Sudden Cardiac Death in Young Athletes

Sudden cardiac death is very rare in young athletes (<35 years of age), however, it is the most common medical cause of death in the athletes. There are tests, commonly performed as a preparticipation screening, to detect the abnormal heart rhythms that lead to SCD, however, the tests can also have false-positive results and can miss some heart abnormalities.

There are no current standards for what needs to be included in athlete preparticipation screening but personal and family histories, physical examination (PE), and 12-lead electrocardiography (ECG) are most commonly used. Would ultrasound help to increase the efficacy of the screening?

Point-of-care ultrasound (POCUS) provides real-time bedside images that can assist in clinical decision making by potentially identifying dilated cardiomyopathy, aortic root dilatation, and coronary artery anomalies, which history, PE, or ECG frequently miss.

In a recent study to determine whether POCUS would be a beneficial adjunct to the preparticipation screening, the researchers found that although POCUS would have resulted in a 4-fold decrease in referrals, that was based on older studies using now outdated ECG guidelines. The 2017 guidelines greatly reduced the number of false-positives results, so adding POCUS as an adjunct would not create such a large decrease anymore.

POCUS did identify one primary diagnosis, left ventricular noncompaction, which was not identified by any other part of the screening. So, although the value of a POCUS adjunct may not be in reducing false-positives, it’s value may be in identifying anatomic anomalies.

Read the full article on the study by Cassels M, Moulson N, Reganin J, et al, in “Point-of-Care Ultrasound as a Component of Preparticipation Screening of Athletes: A Systematic Review” in the Journal of Ultrasound in Medicine (J Ultrasound Med 2019; 38:3123–3130. doi: 10.1002/jum.15021).

Interested in learning more about ultrasound for athletes? Check out the following resources from the American Institute of Ultrasound in Medicine (AIUM):