Sudden cardiac death: Prevention and recommendations for physical activity

Physical activity provides many well-documented health benefits, while physical inactivity is a leading risk factor for cardiovascular morbidity and mortality. In order to achieve these benefits, one must expose himself to relatively moderate physical activity. However, many athletes and recreationists go beyond these limits and engage in higher level of physical activity. Occasionally, intense physical activity is associated with sudden death in individuals with concealed heart disease. Despite the media attention provided by such accident, the reputation of physical activity remains intact, as most deaths can be explained by a basic cardiac abnormality where exercise is only the trigger of a fatal arrhythmia, not the actual cause of death. The paradox is that athletes with these abnormalities show identical performance in the form of minute heart volume compared to healthy individuals. In athletes younger than 35, congenital heart disease, especially hypertrophic cardiomyopathy and congenital coronary artery abnormalities, are the leading cause of sudden cardiac death, while most athletes older than 35 die due to atherosclerotic changes in the coronary arteries. Pre-competition screening with apparently healthy individuals is the only way to prevent sudden cardiac death in sports. When diagnosing a specific condition of the cardiovascular system, it is necessary to determine the risk of sudden cardiac death associated with continued physical activity and competitive sports activity, and to define clear disqualification criteria for each athlete individually.