Screening for heart disease in athletes

Abstract

Physical activity, be it regular exercise or sports at whatever level, should be beneficial and not deleterious. Hence, it is important that the medical profession is aware that cardiovascular related deaths are the leading cause of mortality in athletes during sports. In 2009 the International Olympic Committee issued a consensus statement on the periodic health evaluation of elite athletes. This includes ‘a comprehensive assessment of the athlete’s current health status and risk of future injury or disease and, typically, is the entry point for medical care of the athlete’. Although this consensus statement targeted elite athletes, the periodic health evaluation design is simple enough that it could easily be extrapolated for use for all physically active individuals. The periodic health evaluation’s role is to screen for musculoskeletal or medical conditions that may place an athlete at risk for safe participation. Since this statement was issued, numerous international sport organisations have recommended a screening programme for individuals who partake in regular physical activity. Stress is made on the importance of a thorough health and family history with an emphasis on cardiovascular issues. There is no international consensus on the use of an electrocardiogram (ECG) as part of a screening programme; however most international sports federations and the European Cardiac and Sports Medicine societies strongly recommend it. What there is agreement on is that the doctor that reads an ECG should be knowledgeable of the physiological adaptations of the athletic heart that could lead to errant, yet perfectly safe, ECG traces.