Doctors can now reliably detect heart abnormalities that could lead to sudden death in adult athletes, and should use the test whenever a healthy athlete experiences heart symptoms with exertion, a Florida team reports.
The test is based on computed tomography of the heart, which can show anomalies in the coronary arteries. "Coronary CT should be considered as the gold standard when a coronary anomaly is suspected in an athlete with cardiovascular symptoms related to exercise, regardless of his or her age," Dr. Eric E. Harrison of the Memorial Cardiovascular Center in Tampa and colleagues advise.

One in every 100,000 to 300,000 US athletes has a coronary anomaly, which may involve a coronary artery originating from an abnormal part of the heart, interfering with blood flow during exertion, Harrison and his colleagues note. However, more than half of young athletes with such heart defects may experience no symptoms at all before sudden death, they add in the April issue of Current Sports Medicine Reports.

The investigators describe three case studies of adult male athletes who experienced chest pain and fainting during exercise and were eventually found to have coronary anomalies.

In the first case, which occurred before the widespread use of cardiac CT to diagnose heart disease made the test readily available, a series of invasive tests including coronary angiography were necessary before the abnormality was identified. In the other two cases, doctors were able to use cardiac CT to spot both the malformation and the course of blood flow.

While coronary angiography can identify a misplaced blood vessel, it cannot always determine in which direction the blood is flowing, which is important in determining whether the flaw is potentially fatal, the researchers note. This test is also risky, they point out, because it requires injections of contrast material and the insertion of a catheter into the heart.

Whenever an otherwise healthy athlete experiences chest pain, fainting or heart palpitations with exercise, they conclude, coronary anomalies should be suspected, and tested for with coronary CT.