural cardiac disorders such as hypertrophic cardiomyopathy, inflammatory disorders, coronary artery anomalies, as well as conditions without structural cardiac abnormalities such as primary electrical diseases (Brugada's syndrome, long QT, short QT syndrome and catcholaminergic polymorphic ventricular tachycardia) are important causes of sudden death. At the age > 35 years coronary artery disease is the most common cause of cardiac death in athletes. In this review we give an overview about actual evaluation of competitive athletes and prevention of sudden cardiac death.

Gray zone problem in athletes

Sudden death is the most unpleasant complication of hypertrophic cardiomyopathy (HCM), which is the leading cause of cardiac death in athletes. The accurate diagnosis of HCM is a more important problem than its risk stratification profile.1,2 An early and correct diagnosis of HCM, particularly in asymptomatic subjects, is crucial during pre-participation screening in athletes. However, detection of an increased risk group remains to be a major problem with many aspects, including medical, social, ethical, financial, and legal.3 The law allows the medical profession to establish the appropriate nature and scope of pre-participation screening of athletes, based on its collective …

Automated External Defibrillators in National Collegiate Athletic Association Division I Athletics

Background Sudden cardiac death is the leading cause of death in athletes. Evidence on current sudden cardiac death prevention through preparticipation history, physicals, and noninvasive cardiovascular diagnostics has demonstrated a low sensitivity for detection of athletes at high risk of sudden cardiac death. Data are lacking on automated external defibrillator programs specifically initiated to respond to rare dysrhythmia in younger, relatively low-risk populations. Methods Surveys were mailed to the head athletic trainers of all National Collegiate Athletic Association Division I athletics programs listed in the National Athletic Trainers’ Association directory. In all, 303 surveys were mailed; 186 departments (61%) responded. Results Seventy-two percent (133) of responding National Collegiate Athletic Association Division I athletics programs have access to automated external defibrillator units; 54% (101) own their units. Proven medical benefit (55%), concern for liability (51%), and affordability (29%) ranked highest in frequency of reasons for automated external defibrillator purchase. Unit cost (odds ratio = 1.01; 95% confidence interval, 1.01-1.0), donated units (odds ratio = 1.92; confidence interval, 3.66-1.01), institution size (odds ratio = .0001; confidence interval, 1.3 E-4 to 2.2E-05), and proven medical benefit of automated external defibrillators (odds ratio = 24; confidence interval, 72-8.1) were the most significant predictors of departmental defibrillator ownership. Emergency medical service response time and sudden cardiac death event history were not significantly predictive of departmental defibrillator ownership. The majority of automated external defibrillator interventions occurred on nonathletes. Conclusions Many athletics medicine programs are obtaining automated external defibrillators without apparent criteria for determination of need. Usage and maintenance policies vary widely among departments with unit ownership or access. Programs need to approach the issue of unit acquisition and implementation with knowledge of the surrounding emergency medical service system, geography of their individual sports medicine facilities, numbers and relative risk of their athletes, and budgetary constraints.

Hypertrophic cardiomyopathy--sports-related aspects of diagnosis, therapy, and sports eligibility.

Hypertrophic cardiomyopathy (HCM) is one of the primary causes of sudden cardiac death in athletes < 35 years of age. The highest risk of sudden cardiac death is associated with syncope, early age, extreme ventricular hypertrophy, ventricular tachycardia, and a family history of sudden death. The relative risk in competitive sports is unknown. Usually, sports eligibility is rejected. However, some athletes with HCM tolerate extreme athletic lifestyles without complications. Sports-related aspects of diagnosis, therapy, and sports eligibility are presented, and discussed. Two case reports are presented: a 20-year-old professional soccer player and a 66-year-old long-distance runner. Athletes with HCM should not participate in most competitive sports with the possible exception of those of low dynamic and low static intensity. Participation in low to moderate athletic activities may be allowed in selected patients without risk factors and > 35 years of age.