Downloaded from http://bjsm.bmj.com/ on January 20, 2016 - Published by group.bmj.com

Warm up

communities. Physicians responsible for the Sports : preventing sudden cardiovascular care of athletes should be knowledgeable in the physiological cardiac cardiac death adaptations to regular intense exercise (athlete’s heart); the conditions associated 1 2 3 Jonathan A Drezner, Sanjay Sharma, Mathew G Wilson with SCD in athletes; and ECG interpret- ation standards that distinguish common training-related findings in athletes from BMJ Heart The sudden death of an athlete on the specialty journal to highlight changes associated with pathological fi playing eld remains one of the most strik- key areas in sports cardiology to the cardiac disorders and the secondary investi- ing and tragic events in sport. For the broader cardiology community. gations necessary to properly evaluate ECG – sports physician, the occurrence of an abnormalities.6 8 As a reminder, a compre- athlete in sudden cardiac arrest is both ADVANCING THE SCIENCE OF hensive E-Learning course addressing these unforgettable and terrifying. Well-known CARDIAC SCREENING areas is freely available at http://learning. cases such as Hank Gathers (1990), This issue presents many original investiga- bmj.com/ECGathlete. BJSM, along with its Marc-Vivien Foé (2003) and Fabrice tions that advance the cardiovascular care of partner societies, will continue to empha- Muamba (2012), provide graphic exam- athletes. While a standardised personal and sise new research and education towards ples of an athlete enduring this deadly family history is widely recommended for the effective prevention of SCD in sport. crisis—collapsed and unresponsive, eyes cardiac screening in athletes, the actual rolled back, brief myoclonic seizure-like questionnaires utilised remain largely Competing interests None. activity and perhaps the presence of agonal unstudied. Fudge and colleagues analyse Provenance and peer review Not commissioned; respirations as limbs go from rigid to limp. history responses to the Pre-Participation internally peer reviewed. For physicians responsible for the medical Evaluation Monograph, 4th Edition, and care of athletes, a single universal priority compare to ECG screening in a population should guide our clinical efforts, namely to of active adolescents and young adults.1 In a protect the health and safety of athletes. critically important study, Asif and collea- This journal once again assumes a leading gues examine the psychological impact of role in the field of sports cardiology by cardiac screening to address the assumption To cite Drezner JA, Sharma S, Wilson MG. Br J Sports Med presenting current information relevant to that ECG screening causes undue anxiety in 2014;48:1133. the prevention of sudden cardiac death athletes (seepage1162). In addition, Tipton Accepted 9 June 2014 (SCD) in athletes. explores the increased rate of SCD during Br J Sports Med 2014;48:1133. open water swimming through his novel doi:10.1136/bjsports-2014-093922 INCIDENCE OF SCD: AT THE HEART theory on autonomic conflict (see page OF THE MATTER 1134), and Pelliccia discusses whether Cardiac screening of young individuals patients with long QT syndrome can partici- engaged in regular exercise to detect silent pate in sports safely (see page 1135). REFERENCES yet potentially lethal cardiac disease is uni- 1 American Academy of Family Physicians, American ECG INTERPRETATION: TESTING OUR Academy of Pediatrics, American College of Sports versally supported. However, intense Medicine, American Medical Society for Sports debate continues regarding the most STANDARDS Medicine, American Orthopaedic Society for Sports effective and feasible method for screen- When evaluating the potential value and Medicine, American Osteopathic Academy of Sports ing. Central to the development and evalu- limitations of ECG screening, it is import- Medicine. Preparticipation physical evaluation. 4th ation of effective prevention programmes ant to recognise that the total-positive and Edn. American Academy of Pediatrics, 2010. 2 Corrado D, Pelliccia A, Heidbuchel H, et al. is an accurate assessment of the incidence false-positive rates are largely affected by Recommendations for interpretation of 12-lead of SCD in athletes. Methodological limita- the criteria selected to define ECG abnor- electrocardiogram in the athlete. Eur Heart J tions and heterogeneity have provided a malities. In recent years, interpretation 2010;31:243–59. wide range of estimates of the risk of SCD standards to detect life-threatening cardiac 3 Uberoi A, Stein R, Perez MV, et al. Interpretation of the electrocardiogram of young athletes. Circulation in sport. Harmon and colleagues (see page conditions in young athletes have under- – fi 2011;124:746 57. 1185) present a state-of-the-art review on gone several modi cations to improve 4 Drezner JA, Ackerman MJ, Anderson J, et al. 2–4 the incidence of SCD in athletes, carefully the accuracy of ECG screening. Electrocardiographic interpretation in athletes: the examining study methodology and the reli- Brosnan and colleagues (see page 1144) ‘Seattle criteria’. Br J Sports Med 2013;47:122–4. et al ability of reported estimates. This article is test the sensitivity and specificity of the 5 Drezner JA, Asif IM, Owens DS, . Accuracy of ECG fi interpretation in competitive athletes: the impact of the rst in a series of state-of-the-art Seattle criteria in a cohort of elite using standardised ECG criteria. Br J Sports Med reviews that will be co-published in the Australian athletes. Exeter and colleagues 2012;46:335–40. also investigate the value of using standar- 6 Drezner JA, Fischbach P, Froelicher V, et al. Normal fi 1 dised criteria for ECG interpretation in electrocardiographic ndings: recognising physiological Department of Family Medicine, University of adaptations in athletes. Br J Sports Med 2 competitive athletes (see page 1167), and Washington, Seattle, Washington, USA; Cardiovascular 2013;47:125–36. Sciences Research Center, St George’s University of Riding and colleagues describe ECG and et al 3 7 Drezner JA, Ashley E, Baggish AL, . Abnormal London, London, UK; Department of , echocardiographic adaptations in Arab electrocardiographic findings in athletes: recognising Aspetar Orthopaedic and Sports Medicine Hospital, athletes.5 changes suggestive of . Br J Sports Doha, Qatar Med 2013;47:137–52. Correspondence to Dr Jonathan A Drezner, 8 Drezner JA, Ackerman MJ, Cannon BC, et al. Department of Family Medicine, University of EDUCATION IS KEY! Abnormal electrocardiographic findings in athletes: Washington, Box 354060 Seattle, WA 98195, USA; Prevention of SCD in athletes remains a recognising changes suggestive of primary electrical [email protected] fundamental goal of the sports and medical disease. Br J Sports Med 2013;47:153–67.

Drezner JA, et al. Br J Sports Med August 2014 Vol 48 No 15 1133 Downloaded from http://bjsm.bmj.com/ on January 20, 2016 - Published by group.bmj.com

Sports cardiology: preventing sudden cardiac death

Jonathan A Drezner, Sanjay Sharma and Mathew G Wilson

Br J Sports Med 2014 48: 1133 doi: 10.1136/bjsports-2014-093922

Updated information and services can be found at: http://bjsm.bmj.com/content/48/15/1133

These include: References This article cites 7 articles, 7 of which you can access for free at: http://bjsm.bmj.com/content/48/15/1133#BIBL Email alerting Receive free email alerts when new articles cite this article. Sign up in the service box at the top right corner of the online article.

Notes

To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions

To order reprints go to: http://journals.bmj.com/cgi/reprintform

To subscribe to BMJ go to: http://group.bmj.com/subscribe/