Plötzlicher herztod bei sportlern

Regular physical activity is effective and well accepted in the prevention of cardiovascular and metabolic disorders and therefore an essential part of current guidelines. In contrast, acute exercise leads to recurrent cases of sudden cardiac death even in elite athletes, provoking incomprehension and consternation. Nonetheless, sudden cardiac death in athletes is a tragic but rare event. In young athletes it is mainly caused by hypertrophic cardiomyopathy, congenital coronary anomalies or myocarditis whereas in older ones coronary heart disease is the leading cause. The risk increases with inadequate fitness level and excessive intensity. A standardized pre-participation screening is recommended to exclude or treat potential causes. This should at least include detailed anamnesis and resting ECG. In persons above 35 years an additional exercise test and in elite athletes regular echocardiography is advised, followed by further examinations if indicated. This strategy has lead to a significant reduction of exercise-related sudden cardiac deaths in recent years. In addition, an adequate training protocol with several months of only moderate, slowly increasing intensity helps to prevent cardiac events during physical activity.