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Sudden Cardiac Death in Athletes
David J. Callans, MD, is professor of medicine at the University of Pennsylvania and director of the electrophysiology laboratory at the Hospital of the University of Pennsylvania. Here, he discusses the scope and demographics of sudden death in athletes, the disease processes that lead to the syndrome, and the recommendations and limitations of pre-participation screening. Silent structural heart disease is at the root of sudden cardiac death in young athletes, says Dr. Callans, and while its incidence is very rare, accounting for between 10 and 25 deaths a year in the US, its societal impact is profound. He discusses their usually genetic origin and the difficulty of diagnosis, with the key component being physical exertion in 90% of sudden death syndrome in young athletes. Among the causative structural cardiovascular diseases involved are hypertrophic cardiomyopathy (HCM), and coronary artery anomalies such as Marfan syndrome, and arrhythmogenic right ventricular cardiomyopathy/dysplasia. Most cases of HCM are asymptomatic. Myocarditis accounts for 20% of sudden death in athletes. Primary electrical cardiovascular diseases include Long QT syndrome which can lead to torsade des pointes polymorphic ventricular tachycardia. For those at high risk, an implantable cardioverter defibrillator is a therapeutic option. The lecture details Brugada syndrome and Wolff-Parkinson-White syndrome as well as Commotio Cordis which is trauma related and unrelated to underlying structural cardiovascular disease, and touches upon such miscellaneous causes of sudden death as cocaine and ephedrine. The lecture concludes with a discussion on difficulties in screening athletes at risk and methods which have been adopted to improve the process. Guidelines for disqualification of athletes at risk are appended. |
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