22 May 2020 Author : Paulo Dinis The main objective of cardiovascular sports assessment in athletes is to i dentify persons with heart disease , often asymptomatic, to prevent a potential sudden death. Sudden cardiac death is an unexpected, non-traumatic cardiac death in an individual with no previous suspicion of any disease. It happens because physical exercise can act as a trigger for cardiac dysrhythmic phenomena in predisposed individuals. Cardiovascular sports assessment is also important for: Screening for major heart diseases; Identification of possible risk factors and its correction; Assessment of physical condition and improvement of the athlete performance. Sudden death is considered a rare event, estimated in 1-3 cases per 100 thousand individuals. However, it has an enormous psychosocial burden, both because of the notoriety it has in the media, and because of the death of young sportsman, who are one of the healthiest representatives of our society. What is the methodology of cardiovascular sports assessment? Performing pre-participation cardiovascular screening is a topic still debated. There is consensus on its importance, but the methodology continues to divide opinions. The European and American recommendations are similar, however, there are different points of view in relation to the use of diagnostic tests, namely electrocardiogram. Both European and American recommendations advocate: A clinical history guided by a questionnaire with essential points; A complete physical exam. The questionnaire should focus on: Clinical signs that may be present, such as chest pain, palpitations, dyspnea or occurrence of syncope; Family history, since most heart diseases that cause sudden death in young people have a genetic component. The physical examination should include: Skeletal muscle assessment; Blood pressure assessment; Assessment of arterial pulses; Cardiopulmonary auscultation. The presence of a heart murmur may alert the physician to valve pathology or left ventricular outflow tract obstruction that may be present in hypertrophic cardiomyopathy, which is the main cause of sudden death in the young athlete. The European recommendations also defend the inclusion of an electrocardiogram as a screening test, being interpreted together with the clinical history and objective exam. The electrocardiogram is an exam that is easy to perform and of huge importance for the identification of cardiomyopathies, which are responsible for most cases of sudden cardiac death, namely: Hypertrophic cardiomyopathy; Arrhythmogenic dysplasia of the right ventricle; Dilated cardiomyopathy; Left ventricle not compacted. These diseases present mostly with changes in the electrocardiogram that can be identified by a cardiologist. It is up to the clinician to know how to recognize and interpret the exam, using specific criteria for the population concerned. If any of these assessment components - clinical history, objective examination, electrocardiogram - show significant changes, other appropriate cardiovascular exams should be performed , which may include echocardiography, exercise testing, cardiopulmonary exercise testing, 24-hour Holter, cardiac magnetic resonance, among others. Is the same methodology used for all athletes? Although all athletes need a cardiovascular assessment before sports participation, this assessment also varies with the age group, sports modality and the intensity of the exercise practiced . This is because the main heart diseases with potential to progress to sudden death are different in young athletes, adult, or veteran athletes. In adolescents and young athletes up to 35 years of age, the main causes of sudden death are cardiomyopathies, the anomalous origin of coronary arteries and channelopathies; from 35 years of age the main cause of death is coronary artery disease. As such, in this population, in addition to clinical history, objective examination and electrocardiogram, cardiovascular risk should be calculated individually. If it is high, it will make sense to perform a stress test to exclude ischemic cardiac disease. It is also important to assess the modality and the level of intensity practiced. There is a wide range of sports, with particularities in the assessment related to the intensity of the exercise practiced. Thus, the cardiologist needs knowledge, training, and differentiation, because although all athletes need specialized follow-up , this must be individualized according to factors such as age, modality or intensity practiced. Meet the cardiology team from Hospital da Luz network and book your consultation . The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
