Abstract

Sudden death in the athlete has intrigued the medical community and the public since the initial report of the unexpected death of the Greek soldier Pheldippides on completing his historic run from Marathon to Athens to deliver the message of victory over the Persians in 490 B.C. Because sudden death in an athlete is relatively uncommon, the identification of athletes at risk remains a considerable challenge. Although approaches to the prediction and prevention of sudden cardiac death in the athlete have evolved in the last few years, much remains unknown regarding optimal screening strategies, pathophysiologic mechanisms, and prevention. Many of the underlying cardiovascular diseases responsible for sudden death with exercise are now identified; they include hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, Wolff-Parkinson-White syndrome, anomalous origin of the coronary arteries, and the inherited long QT syndromes. Guidelines for screening to detect predisposing cardiovascular conditions now exist for high school and college athletes. Appropriately designed epidemiologic studies and a prospective registry are needed to monitor the efficacy and cost of this strategy. In order to prevent fatalities and unnecessary restriction on athletic participation, the best available information has been used to update consensus recommendations regarding the eligibility for competition of athletes with cardiovascular disease. This book was conceived to fulfill the need for a comprehensive text that would serve as an authoritative reference for the medical and athletic community and the public with an interest in the issues involved in the screening, evaluation, or care of athletes. It is written to provide scholarly yet practical reference for the family practitioner, pediatrician, internist, sports medicine physician, cardiologist, team physician, and athletic trainer. The prediction and prevention of sudden cardiac death in the athlete is viewed from multiple perspectives. The book uses a multidisciplinary approach to incorporate current information on epidemiology, cardiovascular pathophysiology, screening guidelines, recommendations for participation, and the vexing legal and ethical issues. Aus dem Vorwort