1. Experience of Cardiac Screening in Elite Men's Water Polo Team
Stan Baltsezak MD, MSc (SEM), DFSRH, DSEM, MFSEM (UK), English Institute of Sport, Manchester, UK
Contact email: stanislav@doctors.org.uk
European society of cardiology and
International Olympic Committee
recommend cardiac screening for any
young person taking part in
c o m p e t i t i v e s p o r t . R e g u l a r
participation in athletic competition is
associated with an increased risk for
sudden cardiac death (SCD). Relative
risk is increased by 2.8 times
c o m p a r e d w i t h n o n - a t h l e t e s
(Ljungqvist et al. 2009 Br J Sports
Med 43:631-643). It is not the sport
but combination of intensive physical
e x e r c i s e w i t h u n d e r l y i n g
cardiovascular disease that can
trigger life threatening arrhythmia
leading to SCD. It has been
demonstrated that adding 12 lead
ECG to history and examination
results in a substantial increase in the
ability to identify potentially lethal
heart disorders (Corrado et al. 2005
Eur Heart J 26 (5): 516-524.).
However, the debate regarding what
constitutes the best cardiac screening
in sport is still on-going (Hamilton et
al. 2012 Br J Sports Med 46:i9-i14.).
Preparticipation physical evaluation
history form (which includes 12 heart
health questions) (2010 retrieved on
0 1 J u n e 2 0 11 f r o m h t t p : / /
www.aafp.org/online/en/home/
clinical/publichealth/sportsmed/
p r e p a r t i c i p a t i o n - e v a l u a t i o n -
forms0.html) (table 1 and table 2),
ECG and echocardiogram (provided
by Cardiac Risk in the Young team)
were used to screen for inherited
cardiac diseases. Blood pressure,
weight and height were also
measured.
Introduction
Performance question
Methods
Results
Conclusion
What is the best way to screen for
underlying cardiovascular problems
in elite athletes?
Combination of history, ECG, and
echocardiogram is a thorough initial
way to screen elite athletes for
cardiac diseases causing SCD.
Echocardiogram allows detection of
some cardiac abnormalities even in
the presence of normal ECG.
However, it may increase chances of
having further investigations and
consequently create anxiety for the
athlete and his/her family. A proper
informed consent should be taken
before cardiac screening is initiated.
Picture 1. ECG changes showing
intravetricular conduction delay and LVH
(typical group 1 training related changes).
Table 2 . Personal ‘heart health’
questions.
Heart health questions about you
1. Have you ever passed out or nearly passed out
during/after exercise?
2. Have you ever had discomfort, pain, tightness,
or pressure in your chest during exercise?
3. Does your heart ever race or skip beats during
exercise?
4. Has a doctor ever told you that you have any
heart problems? (high BP, cholesterol, Kawasaki
disease, heart murmur, heart infection etc.)
5. Has a doctor ever ordered a test for your
heart?
6. Do you get lightheaded or feel more short of
breath than expected during exercise?
7. Have you ever had an unexplained seizure?
8. Do you get more tired or short of breath more
quickly than your friends during exercise?
19 water polo players took part in the
screening. Mean age of the athletes
was 23 (19-32). According to the
questionnaire form, 7 players were
highlighted as having potential cardiac
risk factors either from family or
personal history: 3 sportsmen
answered ‘yes’ to questions from
family heart health section, 1 player
answered ‘yes’ to a question from
personal heart health section and 3
players answered ‘yes’ to questions
from both sections.
Sinus bradycardia and isolated QRS
voltage criteria for left ventricular
hypertrophy (LVH) were the most
common ECG findings consistent with
training related changes (Picture1).
Family heart health history
1. Has any family member or relative died of
heart problems or had an unexpected or
unexplained sudden death before age 50
(including drowning, unexplained car accident,
or sudden infant death syndrome)?
2. Does anyone in your family have hypertrophic
cardiomyopathy, Marfan syndrome,
arrhythmogenic right ventricular
cardiomyopathy, long QT syndrome, Brugada
syndrome, or catecholaminergic polymorphic
ventricular tachycardia?
3. Does anyone in your family have a heart
problem, pacemaker, or implanted defibrillator?
4. Has anyone in your family had unexplained
fainting, unexplained seizures, or near drowning?
After echocardiogram, one player was
found to have mildly dilated left
ventricle with sluggish systolic
function. Another athlete had subaortic
bulge. None of the players was
advised to stop/reduce training or
s p o r t p a r t i c i p a t i o n a f t e r t h e
i n v e s t i g a t i o n s . P l a y e r s w i t h
echocardiogram abnormalities were
advised by a cardiologist to undergo
further tests. VO2 max followed by
echocardiogram was the next step in
investigating dilated left ventricle. A
player with subaortic bulge was
a d v i s e d t o r e p e a t E C G a n d
echocardiogram in two years time.
Table 1. Family health history.