Sudden Cardiac Death in young athletes: Sudden Cardiovascular Death in Sport

LAUSAN NE RECO M M E N D ATIONS

“Screening forthe needle in a haystack” IOC Medical Commission 2004

< 35 years of Age PREPARTICIPATION CARDIOVASCULAR SCREENIN

A Rare event!!

Typically unrecognized prior

to death & rather
unpreventable.

M ostly congenital/ Structural

defects:
ƒCoronary anomaly
ƒCardiomyopathy:
ƒHypertrophic
ƒArrhythmogenic RV
ƒIon channelopathy:
ƒLong QT syndrome
ƒBrugada syndrome

Sudden Cardiovascular Death in Sport

Sudden Cardiovascular Death in Sport LAUSAN NE RECO M M E N D ATIONS
LAUSAN NE RECO M M E N D ATIONS IOC Medical Commission 2004
IOC Medical Commission 2004 PREPARTICIPATION CARDIOVASCULAR SCREENIN
PREPARTICIPATION CARDIOVASCULAR SCREENIN

1
 Sudden Cardiovascular Death in Sport
LAUSAN NE RECO M M E N D ATIONS
IOC Medical Commission 2004
PREPARTICIPATION CARDIOVASCULAR SCREENIN

ESC recommendation 2004

A H A Recom mendations to pre-participation Screening

For Cardiovascular Abnormalitiesin Competitive Athletes: 2007 update.

Circulation online Mar 12,2007

*Parental verification is
recom mended for high school and
middle school athletes.
†Judged notto be
neurocardiogenic(vasovagal); of
particular concern when related to
exertion.
‡Auscultation should be
performed in both supine and
standing positions (or with
Valsalva maneuver),specifically
toidentify murmurs of dynamic
left ventricular outflow tract
obstruction.
:Preferably taken in both arms.37

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 Assessing CHD risk: men
NCEP ATP III Framingham Risk Scoring
Pre-participation Evaluation Step 1: Age
Years Points
Step 4: Systolic Blood Pressure
Systolic BP Points Points
Step 6: Adding Up the Points
Age
20-34 -9 (mm Hg) if Untreated if Treated TC
35-39 -4 <120 0 0
HDL-C
40-44 0 120-129 0 1
Systolic BP
45-49 3 130-139 1 2
Smoking status
ƒ Resting ECG: 50-54
55-59
6
8
140-159
• 160
1
2
2
3
Point total

60-64 10
ƒ Recoomended by ESC/IOC, but not the AHA 65-69
70-74
11
12
Step 7: CHD Risk

guidelines 75-79 13 Point Total

<0
10-Year Risk
<1%
Point Total 10-Year Risk
11 8%

ƒ Detection of HOCM, channelopathy etc. Step 2: Total Cholesterol

0
1
1%
1%
12
13
10%
12%
TC Points at Points at Points at Points at Points at 2 1% 14 16%

ƒ Treadmill stress test: (mg/dL)

<160
Age 20-39
0
Age 40-49
0
Age 50-59
0
Age 60-69
0
Age 70-79
0
3
4
1%
1%
15
16
20%
25%
160-199 4 3 2 1 0 5 2% 17 30%
ƒ Recommended for older athletes esp. at high risk 200-239
240-279
7
9
5
6
3
4
1
2
0
1
6
7
2%
3%
• 280 11 8 5 3 1

ƒ Echocardiogram:
8 4%
Step 3: HDL-Cholesterol 9 5%
10 6%
HDL-C
ƒ Cardiomyopathy: hypertrophic / RV dyplasia (mg/dL) Points
Step 5: Smoking Status
>60 -1
ƒ Valvular: AS, MVP, Aortic root dilatation 50-59 0
Points at
Age 20-39
Points at
Age 40-49
Points at
Age 50-59
Points at
Age 60-69
Points at
Age 70-79
40-49 1 Nonsmoker 0 0 0 0 0
ƒ Coronary anomaly <40 2 Smoker 8 5 3 1 1

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.
JAMA 2001;285:2486-2497.