The American Heart Association currently recommends a physical exam and family history questionnaire as a first-line screening, with further examination based on the results of those initial steps.
In contrast, the European Society of Cardiology and the International Olympic Committee promote the use of routine ECGs for athletic pre-participation screening. Consensus of the European Cardiology and Exercise Physiology Associations recommends systematic pre-participation cardiovascular screening of young competitive athletes for the timely detection of cardiovascular abnormalities predisposing to sport-related cardiac death, thereby to reduce the cardiovascular risk associated with sport participation. The recommended protocol includes 12-lead ECG in addition to history and physical examination.
Family history: is considered positive when close relative(s) had experienced a premature heart attack or sudden death (<55 years of age in males and <65 years in females), or in the presence of a family history of cardiomyopathy, Marfan syndrome, long QT syndrome, Brugada syndrome, severe arrhythmias, coronary artery disease, or other disabling cardiovascular diseases.
Personal history: is considered positive in the case of exertional chest pain or discomfort, syncope or near-syncope, irregular heartbeat or palpitations, and in the presence of shortness of breath, or fatigue out of proportion to the degree of exertion.
Physical examination: Positive physical findings include musculoskeletal and ocular features suggestive of Marfan syndrome, diminished and delayed femoral artery pulses, mid- or endsystolic clicks, a second heart sound single or widely split and fixed with respiration, marked heart murmurs (any diastolic and systolic grade ≥ 2/6), irregular heart rhythm, and brachial blood pressure >140/90 mmHg (on >1 reading).
ECG: Twelve-lead ECG is considered positive, according to accepted criteria.
How European Pre-participation screening can be effective is best shown in the Veneto region of Italy. Mandatory history, physical examination and 12-lead ECG has been shown to be effective in detecting athletes with cardiomyopathy. Most of the reduced incidence of sudden cardiovascular death in athletes was due to fewer cases of fatal cardiomyopathies over the 26-year period. The proportion of athletes who died suddenly from cardiomyopathy decreased from 36% in the prescreening period to 17% in the late screening period. These findings suggest that screening athletes for cardiomyopathies is a life-saving strategy and that 12-lead ECG is a sensitive and powerful tool for identification and risk stratification of athletes with cardiomyopathies.
Corrado D, Pelliccia A, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. European Heart Journal (2005) 26, 516-524
Benton Ng. Sudden Cardiac Death in Young Athletes: Trying to find the Needle in the Haystack. Wisconsin Medical Journal 2007, Vol. 106, No 16
Corrado D., et al. Trends in Sudden Cardiovascular Death in Young Competitive Athletes After Implementation of a Preparticipation Screening Program. JAMA, October 4, 2006-Vol 296, No. 13
Koester M. A Review of Sudden Cardiac Death in Young Athletes and Strategies for Preparticipation Cardiovascular Screening. Journal of Athletic Training 2001;36(2):197-204
Pelliccia A, Fagard R., et al. Recommendations for competitive sports participation in athletes with cardiovascular disease. A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. European Heart Journal (2005) 26, 1422-1445
Prepared by: Dr. Nenad Radivojevic