Sudden Cardiac Death in the Active Adult

Abstract

Cardiovascular disease is the most frequent cause of death among Americans today and unfortunately is not limited to the elderly and those with various comorbidities, but also takes the lives of young, seemingly healthy individuals, including elite athletes. Because of the tremendous social and psychologic impact that these albeit rare events entail, there has been a drive in recent years to develop preventive strategies so that such tragedies may be avoided. It is also imperative that recommendations be made for those older individuals with existing disease who wish to remain active and healthy. If such individuals are to engage in such activities they must know the risks involved. This review defines the spectrum of cardiac disease commonly affecting athletes and presents the most current diagnostic strategies as well as recommendations for disqualification from sport. In addition, it is important to recognize the benefits of regular physical activity even in those older patients at risk because of existing heart disease and provide them with adequate information regarding the extent to which they may participate in physical activity.

Endurance Sport and “Cardiac Injury”: A Prospective Study of Recreational Ironman Athletes

“…The most substantial cardiac injury is sport-related sudden death. Most cases of sudden death in athletes over 35 years of age are caused by coronary disease [ 25 ], and their prognoses depend on the coronary arteriosclerosis burden [ 26 ] rather than on a possible increase in biomarkers during competition. The sudden deaths of young athletes <35 years ( Table 10 ) typically have different causes (hypertrophic cardiomyopathy, coronary disease, coronary anomalies, myocarditis and arrhythmogenic right ventricle) [ 27 , 28 , 29 , 30 ].…”

How Do Humans Control Physiological Strain during Strenuous Endurance Exercise?

“…These examples support the idea that ‘physiological catastrophes’ can and do occur with some frequency during competition precisely because the athletes were either unwilling or unable to down-regulate effort despite dangerously high levels of strain. In the event of a pre-existing (frequently undiagnosed) cardiac disorder [41] or drug abuse, as in the case of Tom Simpson [15], the inability to regulate effort or over-ride a “central governor” can be fatal even in well accomplished athletes.…”

No psychological distress in sportsmen aged 45 years and older after cardiovascular screening, including cardiac CT: The Measuring Athlete’s Risk of Cardiovascular events (MARC) study

“…An ideal screening program meets the following six criteria: 1) the condition must have a significant impact on public health and 2) should have an asymptomatic period during which detection may be possible, 3) the outcome for a condition should improve by treatment during this asymptomatic period, 4) the screening test should be sensitive enough to detect the disease during the asymptomatic period, 5) specific enough to minimise false-positive results and 6) acceptable to those undergoing the test [14]. The US National Heart, Lung, and Blood Institute outlined the need to understand the psychological burden of screening in athletes, prior to widespread implementation of the PPS program [15].…”