Exercise and Sudden Death

Is It Angina?

In brief Most chest pain in athletes is brief noncardiac, and it resolves spontaneously or with appropriately directed treatment. But when the patient's medical history suggests angina pectoris, accurate diagnosis of cardiac disease is imperative. If cardiac examination suggests an organic heart murmur in conjunction with angina, or a resting ECG reveals inappropriate left ventricular hypertrophy, Q waves, or repolarization variations, echocardiography should be done to detect hypertrophic cardiomyopathy. A standard exercise ECG is also valuable, though a thallium stress scan may be necessary to exclude a false-positive treadmill test. If these tests are inconclusive, medication trials and other diagnostic tests can help determine the athlete's source of pain.

Sudden Death During Basketball Games

In brief Four athletes, aged 16 to 20, died shortly after they collapsed while playing basketball. Preparticipation screening had revealed no cardiac abnormality in three of them. The fourth, who had been advised not to participate in sports, had been treated for hyperlipidemia at age 7 and for exercise-related syncope at age 15. Physicians should make a concerted effort to identify those athletes with risk factors (eg, exertional syncope, chest pain, or dyspnea) through careful history taking and physical examination.

Exercise-Related Sudden Death: Risks and Causes (Part 1 of 2)

In brief: Exercise-related sudden death is a clinical syndrome that is well known both to the general public and to the medical community. Autopsy studies of victims have identified multiple structural cardiovascular diseases underlying sudden death in young athletes (aged 30 years and younger). These diseases include myocardial, coronary arterial, aortic, valvular, and cardiac conduction system disorders. In athletes over 30 years of age, the underlying cause is almost invariably severe coronary artery disease. The author discusses these diseases, along with apparent mechanisms of sudden death, clinical points, risks of exercise stress testing, and cardiac rehabilitation, as a basis for attempts to prevent these tragic events.