at the Olympic Medical Institute (OMI). It offers a specialist cardiac referrals clinic at the OMI, for assessment and diagnosis of any suspected cardiac abnormalities within athletes. In addition it also operates a mobile screening unit where CRY will visit the group requesting screening. The initial cardiovascular evaluation of a mobile screening consists of a personal and family history, physical examination by a sports cardiologist with specific expertise in athletes 12-lead ECG and possible echocardiography. Due to sponsorship from Philips, who have generously donated state of the art equipment and funding, over the next two to three years we are currently able to offer full mobile cardiac screening (including echocardiography), to Olympic sports. This initiative was launched in London in July 2007 and the first screening took place at the National Cycling Velodrome in Manchester in October 2007, where a number of the GB cycling team were screened. Additional testing is also available as requested by the examining cardiologist that includes exercise stress testing, contrast and/or transesophageal echocardiography, 24- hour holter monitoring and cardiac MRI amongst others.

DIAGNOSIS AND MANAGEMENT

Diagnosing potentially fatal cardiac conditions can prevent SCD by reducing the amount of intensive training and competition that athletes are involved in. Early diagnosis is

important but can be problematic. Athletic training can lead to adaptive changes that mimic and overlap clinical characteristics cardiac disease states and this physiological response to increased workload is referred to as “Athletes Heart”(12). Differentiating between a clinical diagnosis of pathology and physiologic changes is of extreme importance. An incorrect diagnosis of cardiac disease in an athlete will lead to unnecessary withdrawal from competition. This in turn could have highly debilitating effect on the athlete in terms of physical, psychological and financial well-being. Alternatively, a failure to diagnose correctly may result in a life threatening condition going unnoticed (12). If a diagnosis is identified, management of the athlete is dependent on the condition diagnosed. Since most deaths occur either during or after physical exercise, it is often advisable to recommend that the athlete no longer takes part in either medium or high intensity exercise. This may be difficult and even impossible as some athletes may be prepared to accept the risk of SCD and continue to be involved in sport. Drug therapy can also be implemented to help control certain symptoms and the implantation of an internal cardiac defribulator (ICD) is recommended with some patients with conditions such as HCM, ARVC, long QT and Brugada (12).

CONCLUSIONS Whilst sudden death is uncommon, its impact is enormous. A screening programme consisting of personal and family history and 12-lead ECG has been shown to be effective in the detection of conditions that have the potential to cause sudden cardiac death. However, Screening carries resource and cost implications. The CRY/Philips© programme offers opportunities for screening without financial burden allowing the opportunity to evaluate the efficacy

TH C THE AUTHOR

Anthony Shaw BSc, is the screening manager at the CRY Centre for Sports Cardiology, responsible for the running of CRY’s specialist athlete referrals clinic at the centre and its cardiac screening programme. Previously, he studied sports

, is the screening manager at the C

science at the University of Wolverhampton and has worked for the Medical Research Council and Great Britain Rowing.

8 sportEX medicine 2008:36(Apr):6-8

of pre-participation cardiovascular screening. In support of this and other programmes, raising awareness within the UK together with specialist clinics are important in improving the quality of care for athletes.

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