The Cardiovascular Complications of Vigorous Physical Activity

OBJECTIVE: To review the cardiovascular risks of exercise for practicing physicians. DATA SOURCES: Relevant medical literature as well as the author's clinical and research experience on the topic. RESULTS: The predominant causes of exercise-related cardiovascular complications are congenital abnormalities in young subjects and atherosclerotic coronary disease in adults. The absolute incidence of exercise deaths is low. Only approximately 0.75 and 0.13 per 100,000 young male and female athletes and 6 per 100,000 middle-aged men die during exertion per year. Nevertheless, exercise does acutely and transiently increase the risk of cardiac events. CONCLUSIONS: Routine cardiovascular testing to prevent exercise events (echocardiography in the young and exercise testing in adults) has limited usefulness because of the rarity of such events, the cost of screening, and poor predictive accuracy of exercise testing for exercise events. Physicians should (1) perform routine screening and cardiac auscultation in young athletes; (2) carefully evaluate exercise-induced symptoms; and (3) ensure that adults know the symptoms of cardiac ischemia.