The Heart of the Athlete

Sudden cardiac death in athletes is a personal and professional interest of mine. In the past few years, running, triathlon and nordic skiing have all had major events where an athlete died of sudden cardiac death (death within an hour of cardiac arrest). In general, these deaths are not attributable to what we consider “traditional” risk factors for cardiac arrest. Many of these athletes had an underlying condition called hypertrophic cardiomyopathy, a generally asymptomatic enlarging of the heart. Until it isn’t. One of the biggest questions that I hope to answer across my career is whether or not this hypertrophy is part of why these athletes end up excelling at endurance sports in the first place; that is, if we’re going to screen, does focusing on endurance sports make sense?

This article frames the conversation about screening nicely. As Dr. Maron points out, the more people you screen with a test that isn’t perfectly specific, the more false positives you have which can trigger a battery of invasive, unnecessary tests. As a coach, this is an issue that sits at the back of my head. Last year at the Craftsbury Marathon, an event where Olympians, high schoolers and weekend warriors can all race together, a skier from Dartmouth died on the course. Some of my skiers were right around him and it was a difficult conversation to have with them about the likelihood of them having a similar experience.

At this point, the Class I recommendation is to use a 14 point screening test and then refer to ECG and further testing if an athlete says yes to any of the items. It’s not a perfect tool but may be a start towards earlier identification of cardiac issues in a population we often consider our most healthy.

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