How Can the Risk of Sudden Cardiac Arrest in Athletes Be Prevented With Check-Up?

The risk of sudden cardiac arrest in athletes cannot be completely eliminated with pre-sports and regular health evaluations, but it can be noticed earlier and precautions can be taken for risky conditions. The aim of the check-up process is to evaluate individually the risks of heart rhythm disorders, structural heart diseases, heart muscle diseases or vascular disease that may be triggered during exercise.

Sudden cardiac arrest is the sudden stopping of blood circulation due to serious disturbances in the electrical system of the heart. Although it is rare in athletes, it has special importance in athlete health evaluations because its impact is very serious. The European Society of Cardiology states that sudden cardiac death is one of the most feared conditions in sports cardiology and that understanding risky conditions is important for primary prevention.

At this point, check-up is not a method that provides a guarantee on its own. A normal examination or normal ECG result does not mean that the risk of sudden cardiac arrest is zero. However, detailed history, physical examination, ECG, blood pressure measurement, questioning family history and, when necessary, advanced evaluations such as exercise stress test or echocardiography may make an important contribution to identifying at-risk athletes.

This content is for general informational purposes. If chest pain, fainting, feeling as if about to faint, sudden palpitations, unusual shortness of breath, confusion or unexplained performance decline occurs during exercise, a healthcare institution should be consulted without waiting for a check-up appointment.

What Is Sudden Cardiac Arrest in Athletes?

Sudden cardiac arrest is the heart’s sudden inability to pump blood effectively and the stopping of circulation. This condition is often associated with serious rhythm disorders. If not intervened, it may create life-threatening risk within a short time; therefore, rapid recognition, basic life support and access to an automated external defibrillator are very important in sports areas.

Sudden cardiac arrest in athletes may occur due to different causes in different age groups. In young athletes, congenital or genetic heart diseases, heart muscle diseases and some rhythm disorders come into consideration more often; in older athletes, coronary artery disease and atherosclerosis risk become more important.

Therefore, risk assessment in athletes should not be made with the assumption that “the person exercises regularly, so they are healthy.” Regular exercise may support health; however, it does not always make underlying silent heart diseases visible. The check-up process offers a structured opportunity to question these silent risks.

Does Check-Up Definitely Prevent Sudden Cardiac Arrest?

Check-up does not definitely prevent sudden cardiac arrest; however, it may help risk factors be noticed earlier. This distinction is important. Because the aim of athlete heart screening is not to tell the person “there is no risk at all”; it is to detect existing risks as early as possible, perform advanced evaluation when necessary and make conscious decisions for safe sports participation.

Some diseases that may lead to sudden cardiac arrest may progress without symptoms. Others may show themselves only with warning signs such as palpitations, fainting, chest pressure or shortness of breath during exercise. Therefore, check-up does not consist only of tests; the athlete’s history and complaints are at least as important as the tests.

The American Heart Association does not recommend routine ECG or echocardiography for everyone in mandatory screening programs; it states that these tests are more appropriate as follow-up when suspicious findings are present in the initial evaluation. This approach shows that athlete screening should be planned individually.

First Step for Sudden Cardiac Arrest Risk: Detailed History

The first and most critical step in evaluating sudden cardiac arrest risk in athletes is detailed medical history. Because some risk signs become apparent in the person’s past and family history before laboratory or imaging tests. Symptoms experienced especially during exercise should be questioned carefully.

When taking history, not only current complaints but also previous fainting episodes, unexplained seizure-like events, heart murmur heard in childhood, previous heart inflammation, chest pain continuing after COVID-19 or other infections, and family history of sudden death should also be evaluated.

Warning Signs That Should Be Questioned

The following areas should be especially questioned in the athlete check-up process:

• Fainting during or immediately after exercise.
• Chest pain or feeling of pressure in the chest that increases with exercise.
• Unexplained palpitations or feeling of rhythm irregularity.
• Shortness of breath more than expected according to exertion.
• Unexplained performance decline.
• Family history of sudden death before the age of 50.
• Family history of cardiomyopathy, rhythm disorder or inherited heart disease.
• Previous detection of heart murmur, heart enlargement or ECG abnormality.
• Dizziness or feeling as if about to faint during exercise.
• Stimulant substance, performance-enhancing product or unconscious supplement use.

If one of these symptoms is present, the athlete should not be evaluated only with routine check-up. Cardiology opinion and necessary advanced tests may come into consideration.

Why Are Physical Examination and Blood Pressure Measurement Important?

Physical examination is one of the basic parts of athlete heart screening. Heart sounds, murmur, pulse characteristics, blood pressure, body structure and some connective tissue findings may give clues in terms of cardiovascular risk. Especially if heart murmur, uncontrolled high blood pressure or irregular pulse is present, more detailed evaluation may be needed.

Blood pressure measurement may sometimes be neglected in athletes; however, high blood pressure is not seen only in inactive individuals. Genetic predisposition, stress, sleep disturbance, unconscious supplement use, excessive caffeine or some medications may also contribute to high blood pressure in people who train intensely.

During weight training, sprint or high-intensity exercises, blood pressure may temporarily increase. However, high resting blood pressure should be evaluated, especially if it is present together with cardiovascular risk factors. Therefore, regular blood pressure follow-up is a simple but valuable step in the athlete check-up process.

How Is ECG Used to Evaluate Sudden Cardiac Arrest Risk in Athletes?

ECG is one of the basic tests that evaluates the electrical activity of the heart. In athletes, it may provide clues about rhythm disorders, conduction abnormalities and some inherited electrical heart diseases. However, interpreting ECG in athletes requires special attention; because physiological changes related to regular training may affect some ECG findings.

Physiological adaptations known as athlete’s heart do not always mean disease. Therefore, ECG results should be interpreted by physicians experienced in athlete evaluation. The purpose of international athlete ECG criteria is to help distinguish normal athletic adaptations from findings that may suggest disease.

Even if the ECG is normal, the risk of sudden cardiac arrest is not completely excluded. Some structural diseases, vascular problems or exercise-triggered rhythm problems may require additional evaluation. Therefore, ECG should be interpreted together with history and examination.

When May Exercise Stress Test and Echocardiography Be Needed?

Exercise stress test may be used to evaluate how the heart responds during exercise. It may be requested by the physician especially in athletes who experience chest pain, shortness of breath, palpitations, dizziness or performance decline with exercise. In athletes over the age of 35, especially if there are risk factors for coronary artery disease, exercise stress test may gain more importance.

Echocardiography is an imaging method that helps evaluate the structure of the heart, valves, heart muscle thickness and pumping function. It may not be routinely necessary in every athlete; however, it may be planned if there is family history, ECG abnormality, murmur, fainting, suspicion of cardiomyopathy or unexplained symptoms.

Conditions That May Require Advanced Cardiology Evaluation

Additional tests to ECG may be needed in the following situations:

• Fainting or feeling as if about to faint during exercise.
• Chest pain, pressure or tightness.
• Palpitations that become prominent with exercise.
• Family history of sudden death or inherited heart disease.
• ECG finding that cannot be explained by athletic adaptation.
• Murmur or rhythm irregularity on cardiac examination.
• Continuing cardiac complaints after COVID-19 or myocarditis.
• Risk factors such as hypertension, diabetes, smoking or high cholesterol over the age of 35.
• Performance decline that cannot be explained by training load.
• Having previously been diagnosed with heart disease.

These evaluations are performed to help the athlete continue exercise safely. The necessity of tests varies from person to person and should be planned by physician decision.

How Does Sudden Heart Risk Change by Age in Athletes?

Age is an important determinant when evaluating sudden cardiac arrest risk in athletes. In young athletes, inherited rhythm disorders, congenital coronary anomalies, hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy or channelopathies may come into consideration more often. Some of these diseases may progress without symptoms, and family history may provide important clues.

In athletes over the age of 35, classical cardiovascular risk factors such as coronary artery disease, atherosclerosis, hypertension, diabetes, high cholesterol and smoking become more important. This evaluation is especially important in people who start intensive training after a long break from sports.

Therefore, the check-up plan of a young professional athlete and a middle-aged person aiming for a marathon or triathlon should not be the same. The screening approach should be arranged according to age, sports branch, training intensity and personal risk factors.

How Do Sports Branch and Training Intensity Affect Risk Assessment?

Not every sport creates the same load on the cardiovascular system. Endurance sports require the heart to work for a long time, while high-intensity interval exercises may create sudden increases in heart rate. In weight training and strength sports, short-term but high pressure loads may be seen.

Therefore, the sport branch performed by the athlete must be questioned during the check-up process. Football, basketball, tennis, marathon, triathlon, cycling, swimming, CrossFit, weight training or combat sports may create different physiological demands. Risk assessment should also be shaped according to these demands.

Training intensity, competition calendar, weekly exercise duration, recovery habits and previous injuries should also be included in the evaluation. Because sudden cardiac arrest risk may be related not only to heart diseases, but also to overloading, early return after infection, fluid-electrolyte imbalances and unconscious performance products.

Why Is Heart Evaluation Important When Returning to Sports After Infection?

Viral infections may be associated with conditions such as myocarditis, meaning inflammation of the heart muscle, in some people. Myocarditis may not always cause clear symptoms; however, it should be handled carefully for athletes because it may increase the risk of rhythm disorder during exercise.

If there is febrile illness, chest pain, palpitations, shortness of breath, extreme fatigue or performance decline lasting longer than expected after infection, medical evaluation before returning to sports is important. This situation should be managed more carefully especially in athletes who train intensely.

Returning immediately to high-intensity training by saying “I feel well” after infection may be risky in some people. The return-to-sport plan should be made according to symptoms, severity of infection, presence of cardiac complaints and physician evaluation.

What Precautions Should Be Taken Against Sudden Cardiac Arrest Besides Check-Up?

Check-up is an important step in reducing the risk of sudden cardiac arrest; however, it is not sufficient on its own. Emergency action plans, basic life support training and availability of automated external defibrillators in sports areas may be lifesaving. When sudden cardiac arrest occurs, minutes are critically important.

Sports clubs, schools, fitness centers and race organizations should invest not only in athlete performance, but also in emergency response infrastructure. It is important for coaches, teammates and facility staff to quickly recognize signs such as fainting, loss of consciousness and absence of breathing.

Basic Steps for a Preventive Approach

A comprehensive approach to reducing sudden cardiac arrest risk in athletes may include the following areas:

• Pre-sports health history and physical examination are performed.
• Family history of sudden death and inherited heart disease is questioned.
• Warning symptoms are taken seriously.
• ECG, exercise stress test or echocardiography is planned when necessary.
• Return to sports after infection is medically evaluated.
• Unconscious supplement and performance-enhancing product use is avoided.
• Emergency action plan is created in sports areas.
• Access to automated external defibrillator is provided.
• Coaches and teams are made aware of basic life support.
• Athletes with symptoms are not forced to continue competition or training.

These steps do not completely eliminate the risk; however, they may create a strong safety framework in terms of early awareness, correct guidance and rapid intervention.

In Which Symptoms Should an Athlete Be Evaluated Without Waiting for Check-Up?

Some symptoms in athletes may be considered “training fatigue”; however, they should be carefully evaluated in terms of cardiovascular health. Symptoms that appear especially with exercise or increase during exercise should not be ignored.

In the following situations, a healthcare institution should be consulted without waiting for check-up:

• Chest pain, pressure or tightness during exercise.
• Fainting or feeling as if about to faint.
• Sudden and unexplained palpitations.
• Shortness of breath more than expected with exercise.
• Dizziness or confusion during exertion.
• Cardiac complaint together with family history of sudden death at a young age.
• Chest pain or palpitations after infection.
• Unexplained performance decline.
• Seizure-like event during sports.
• Unusual fatigue that does not improve with rest.

These symptoms do not always mean there is a risk of sudden cardiac arrest; however, they should not be delayed for safe evaluation. The main approach in athlete health is to notice warning signs early and make return-to-sport decisions with medical evaluation.

Plan Your Check-Up Services Process With Happ Health

The risk of sudden cardiac arrest in athletes cannot be evaluated only by performance level. In people who train regularly, prepare for races or engage in high-intensity sports, heart health should be addressed together with history, physical examination, ECG, blood pressure measurement and necessary advanced cardiology evaluations.

As a digital health platform, Happ Health may help you manage your health evaluation process suitable for your sports goals in a more planned way with Check-Up Services. You can receive information about appropriate tests, interpret your results together with physician opinion and, if needed, plan your follow-up steps more consciously.