In young athletes sudden cardiac death can have various causes (see Table: causes of sudden cardiovascular death in young athletes-*); the most common is, however,
About 1 / 200,000 apparently healthy young athletes developed without notice ventricular tachycardia or ventricular fibrillation and sudden death during exercise. Men are 10 times more frequently affected than women. Basketball and football player in the US and soccer player in Europe seem to have the highest risk. In young athletes sudden cardiac death can have various causes (see Table: causes of sudden cardiovascular death in young athletes-*); However, the most common is an undiscovered hypertrophic cardiomyopathy concussion cordis (sudden ventricular tachycardia or ventricular fibrillation by a blow to the precordium) is a risk in athletes with thin, flexible chest walls, even if no cardiovascular disease is present. The strike against Bruskorb may be caused by Projektiel with medium force (eg. As by a baseball, hockey puck or lacrosse ball) or by a collision with another player in the vulnerable phase of myocardial repolarization. Other causes include congenital arrhythmia syndromes (z. B. Long QT syndrome, Brugada syndrome). Some young athletes die from the rupture of an aortic aneurysm (at a Marfan syndrome). In older athletes sudden death typically caused by coronary heart disease. Occasionally are also other conditions such as hypertrophic cardiomyopathy, mitral valve prolapse or acquired valvular based. In case of other zugrnudeliegenden sudden cardiac death disease (eg. As bronchial asthma, heat stroke or complications as a result of taking illegal or performance enhancing drugs) are ventricular tachycardia or ventricular fibrillation not the primary but the terminal event. Symptoms and signs of the same as those of a cardiovascular collapse; the diagnosis is clear. The immediate cardiopulmonary resuscitation is successful in <20% of cases; perhaps the success rate increases with the proliferation of publicly accessible automated external defibrillators. The survivors have the therapy in the treatment of the underlying disease. In some cases, an implanted defibrillator may ultimately be necessary. Causes of sudden cardiovascular death in young athletes-* Obstructive hypertrophic cardiomyopathy concussion cordis coronary anomalies (eg. As atypical origin of the left coronary artery, atypical origin of the right coronary artery, anomalous coronary artery origin rechtee, Koronarhypoplasie) Cardiac hypertrophy myocarditis Ruptured aortic aneurysm Arrhythmogenic right ventricular dysplasia Tunneled (intramyocardial running) left anterior descending artery stenosis early manifestation of coronary heart disease dilated cardiomyopathy myxomatous degeneration of the mitral valve Long QT syndrome Brugada syndrome Wolff-Parkinson-White syndrome polymorphic (for antegrade line) Catecholaminergic tachycardia tachycardia of the right ventricular outflow tract coronary spasm Cardiac Sarcoidosis Cardiac Trauma Ruptured cerebral aneurysm * Causes are listed by approximate frequency of occurrence. Cardiovascular sports fitness test athletes are screened in general to identify the risk before a sporting burden. They are every 2 years (high school age) or every 4 years (college-age or older) re-examined. Screening recommendations for all children, adolescents and young adults in college-age include medical, family and drug history (including the taking of performance-enhancing drugs and medications that can lead to long QT syndrome) Physical examination (including blood pressure and auscultation the heart in the supine and standing) Selective investigations based on abnormalities in history and physical examination. Clinical Calculator: QT interval correction (ECG) screening for older adults includes symptom-limited stress test stages. The medical history and physical examination are neither sensitive nor specific; false-negative and false-positive findings are very low due to the low prevalence of cardiac disease in presumably healthy. A screening using ECG or echocardiography screening would certainly improve the early detection of heart disease, but would produce the more false-positive results and is not practical for the overall population. Genetic testing for hypertrophic cardiomyopathy or long QT syndrome are not recommended for screening of athletes and also not feasible. Selected tests For athletes with a family history or symptoms or signs of hypertrophic cardiomyopathy (hypertrophic cardiomyopathy), the Long QT syndrome (long QT syndrome and torsade de pointes tachycardia) or Marfan syndrome (Marfan syndrome ) is a more detailed assessment usually with ECG, echocardiography, or both erforderleich. The confirmation of these conditions can optionally exclude a sporting activity. In athletes with syncope (n. D. Talk .: In Germany, a further cardiological diagnostics already in case of a presyncope among young people recommended) or syncope should have a anomalies of the coronary arteries (z. B. by cardiac catheterization) are excluded. Should show the ECG AV block II type Mobitz, complete heart block, complete right bundle branch block or left bundle branch block, or if clinical or electrocardiographic evidence of supraventricular or ventricular arrhythmias are present, the search for the presence of heart disease is needed. If in echocardiography (or random) is detected an enlarged aorta, further investigation notwendig.Empfehlungen addition, athletes are not recommended by the use of illegal performance-enhancing drugs. Patients with mild or moderate heart valve disease can operate energetically; However, patients with severe valvular heart disease (especially the stenotic variant) can not run a competitive sport. Summary Sudden cardiac death during exercise is rare and usually due to hypertrophic cardiomyopathy (younger athletes) or coronary heart disease (older athletes) is caused. Younger participants (children up to young adults) should be screened by history and physical examination; in those with abnormal findings or a positive family history ECG should be performed echocardiography. Older participants should be screened by history, physical examination and usually stress test.