Ppe Sm 07s

Sudden Cardiac Death in young athletes: “Screening forthe needle in a haystack” < 35 years of Age

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

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

PREPARTICIPATION CARDIOVASCULAR SCREENIN

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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

Pre-participation Evaluation ƒ Resting ECG: ƒ Recoomended by ESC/IOC, but not the AHA

guidelines ƒ Detection of HOCM, channelopathy etc.

ƒ Treadmill stress test: ƒ Recommended for older athletes esp. at high risk

ƒ Echocardiogram: ƒ Cardiomyopathy: hypertrophic / RV dyplasia ƒ Valvular: AS, MVP, Aortic root dilatation ƒ Coronary anomaly

NCEP ATP III Framingham Risk Scoring Years 20-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79

Step 6: Adding Up the Points

Step 4: Systolic Blood Pressure

Step 1: Age Points -9 -4 0 3 6 8 10 11 12 13

Systolic BP (mm Hg) <120 120-129 130-139 140-159 • 160

Points if Untreated 0 0 1 1 2

Points if Treated 0 1 2 2 3 Step 7: CHD Risk

Step 2: Total Cholesterol TC (mg/dL) <160 160-199 200-239 240-279 • 280

Points at Age 20-39 0 4 7 9 11

Points at Age 40-49 0 3 5 6 8

Points at Age 50-59 0 2 3 4 5

Points at Age 60-69 0 1 1 2 3

Points at Age 70-79 0 0 0 1 1

Step 3: HDL-Cholesterol HDL-C (mg/dL) >60

Points -1

50-59

0

40-49

1

<40

2

Age TC HDL-C Systolic BP Smoking status Point total

Point Total <0 0 1 2 3 4 5 6 7 8 9 10

10-Year Risk <1% 1% 1% 1% 1% 1% 2% 2% 3% 4% 5% 6%

Point Total 10-Year Risk 11 8% 12 10% 13 12% 14 16% 15 20% 16 25% 17 30%

Step 5: Smoking Status

Nonsmoker Smoker

Points at Age 20-39 0 8

Points at Age 40-49 0 5

Points at Age 50-59 0 3

Points at Age 60-69 0 1

Points at Age 70-79 0 1

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

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