CARDIOVASCULAR EVALUATION OF THE ATHLETE - ISSUES REGARDING PERFORMANCE, SCREENING AND SUDDEN CARDIAC DEATH

Recent studies have reported ECG anomalies and a high prevalence of ex ercise related arrhythmias among well trained, apparently healthy endu rance athletes with superior levels of cardiorespiratory fitness. The occurrence of sudden and premature cardiac deaths in amateur and profe ssional athletes, who appear to embody all of the virtues of health an d fitness, has raised our consciousness regarding the underlying ather osclerotic or nonatherosclerotic causes, and the need for, and extent of, preparticipation screening in competitive athletes. It appears tha t strenuous physical activity may trigger acute cardiovascular events in some athletes. Coronary artery disease is the most frequent autopsy finding in those over the age of 35 years who die suddenly. In contra st, structural cardiovascular abnormalities, including hypertrophic ca rdiomyopathy and malformations of the coronary arteries, are the major cause of sudden death in younger athletes. This article reviews these issues, with specific reference to the assessment of cardiorespirator y fitness, legal and prohibited performance-altering medications, the pathophysiological basis of exertion-related untoward events, the athl ete at risk, limitations of conventional screening programmes and cont emporary recommendations to identify latent cardiovascular disease in athletic populations.