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November 21, 1996

Cardiovascular testing in athletes has limited value in preventing exercise-related sudden death

A University of Pittsburgh Medical Center (UPMC) cardiologist has found that routine cardiovascular testing to prevent exercise-related sudden death in athletes has limited usefulness because of the rarity of such events, the cost of screening and the poor accuracy of exercise testing for such events.

Despite problems with routine testing, however, Paul Thompson, UPMC director of preventive cardiology, still recommends that all young athletes undergo a brief cardiovascular examination by a practitioner who is aware of conditions that cause exercise-related cardiac events.

If an athlete cannot afford the examination, Thompson says schools should provide it, as well as cardiopulmonary resuscitation training for coaches.

Physicians also should inform exercising adults of the nature of cardiac symptoms, especially the fact that cardiac discomfort is often not perceived as pain, but as discomfort, tightness or heartburn. Symptoms such as fainting, difficulty in breathing and discomfort should be carefully evaluated in athletes of all ages.

Writing in the Nov. 11 issue of the "Archives of Internal Medicine," Thompson says that physicians should perform routine screenings on young athletes, carefully evaluate exercise-induced systems and make certain that adults know the symptoms of heart problems.

Coronary artery disease is the major cause of exercise-related cardiovascular complications in adults. In younger people, the main cause for cardiovascular problems is congenital abnormality.

Incidences of exercise death are low in young athletes, according to Thompson. Approximately 0.75 per 100,000 young male athletes are struck by exercise-related sudden death and 0.13 per 100,000 females.

About six per 100,000 middle-aged men die during exertion each year.

Even though there is a low risk of cardiac problems during exercise in previously healthy athletes, the death rate per hour of exercise increases as activity continues. A study in Rhode Island found that the relative risk of sudden death from exercise was seven times higher during jogging than other activities.

Routine testing is recommended to detect hypertrophic cardiomyopathy or inflammation of the heart muscle, the leading cause of sudden death. According to Thompson, though, five studies involving more than 5,000 high school and college athletes found no definite cases of hypertrophic cardiomyopathy.

Filed under: Feature,Volume 29 Issue 7

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