Monday, 23 July 2018

SC - Principles and practices of Cardiovascular evaluation of athletes

Sudden death in young athletes is largely due to a variety of clinically unsuspected congenital cardiac abnormalities. In the United States, genetic cardiovascular diseases including hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy, Marfan syndrome, and ion channelopathies (eg, long QT syndrome) account for approximately 40% of sudden deaths in young athletes, with HCM being the single most common cause and accounting for one third of the cases. Other less common causes include coronary artery anomalies, myocarditis, aortic valve stenosis, mitral valve prolapse, dilated cardiomyopathy, and premature atherosclerotic coronary artery disease. Available prevalence data for sudden death in young athletes are limited and may underestimate the magnitude of this public health problem.

Preparticipation Athletic Screening

Preparticipation screening is the systematic medical evaluation of large, general populations of athletes prior to training for the purpose of identifying (or raising suspicion) of cardiovascular abnormalities that could provoke disease progression or sudden death. Identification of these diseases may well prevent or delay some cases of sudden death because of physician-recommended temporary or permanent withdrawal from sports or treatment interventions. An impediment to implementing preparticipation screening is a large number of young athletes (an estimated 10 million-12 million per year) and the infrequency of sudden death. Furthermore, customary screening practice for US high school and college athletes consists only of performing a personal and family history and a physical examination. The efficacy of this practice has come under scrutiny. The 1996 American Heart Association consensus panel6 stipulated that such preparticipation cardiovascular screening is a justifiable clinical practice, but routine non-invasive testing is not recommended due to the low-anticipated yield and associated cost-efficacy considerations. Specific screening recommendations were formulated to target those cardiovascular lesions known to cause youthful sudden death.

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