The Importance of Pre-Exercise and Pre-Marathon Cardiac Screening
As cardiologists, we encourage regular moderate exercise to reduce your long term risk of heart disease.
An athlete’s sudden cardiac death is one of the tragic risks of strenuous exercise in the presence of a dormant cardiac abnormality.
Most major international sports organisations recommend a pre-exercise cardiac screening for the participants. The aim of screening is to identify these “silent” but high-risk problems that increase the risk of death due to high-intensity exercise.
In younger athletes – under 35 years – the usual causes of sudden cardiac death are due to structural abnormalities affecting the heart. These abnormalities can be genetic or acquired. They can affect the heart muscle, valves or anomalous origin of the coronary arteries. Another major subset of conditions that run a higher risk are electrical cardiac abnormalities. Cardiologists believe that the mechanism of sudden death is secondary to a malignant arrhythmia.
In older people, the most common cause of sudden cardiac death is due to coronary artery plaque rupture leading to a heart attack. High blood pressure, smoking, high LDL cholesterol, diabetes and a family history of premature coronary disease increase this risk.
The vast majority of individuals who suffered a fatal cardiac event showed no prior symptoms. Worrying clinical features include:
- Chest pains, giddiness, dizzy spells, palpitations or blackouts during exercise
- Feeling short of breath which is out of proportion to the intensity of the exercise
- Family history of a hereditary cardiac disorder or sudden cardiac death
The pre-exercise cardiac screening includes a medical history, physical examination, an ECG and echocardiogram. All the tests are safe, non-invasive, can be done at a clinic and take no longer than 1 hour to perform. Currently, genetic testing for common genetic cardiac conditions is not part of a cardiac screening.
Another pre-exercise screening test is cardiopulmonary exercise testing (CPET). This is a non-invasive simultaneous measurement of the cardiovascular and respiratory systems during exercise to assess an individual’s capacity. A CPET has many applications for evaluating a wide range of cardiac problems. The peak VO2 max achieved is a measure of someone’s maximal physiological uptake of oxygen. This means that it can act as a surrogate marker of cardiovascular fitness. The peak VO2 max can guide exercise training programs.
Pre-exercise screening has the potential to identify a high-risk subgroup of individuals. Based on the results, doctors can then tell them about their best exercise options. In the case of a high-risk patient, the screening will also provide an opportunity to prevent sudden cardiac death by implantation of an automated cardio-defibrillator.
Contributed by:
The Harley Street Heart & Vascular Centre
https://www.harleystreet.sg/heart/
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