Physical exercise is a very important factor in the prevention of cardiovascular disease at the level of the general population. Thus, all medical societies’ prevention guidelines recommend moderate-intensity aerobic physical activity for at least 150 minutes per week with the goal of reducing cardiac events. Indeed, from valid statistics, we know that regular exercise reduces cardiovascular and total mortality by 20-30% in people with risk factors for coronary heart disease as well as in patients with already diagnosed heart disease.

The case of athletes is somewhat different. An athlete is defined as a young or adult person who, at an amateur or professional level, engages in regular intense exercise and participates in competitive individual or team sports. The prevention of cardiac events in athletes is of particular importance as intense exercise with subsequent dehydration, large adrenaline surges or electrolyte disturbances, while tolerated in a healthy person exercising vigorously, may trigger a cardiac event if there is an underlying undiagnosed disease.

The incidence of sudden cardiac death in athletes is difficult to estimate precisely, as the different registries refer to different populations of athletes. For example, in 20-year-old champions it is estimated at 7 per 100,000 per year, which is 0.0007%. Age, male gender, and black race are risk factors. Despite the low probability, the occurrence of a heart attack in an athlete, especially during competition, is an upsetting experience for fellow athletes and spectators.

Prevention is based on the observation that heart attacks in athletes are due to an underlying disease. Age 35 is a conventional cutoff that somewhat separates the causes of sudden cardiac death. In younger athletes, the most common causes are hypertrophic cardiomyopathy, congenital anomalies of the coronary arteries, diseases of the electrolyte transport channels in the myocardium that lead to threatening arrhythmias. Traumatic puncture of the chest with the ball if it coincides in time with a vulnerable phase of the cardiac cycle is also a cause of cardiac arrest. After the age of 35, the above causes proportionally become rarer as acquired atherosclerotic coronary disease prevails as a cause in 80% of cases.

Based on the above, the main strategy for the prevention of cardiac events aims to identify the common causes according to the age of the athlete. The European Society of Cardiology recommends three basic actions as pre-sport screening:

1. Obtain a detailed family and individual history, focusing on sudden death in young adults and on symptoms during exercise.
2. Physical examination and
3. Carry out a simple electrocardiogram as this is believed to reveal about 60% of cardiac diseases associated with sudden death.

An echocardiogram provides more information but is not considered a necessary test for all examinees. The fatigue test has an important place in the assessment of coronary heart disease in older athletes.

The HYGEIA hospital provides pre-sports screening for people and athletes of every exercise category in the check-up department.

However, beyond the pre-sport check-up process and the advice regarding the possibility of participating in competitive sports, it is important to raise the awareness of the athletes themselves who should pay attention to symptoms such as chest discomfort or unexpected shortness of breath, dizziness or fainting tendency during of exercise or shortly after, and to report them to the doctor. Also, do not compete if an active virus is present, as many viruses cause myocarditis which can cause significant arrhythmias. It has been found that 1/3 of sports heart attacks were preceded by symptoms that were ignored.

Finally, the health organization is of great importance to deal with if there is an unfortunate event. In sports venues, in schools, stadiums and stadiums, the existence of automatic external defibrillators is necessary in combination with training of gymnasts, coaches and the general population in basic cardiorespiratory resuscitation, so that an arrest can be treated with a high probability of success. The Danish football player Christian Eriksen suffered a cardiac arrest during a match at Euro 2020, which was immediately successfully treated on the field thanks to the excellent organization of the field’s medical team and today he is playing normally.

Our heart is the source of our life. September is dedicated to World Heart Day, let’s remember how important it is to take care of our heart every day. A healthy heart contributes to more moments of happiness and well-being with our loved ones.