summary Cardiac conditions are the most common cause of sudden death in young athletic patients and comprise of hypertrophic cardiomyopathy (most common), coronary artery disease, and commotio cordis. Diagnosis requires a thorough history and physical exam to identify history of chest pain, palpitations, syncope during exercise and evaluation for murmurs. An EKG or echocardiogram should be performed when there is high suspicion for hypertrophic cardiomyopathy. Treatment is focused on prevention with avoidance of vigorous exercise when hypertrophic cardiomyopathy is diagnosed. If commotio cordis develops, prompt treatment with cardiac defibrillation is required for survival. Etiology Common conditions include syncope hypertrophic cardiomyopathy CAD commotio cordis long QT syndrome Presentation Symptoms history and physical exam is the best screening tool to identify cardiovascular problems in high school athletes chest pain palpitations syncope Physical exam pre-participation physicals diastolic murmur warrants further workup II/VI systolic murmur Evaluation EKG normal EKG findings in endurance athletes ventricular hypertrophy primary AV block nonspecific STT wave changes in the lateral leads on ECG resting sinus bradycardia at 40 beats per minute Syncope Overview a syncopal episode in a young athlete is a red flag for a serious cardiac condition. Treatment medical evaluation requires a medical evaluation prior to returning to athletic activity Hypertrophic Cardiomyopathy Overview most common cause of cardiac sudden death in young athletic patients Presentation symptoms dyspnea on exertion chest pain positive family history physical exam II/VI systolic murmur a murmur that increases with standing or Valsalva maneuver should raise concern for hypertrophic cardiomyopathy increase in murmur caused by dynamic obstruction of blood outflow caused by enlarged ventricle Evaluation echocardiogram study of choice to make diagnosis will show nondilated, thickened left ventricular wall thickness compared to normal individuals of the same age. Treatment avoid vigorous exercise considered an absolute contraindication to vigorous exercise and sports Coronary Artery Disease and Abnormalities Epidemiology 2nd most common cause of sudden cardiac death most common in older patients Pathophysiology coronary artery disease (CAD) usually seen in older patients risk factors hypertension family history left main coronary artery with abnormal origin is a risk because the artery can become compressed and lead to ischemia Presentation symptoms mostly asymptomatic but when symptoms present they are commonly chest pain palpitations syncope Imaging coronary angiography and MR angiography are gold standards Treatment lifestyle changes healthy eating, stress reduction, quit smoking, lose weight medications b-blocker, aspirin, ACE inhibitors, nitroglycerin, calcium channel blockers surgery angioplasty and stenting coronary artery bypass grafting Commotio Cordis A rare but catastrophic condition that is caused by blunt chest trauma it results in cardiac ventricular fibrillation and is universally fatal unless immediate defibrillation is performed Epidemiology most common in children and adolescents due to high number of athletes Treatment CPR vs.cardiac defibrillation best method of treatment is cardiac defibrillation Prevention chest protectors in baseball and hockey have not yielded the protective results desired Long QT Syndrome An abnormality of ventricular repolarization that can lead to ventricular tachycardia torsades de pointes sudden cardiac death if not recognized and treated Symptoms syncope or near-syncope with exercise often times asymptomatic Diagnosis ECG is gold standard Treatment sports return to play determination of play by genetic makeup, presentation, and need for pacemaker