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athlete

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Sudden death of an athlete is the most devastating medical event in sports. While accidents account for more than 50% of these cases, sudden cardiac deaths (SCD) are less frequent (approx. 15%), but the leading medical cause of deaths. The risk depends on age, sex, ethnicity, type of sport and sport level. There are large variations in the methods of registration of SCD in recreational and competitive sports. This must be taken into account when interpreting reported incidences and causes. High data quality in registries is a prerequisite for meaningful preventive strategies (e.g. ECG screening and safety at sports facilities).
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Traditionally, cardiovascular screening has been recommended mostly for competitive athletes younger than 35 years. The perception that only young competitive athletes at top level are at increased risk, has changed in the last years. Theoretically, we advocate a voluntary cardiovascular screening for all athletes who exercise vigorously, independent of their competitive status, and age. Although, this should be based on an individual estimation of the athlete’s risk. Physical examination, medical history and an ECG should be the baseline investigations for all athletes.
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Leisure-time and elite athletes often seek sports medical advice for inadequate exertional dyspnea and loss of performance. The work-up has to rule-out underlying cardiac pathologies that are associated with sudden cardiac death, although commonly the symptoms are training- and not disease-related. Cardiopulmonary exercise testing (CPET) helps to differentiate between cardiac and pulmonary causes and guides further diagnostic and therapy. This article illustrates the potential of CPET in three clinical cases.
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