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Cardiovascular Screening in Athletes

Health in Sports Report - Issue 2 

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Identifying cardiac disease

Fortunately rare in high school and collegiate athletes, sudden death can occur without warning. Sudden death during intense exercise is the result of electrical instability with consequent fatal arrhythmias (irregular heartbeat) in athletes with cardiac abnormalities. Individuals generally at higher risk include those participating in basketball, football, track and soccer. Unfortunately, screening tools are limited in determining who is at the highest risk. A thorough personal and family history remains the most important aid in identifying those with cardiac disease.

Factors for chest pain

Not all chest pain in athletes results from the heart. Asthma and exercise-induced bronchospasm (EAB) are the most common noncardiac causes of chest pain and need to be considered with a history of allergies and eczema. Symptoms including chest tightness, dry cough and/or shortness of breath typically begin several minutes after starting activity or during recovery. Athletes may also encounter chest pain, nausea, vomiting or cough with esophageal reflux. This may be more apparent in athletes undergoing more vertical motion including jumping and running. Dehydration in humid conditions, exercise-associated collapse, hyperventilation and hypoglycemia are also possible factors.

Personal history is crucial

Although particularly concerning, a personal history of chest pain, palpitations, syncope or dizziness is often unreported or not experienced with athletic activities. Questioning regarding noncardiac causes of disease include a history of allergies and eczema, recent history of fall or minor trauma, dietary consumption and relation to exercise. Personal history of rheumatic fever or previous cardiac disease or surgeries are also important. Additional questioning should include use of prescription medications and over-the-counter regimens. Stimulant medications, even in normal doses, may account for intermittent episodes of palpitations or chest pain with exertion.

Evaluation

Any athlete with history or physical exam findings needs further evaluation before considering athletic participation. Generally, an ECG is done initially with symptoms of chest pain. Echocardiography (ECHO) may also prove beneficial.

Return to play

Returning to athletic participation should only be considered after a team physician or cardiologist completes an appropriate cardiac evaluation. Athletes with confirmed hypertrophic cardiomyopathy (HCM) are considered ineligible for sports except for low-static, low-dynamic exercise such as golf. Those with suspected arrhythmias require monitoring during exercise and typically echocardiography to exclude associated cardiac abnormalities before considering return to play if the athlete is not symptomatic. Athletes with myocarditis require rest from activities for approximately six months followed by echocardiography to ensure left ventricular function has returned to normal.

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