THE CARDIOVASCULAR COMPLICATIONS OF VIGOROUS PHYSICAL-ACTIVITY

Objective: To review the cardiovascular risks of exercise for practici ng physicians. Data Sources: Relevant medical literature as well as th e author's clinical and research experience on the topic. Results: The predominant causes of exercise-related cardiovascular complications a re congenital abnormalities in young subjects and atherosclerotic coro nary disease in adults. The absolute incidence of exercise deaths is l ow. Only approximately 0.75 and 0.13 per 100 000 young male and female athletes and 6 per 100 000 middle-aged men die during exertion per ye ar. Nevertheless, exercise does acutely and transiently increase the r isk of cardiac events. Conclusions: Routine cardiovascular testing to prevent exercise events (echocardiography in the young and exercise te sting in adults) has limited usefulness because of the rarity of such events, the cost of screening, and poor predictive accuracy of exercis e testing for exercise events. Physicians should (1) perform routine s creening and cardiac auscultation in young athletes; (2) carefully eva luate exercise-induced symptoms; and (3) ensure that adults know the s ymptoms of cardiac ischemia.