Screenings may play pivotal role in preventing cardiac events among athletes

Cardiology studies typically focus on the non-athlete, so there’s still much data to collect.

They are shocking instances: An athlete in the middle of competition suddenly drops to the floor in cardiac trouble. It happened, recently, to Denmark soccer player Christian Eriksen, who was hospitalized after collapsing during a European championship match on June 12.

One question on the minds of people who witness the event is simply: How could that happen to a healthy athlete? Another question: Could it have been prevented?

UCLA Health’s Dr. Jeff Hsu, MD, PhD, a member of the UCLA Sports Cardiology Program, is focused on finding the answers.

Dr. Hsu will be among a select group of cardiologists presenting at the American College of Cardiology “Care of the Athletic Heart” virtual event, June 24-26, to discuss sports cardiology research. Among his topics of discussion will be the importance of screenings, such as electrocardiograms (ECG), CTs, MRIs and ultrasounds.

Dr. Hsu stresses that screening strategies are key to preventing sudden cardiac events among athletes. Studies show anywhere from 1 in 40,000 to 1 in 80,000 athletes suffer sudden cardiac death annually.

“We’ve seen or heard stories where an athlete collapses on the court and this is always a tragedy, so the whole purpose of screening is to try to prevent these episodes from happening,” he said. “No screening strategy is perfect, but we’re trying to optimize our screening strategies as a global sports cardiology society.”

According to Dr. Hsu, there is a global effort to improve cardiovascular screening among athletes. However, countries differ on opinion when it comes to the best methods.

“There are different practice patterns between different countries,” Dr. Hsu said.

Dr. Jeff Hsu, MD, PhD (Photo by Joshua Sudock/UCLA Health)

The biggest difference comes down to who should be screened with an ECG. Dr. Hsu explained that in the U.S., the American Heart Association, American College of Cardiology and other groups advise that ECGs be performed only on young athletes with concerning symptoms, abnormalities, or with risk factors such as a family history of heart disease. The European Society of Cardiology, on the other hand, recommends all athletes be screened with ECG.

ECGs measure the electrical activity in the heart with the use of electrodes attached to the body.

Cardiology: athletes vs. non-athletes

Sports cardiology is a fairly new specialty compared to other medical service lines, so cardiologists are pushing to accumulate as much data as possible.

“A lot of studies in cardiology, in general, are done on non-athletes. So, when we have an athletic patient in front of us, we’re looking at their ultrasound, images of their heart, their ECG, CT scans and their MRI. We want to know what changes we should be concerned about,” Dr. Hsu said.

“We know what’s normal in the general population, but we are still working to find out what’s normal in the athlete population.”

Two issues are known to be potentially more common among athletes: coronary artery calcification and scarring in the heart. Coronary artery calcification has been found to be more prevalent in the hearts of 50- and 60-year-old men who have a long history of endurance sports such as running and cycling.

“A large population of male athletes who have had decades of running and cycling have calcification in their coronary arteries,” Dr. Hsu said. “Normally, when we see patients with calcification in their arteries, we think of them being high risk. But we don’t know if it means the same thing if we see calcification in athletes. We’re trying to better understand what the implications are and how to best manage these patients.”

There is also concern among cardiologists that too much exercise can be damaging, Dr. Hsu said. When the body consistently goes through intense workouts, he said, inflammation can occur, potentially causing scarring of the heart muscle.

Cardiac MRIs performed on college athletes during the COVID-19 pandemic showed that a small percentage of athletes who had COVID-19 also had scarring. Doctors were left wondering if the scarring was linked to COVID-19, or simply to the athletes training hard. Dr. Hsu said it is possible this is the normal pattern of a cardiac MRI of a young competitive athlete.

“Exercise is definitely good, but we’re still trying to determine if you can have too much exercise,” Dr. Hsu said.

Identifying cardiac symptoms

Whether you’re an athlete or not, don’t ignore symptoms of cardiovascular distress, including:

  • Fatigue or shortness of breath
  • Pressure or squeezing pain in your chest or arms
  • Nausea
  • Dizziness
  • Heartburn
  • Cold sweats

If you experience any of these symptoms, contact your primary care physician or make an appointment to see a specialist in heart services at UCLA.


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