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The Hurdles of Heart Health

Many athletes could be at risk for sudden cardiac arrest.
By University of Maryland Medical Center

Exercise is known to support a long and happy life, but at what point does it become life-threatening? It seems contradictory—there are well-documented beneficial effects of regular exercise for prevention of cardiovascular disease, and yet, heart complications are becoming more common in the sports world. As heart conditions continue to go undiagnosed, both weekend warriors and student athletes could be at a greater risk for sudden cardiac arrest.

Modern medicine has us more aware of heart health, so screenings and support are readily available. Most importantly, for regular athletes or even those just starting their first 5k, it’s best to be screened for any abnormalities, be aware of symptoms, and to—of course—practice safe exercise. To find out more about the growing practice of sports cardiology, we went to an expert, Scott Jerome, DO, assistant professor of medicine at the University of Maryland School of Medicine and co-director of the sports cardiology program at the University of Maryland Heart and Vascular Center, who has spent much of his career studying this issue.

What exactly is sports cardiology and why is it important?

Sports cardiology is a subspecialty within cardiology that deals with athletes and their hearts. More and more people are exercising regularly these days and this puts a unique strain upon the heart. Sports cardiologists can treat athletes of all ages. For high school and college athletes, there are many potential cardiac problems that may have been present at birth and that, when left untreated, could put them at risk while playing sports. In the adult athlete and recreational competitor, there is a different set of cardiac problems that can also put them at risk for heart attack or death. Although people who exercise regularly generally live better and longer than those who do not, the risks are still there.

Sports cardiology is a subspecialty within cardiology that deals with athletes and their hearts.

Because the consequences of a cardiac issue can lead to sudden death, a sports cardiologist is uniquely focused on the risk factors in these athletes and recreational sports participants. It is critical to identify cardiac issues through early screening, as well as effective treatment and prevention, so people can continue to participate in their favorite activities.

What are some of the cardiac symptoms a person should be aware of? Do they present over time or are they immediate?

Symptoms of a cardiac issue can either be present for a while or appear suddenly. A key indicator is a change in one’s exercise ability. For example, if you used to easily run two miles but now have difficulty running just one, it may be an indication to see a sports cardiologist. Other symptoms include increasing shortness of breath, passing-out spells, or chest, left arm, jaw or upper back pain. Another important symptom is increased palpitations, such as a skipping or racing heartbeat. If you experience any of these symptoms, it is important to check with your doctor or see a sports cardiologist for an athletic screening.

What does the athletic screening process look like?

The screening process starts off with discussing any symptoms you’re experiencing, your family history, and your lifestyle activities. It is key to conduct a physical exam and use a stethoscope to listen for cardiac murmurs, as well as search for other signs of vascular disease. If there are concerns, additional tests may be necessary, including an electrocardiogram (EKG), a cardiac ultrasound, or even sometimes a cardiac CT scan or MRI.

Another aspect of the screening and safety process is ensuring that emergency precautions are readily available, including staff with knowledge of CPR, possibly having an automated external defibrillator (AED) onsite, and an emergency protocol in place at all athletic facilities. If inadequately prepared, it could come down to a matter of life and death.

What triggers sudden cardiac death in young athletes?

Sudden cardiac death in a young athlete can be triggered by many things, which is why pre-screening is essential. One unique trigger is a powerful hit to that chest that causes a heart-rhythm problem and could lead to sudden death. Other triggers include dehydration, extreme heat or humidity, and excessive amounts of activity. Again, an athletic screening appointment can identify specific triggers and a sports cardiologist can recommend prevention strategies.

Are there treatments available?

Yes. Depending on an athlete’s specific cardiac condition, there are all kinds of treatments available at the University of Maryland Heart and Vascular Center. It could be as simple as changing your training or exercise program, to taking a pill, to more complex treatments.

Tell us about common risks and best means of prevention.

Common sense plays an important factor in athletes of all ages. Be mindful of the weather for heat and humidity. Maintaining good hydration is also important during peak summer seasons. Drink frequently and check the color of your urine–it should be near clear. If not, you may be dehydrated and need to drink more.

A common mistake people make when beginning an exercise program is starting out too fast and hard. It is best to start with a gradual increase in duration and intensity of physical activity.

For people over 35, risk factors include being overweight, smoking, diabetes, a family history of heart disease, and a sedentary lifestyle. It is important to diagnose blockages in blood vessels and heart-valve abnormalities early on. The development of plaque within a blood vessel begins very early in life and grows without symptoms for many years.

Up to 50 percent of the time, untreated heart disease leads to sudden death. Because of this, pre-screening before beginning exercise is critical. Anyone who is just starting an exercise program, plans to increase the intensity of their current exercise regime, or has risk factors should be evaluated.