Cardiac Screening of Young Athletes: a Practical Approach to Sudden Cardiac Death Prevention.

PURPOSE OF REVIEW: We aim to report on the current status of cardiovascular screening of athletes worldwide and review the up-to-date evidence for its efficacy in reducing sudden cardiac death in young athletes. RECENT FINDINGS: A large proportion of sudden cardiac death in young individuals and athletes occurs during rest with sudden arrhythmic death syndrome being recognised as the leading cause. The international recommendations for ECG interpretation have reduced the false-positive ECG rate to 3% and reduced the cost of screening by 25% without compromising the sensitivity to identify serious disease. There are some quality control issues that have been recently identified including the necessity for further training to guide physicians involved in screening young athletes. Improvements in our understanding of young sudden cardiac death and ECG interpretation guideline modification to further differentiate physiological ECG patterns from those that may represent underlying disease have significantly improved the efficacy of screening to levels that may make screening more attractive and feasible to sporting organisations as a complementary strategy to increased availability of automated external defibrillators to reduce the overall burden of young sudden cardiac death

A Differential Diagnosis for Left Atrial Mass on Transthoracic Echocardiography: Hiatus Hernia

Hiatus hernia is a common medical condition. An elderly woman being investigated for dyspnoea of unknown aetiology had a transthoracic echocardiogram as part of her investigations. This alarmingly demonstrated a large left atrial mass. Further assessment with cardiac magnetic resonance imaging revealed a large hiatus hernia compressing the left atrium and no intra-cardiac mass. The case succinctly highlights gastrointestinal pathology simulating cardiac symptoms and masses

Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile

Background: Studies in middle aged and older (masters) athletes with atherosclerotic risk factors for coronary artery disease (CAD) report higher coronary artery calcium (CAC) scores compared with sedentary individuals. Few studies have assessed the prevalence of CAD in masters athletes with a low atherosclerotic risk profile. Methods: We assessed 152 masters athletes aged 54.4±8.5 years (70% male) and 92 controls of similar age, sex and low Framingham 10 year CAD risk scores with an echocardiogram, exercise stress test, CT coronary angiogram, and cardiovascular magnetic resonance imaging (CMRI) with late gadolinium enhancement (LGE) and a 24-hour Holter. Athletes had participated in endurance exercise for an average of 31±12.6 years. The majority (77%) were runners with a median of 13 marathon runs per athlete. Results: Most athletes (60%) and controls (63%) had a normal CAC score. Male athletes had a higher prevalence of atherosclerotic plaques of any luminal irregularity (44.3% vs 22.2%;p=0.009) compared with sedentary males and only male athletes showed a CAC ≥300 Agatson units (AU) (11.3%), and a luminal stenosis ≥50% (7.5%). Male athletes demonstrated predominantly calcific plaques (72.7%) whereas sedentary males showed predominantly mixed morphology plaques (61.5%). The number of years of training was the only independent variable associated with increased risk of CAC >70th percentile for age and/or luminal stenosis ≥50% in male athletes: OR 1.08 (95% CI 1.01-1.15);p=0.016. 15 (14%) male athletes but none of the controls revealed LGE on CMRI. Of these, 7 had a pattern consistent with previous myocardial infarction including 3(42%) with a luminal stenosis ≥ 50% in the corresponding artery. Conclusions: Most lifelong masters endurance athletes with a low atherosclerotic risk profile have normal CAC scores. Male athletes are more likely to have a CAC score >300 AU or coronary plaques compared with sedentary males with a similar risk profile. The significance of these observations is uncertain but the predominantly calcific morphology of the plaques in athletes indicates potentially different pathophysiological mechanisms for plaque formation in athletic versus sedentary men. Whereas coronary plaques are more abundant in athletes, their stable nature could mitigate the risk of plaque rupture and acute myocardial infarction