Care

Pre-participation Screening
The intention of pre-participation cardiovascular screening or preventive screening is to prevent a sudden death or cardiac arrest caused by a known or unknown cardiac problem that is triggered by exercising or playing sports.When such a cardiac problem has been discovered it is our mission to make sure you can safely return to playing sports and/or exercising.

Possible Results of Preventive Screening
The possible results of a preventive screening can be:
  1. no cardiac abnormalities, approval of playing sports
  2. cardiac abnormalities with a probable risk of cardiac events discovered, advice to make an appointment with the sports cardiologist of the SMCP or another (sports) cardiologist in your neighbor hood for further cardiac examination. The sports cardiologist of the SMCP will enquire into your cardiac health using the Lausanne protocol. You will be examined closer, your blood pressure will be measured and, if necessary, and new ECG will be made. Next the sports cardiologist will discuss whether there is a need for additional examinations (e.g. exercise testing, echocardiography, circadian heart rhythm registration (24h Holter monitoring), MRI, CT scan, heart catheterization, electrophysiologic investigation) and/or treatment. You could be advised to exercise less or not at all. After the examination(s) you will be given a diagnosis, a sports and exercising advice and a recommendation for treatment, if necessary. After treatment the SMCP will assist you with resuming exercising and/or playing sports.

Final result:
  1. no risk of heart disease during sports or exercise, approval of playing sports;
  2. a heart disease has been discovered, treatment is necessary, provisional advice to exercise less or less intensive. The aim of treatment is to enable you to resume exercising;
  3. a heart disease has been discovered which carries a high risk of exercise related sudden death or cardiac arrest, treatment is essential, disqualifying from playing sports and exercising.
    It is important to know that non-eligibility for sports participation is not necessarily a definite result, it might change after treatment. This result might need to be re-evaluated after treatment.

History
In August 2004 the Section Sports Cardiology of the European Society of Cardiology (ESC) started advocating a systematic pre-participation cardiac screening of young athletes (≤35y) by those qualified for doing so (those knowledgeable about cardiology, sports and exercising) (Corrado Eur Heart J 2005). The ESC has started advocating the inclusion of older athletes (>35y) in this process of examination as well (Borjesson Eur J Preventive Cardiol 2012). The goal of this preventive screening is early identification of athletes carrying known or unknown cardiac diseases that might cause a high risk of sudden death or calamities during exercising. These so-called 'high-risk' athletes will be (temporarily) excluded from exercising and sports participation. The athletes might, however be able to return to their sport after sufficient treatment and re-evaluation (Pelliccia Eur Heart J 2005).

Thanks to the yearly obligatory screening of young athletes in Italy the number of sudden deaths in sports has been substantially reduced, from 2.3/100.000 to 0.8/100.000 (Corrado J Am Med Assoc 2006). So far Italy is the only country in the world that has made screening of athletes obligatory by law.

This preventive cardiovascular screening of young athletes (12-35 y) exists of the examination of a personal (and family) medical history, physical examination and an ECG. If one or more of these tests gives a positive result further examination will be strongly advised. The IOC, FIFA (soccer), UCI (cyclist) and ESC Section Sports Cardiology have decided during a consensus meeting in Lausanne (December 2004), to incorporate this systematic screening in the Lausanne Protocol (Bille Eur J Cardiovasc Preven Rehabil 2007).

The working group Cardiovascular Screening and Sports (a cooperation between KNVB (soccer), NOC*NSF, the Association for Sport Medicine and the committee Cardiology & Sport of the Dutch Association for Cardiology) also advocates the systematic preventive screening for athletes in the Netherlands. She advices setting up a mandatory yearly preventive cardiac screening for all young athletes (12-35y) in national selections, belonging to category A and B athletes, and for promising young talents, and on the advice of a sport association. For all other athletes, the working group advices to voluntary undergo a preventive cardiac screening (Panhuyzen Geneesk en Sport 2006).

The content of these preventive screenings has become a highly controversial and much debated topic all around the globe. In addition to this a number of recommendations have been made by the ESC and numerous scientific articles have been published on the topic.


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