Hypertension is a common cardiovascular condition, even amongst the healthy athletic population. A thorough evaluation of an athlete should involve a detailed history and measurement of their blood pressure during each visit. Measurements of blood pressure during exercise may be useful in diagnosing those with concealed hypertension or to help evaluate effectiveness of ongoing treatment. Depending on the extent of the elevated blood pressure, some athletes would be restricted from sports with particularly high static strain, for example, weightlifting or martial arts, until hypertension is controlled.

In the young athletes, the causes of sudden cardiac death differ from their more senior counterparts. The common causes in the apparently young fit individuals include hypertrophic cardiomyopathy (HCM), anomalous coronary arteries, long QT syndrome, heart valve diseases, diseases of the aorta and myocarditis. Hypertrophic cardiomyopathy (HCM) is a genetic condition that causes the heart muscle to enlarge and may obstruct blood flow out of the heart, leading to abnormal heart rhythm (arrhythmia), heart failure and sudden death. Long QT syndrome is another genetic disorder where abnormality of the electrical system of the heart may trigger arrhythmia during exercise and stress which may be fatal. Anomalous origins of coronary arteries from the aorta is a congenital condition that may cause chest pain or sudden cardiac arrest during exercise. These group of young athletes may be suspected to have these dangerous but treatable conditions if they present with symptoms of chest pain, breathlessness or fainting. Those that are symptomatic or have an episode or resuscitated cardiac arrest or a family history of sudden death are recommended to be fully evaluated and monitored by a sports cardiologist team for diagnosis, treatment and rehabilitation for safe return to play.

When an athlete presents with symptoms of chest pain, breathlessness or syncope (fainting), it could be due to benign and malignant causes. Chest pain and syncope or near syncope during exercise or sports events typically warrant immediate restriction from sport and evaluation. Syncope and presyncope can be physiologic responses to exercise such as vasodilation and blood pooling that can lead to excessive fall in blood pressure (BP) when an upright position is assumed. Athletes over the age of 35 are more likely to present with atherosclerosis as the underlying cause. Evaluation should highlight whether symptoms occurred during or after exercise with the latter more likely to be benign. A detailed physical examination and other tests should include the ECG, echocardiography, ambulatory rhythm monitoring and maximal exercise tolerance test. Basic laboratory evaluations should be performed to rule out anemia, thyroid disorder and other metabolic abnormalities. In addition, ECG, echocardiogram and maximal effort exercise stress test are recommended as part of a complete work-up.

We must be mindful that active individuals are not immune to heart conditions that may endanger lives during physical activities. Hence, before embarking on strenuous exercise, it is vital to get your heart health checked. At IJN we offer Active Fitness Screening program. This package encompasses general assessment, cardiac service investigation, physiotherapy, laboratory tests, consultation by cardiology clinical specialist, refreshment and finally with the report summary.

In the sports world, a healthy heart equals optimum performance. Whether an individual is a professional or an amateur, IJN also offers Active Plus Endurance Screening programme which helps to determine the risk of heart problems, and helps to measure fitness levels and offers a sport prescription to keep you at the top of your game. This screening plan encompasses general assessment, cardiac service investigation that includes electrocardiogram, VO2 Max and 2D echocardiogram, imaging investigation, physiotherapy, laboratory tests, consultation by cardiology clinical specialist, consultation by sports medicine specialist, refreshments and finally with the report summary.

At IJN sports cardiology clinic, we offer evaluation by a cardiologist and an exercise physiologist. They will carry out a full clinical evaluation, including assessment of symptoms, medical and athletic history, and a comprehensive physical examination.

A cardiopulmonary exercise test (PET/CDP/Vo2max) is an exercise test in which your lung and heart’ response to various levels of exercise will be tested. This test is the best test to measure how our heart and lungs cope with daily activity and exercise. This may help identify the reasons why exercise is difficult and may be causing breathlessness, disease progression and fitness levels.

In this test, you will be asked to run on a treadmill or pedal on a bicycle ergometer, while your heart beat rhythm and as well as breathing is measured. The intensity of this exercise will increase gradually and the total duration can vary from about 10 minutes to about 40 minutes. During this test, patients will be using a mask that measures oxygen use during exercise on a treadmill, bicycle or other device. This test provides comprehensive information on maximal heart rates, peak oxygen consumption (VO-2 max) and your anaerobic threshold.

In summary sports cardiology advocates for individuals how to be safe from cardiovascular events while they exercise and to prevent sudden cardiac arrest and death. We would encourage any individual above the age of 35 years to have at least one screening medical check-up before embarking on or chasing your sporting ambitions. Younger athletes who are symptomatic or have a family history of sudden death are also advised to be evaluated to exclude cardiac abnormalities that may be dangerous if left unrecognized.