Dr Butts acts as a specialist advisor and consultant to the board of HeartBeat of Sport, a local charity situated in Elland, West Yorkshire. The charity was set up to reduce sudden cardiac death, related to sporting activities. It is involved in local education about the signs and symptoms of heart disease, in addition to promoting the use of defibrillators at training and sports venues.
The charity is developing a screening service for individuals competing in sport, so that underlying heart disease can be effectively diagnosed, preventing future cardiac events. This involves the screening of athletes at different levels, including semiprofessional and recreational where screening is not routinely available.
Dr Butts will be posting answers to sports cardiology questions commonly raised by individuals in the community and at screening days to offer insight into the area.
Please do visit the charity and offer your support at http://www.heartbeatofsport.org/.
Sports Cardiology Question and Answer Section
If I am successfully screened for underlying heart problems does this last throughout my career or will I need further screening at a later stage?
If you have passed a structured cardiac screening programme, then the likelihood of suffering a cardiac event during sport or training, such as a heart attack or cardiac arrest is very low. Screening offers a level of reassurance that no abnormalities have been detected at the time. As people age, irrespective of whether they play sport, there is a chance of them developing new conditions or abnormalities of their heart muscle that were not previously present. The vast majority of individuals will not develop any problems for many years to come, however a minority will do. This becomes increasingly relevant in sports that attract older participants, as certain conditions such as coronary disease (narrowings in the arteries to the heart) are very uncommon in the young, but become more common later in life. An initial screening goes a long way to excluding structural heart disease of the valves and heart muscle, along with detecting certain abnormalities of the heart rhythm and conduction. These conditions can also develop as people age however leading to positive screening at a later stage.
We need to first consider that a majority of individuals undertaking sport or intensive exercise, go through no formal screening and so if you have successfully completed a programme then you should be reassured. When we consider that things can change through life, then it would be reasonable to consider further screening at intervals or indeed present earlier to a doctor, if you develop any worrying symptoms such as exertional lightheadedness, unexplained loss of consciousness, exertional chest pain / tightness or excessive shortness of breath.
How common is sudden cardiac arrest in athletes?
Sudden cardiac arrest is uncommon in athletes, but has a profound affect on them and their families when it does occur. Naturally, those events that occur in professional sports people attract a lot of media coverage, raising the profile of sudden cardiac death and cardiac arrest. Those people who collapse whilst playing recreational sport conversely attract little media attention and so these episodes the public rarely hear about. Most cardiologists will treat patients of different ages who have either had a cardiac arrest during exercise or have presented earlier due to their experiencing symptoms.
If there is an underlying problem, many would prefer that it be detected earlier, offering the opportunity for treatment and lifestyle advice. Cardiac arrest once it does occur has a high rate of death and other serious consequences including hypoxic brain injury (damage to the brain due to lack of oxygen). It is for this reason that immediate CPR (cardiopulmonary resuscitation) and the availability of community resources such as defibrillators allows prompt treatment, increasing the chances of early survival until a medical team arrive.
On a first aid course I was instructed in CPR. Can I do more harm than good if it is done incorrectly or badly?
There is an understandable level of anxiety amongst the public about the delivery of resuscitation. They will rarely have ever been in the situation before and may be concerned that they will do harm. This is not something that you should be unduly worried about. First do check that the person is unconscious (rather than asleep) and is not breathing or has no pulse. If this is the case then without prompt resuscitation that person will often die.
Poor quality resuscitation is probably a lot better in this situation than no resuscitation at all. Often you will only need to resuscitate the person for a short period of time, before either the emergency services arrive or someone else with first aid experience helps. These first minutes however are crucial to the persons survival and so dont be afraid of acting quickly. I have never in my career criticised a member of the public for acting promptly and we do appreciate the pressure that you are under. If the person does survive and your good work has caused them some temporary chest wall discomfort, then I suspect they will be delighted that you did it and grateful that you saved their life.
What is the difference between a cardiac arrest and a heart attack?
A heart attack is caused by a blockage in one of the blood vessel supplying blood to the heart. This can and often does occur outside of the setting of exercise. It is triggered by an event in the coronary artery itself, leading to the formation of a blood clot. This starves part of the heart muscle of oxygen, leading to heart damage. The symptoms of a heart attack are wide and varied. The most common symptoms include chest tightness or pressure, shortness of breath, neck discomfort or left arm pain. It may however present with indigestion like symptoms or back pain.
A heart attack can certainly lead to a cardiac arrest where the heart either stops or develops a fast dangerous heart rhythm that prevents the heart from functioning. In this setting the heart stops pumping blood to the body and brain leading to sudden collapse and loss of consciousness.
There are however a wide range of other conditions that can lead to cardiac arrest in the setting of exercise. These include abnormalities of the heart valves, heart muscle (cardiomyopathy), coronary arteries (which may be present from birth), electrical conduction and conditions predisposing to abnormal heart rhythms. Many of these can be detected by screening although no screening programme can detect everything.
Useful Educational Links
Journal of the American College of Cardiology: Bethesda Conference 36 and the European Society of Cardiology Consensus Recommendations Revisited: A comparison of US and European criteria for eligibility and disqualification of competitive athletes with cardiovascular abnormalities.