There is general consensus around the world that pre-participation cardiac screening should be carried out on athletes. However the level of screening is controversial and implementing any screening has been difficult. In USA screening is not carried out routinely and young people still die suddenly usually of Hypertrophic Cardiomyopathy (HCM). It is also estimated that 12 young people under the age of 35 die from sudden cardiac death every week in the UK of the same diseases as in USA.

In Italy all young people under age of 35 participating in sporting activity are required by Italian law to undergo regular check-ups usually annually. This has led to a dramatic reduction in deaths from HCM, the main cause of sudden cardiac death and other conditions. In USA similar screening is not performed.

In Italy screening of athletes by Sports Cardiologists has led to an 89% reduction in sudden cardiac deaths (especially HCM from 36% to only 2%).

The screening of athletes involves taking an athlete-specific detailed personal and family history, performing a physical examination, followed by an electrocardiogram (ECG). A Cardiologist with a specialist interest in Sports Medicine should review the ECG. If an abnormality is found then further investigations may be carried out such as a heart scan (Echocardiogram) which with the ECG is an excellent way to exclude most inherited heart defects. Further investigations including exercise testing may be required.

Once an athlete is found to have one of these conditions it might mean that they would have to change the type and intensity of their sport, but more importantly it would mean that they could be offered treatment to prevent them from dying suddenly. Often no specific treatment is needed whilst in other athletes, tablets, a pacemaker or implantable defibrillators may be required.

In addition if there is a family history of someone dying quite young from a heart condition, then usually other members of the family should be screened for the same condition.

Prof John Somauroo  is involved in the management of players from Football Premier League clubs and is also the Cardiologist to Sale Sharks Rugby Club. He is one of the Cardiologists working with CRY (Cardiac Risk in the Young) actively involved in screening of athletes around the UK. He is on the Rugby Football Union Medical Advisory Panel at Twikenham which has set up the national screening of all English Premiership Rugby Union players.

   

Left to right: Alex Anderson, Head of Player Services, The Rugby Players’ Association; Professor John Somauroo, Consultant Cardiologist for CRY, Countess of Chester Hospital;    Dr Steven Cox, Director of Screening, Cardiac Risk in the Young; Dr Simon Kemp, Head of Sports Medicine, Rugby Football Union; and Corin Palmer, Head of Academies and Development, Premiership Rugby

Professional RFU players with cardiac problems are referred to either Prof Sanjay Sharma at St Georges Hospital, London or Prof John Somauroo at the Countess of Chester Hospital.

Prof Somauroo has been invited to meetings to discuss screening and preventing sudden cardiac death at Downing Street and The House of Commons. A national screening programme however is still not in the UK.

Prof John Somauroo is involved in charity work for CRY (pictured above with England and Sale Sharks rugby player Andrew Sheridan).

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