Increases in fructose diet, processed food, and sedentary activity (TV, digital games, etc.) have led to an increase in obesity today. Changes in lifestyle have led to hypertension, type II diabetes and coronary diseases, which were previously known as adult diseases, to be seen in children and young adults as well. In preventing these diseases, the accepted approach is to increase daily activity and especially participation in sports activities, as well as a diet low in carbohydrates. However, as can be seen in the examples reflected in the media, sudden death occurs during sporting activities in individuals who were previously thought to be healthy - including children and young adults - and this is a significant source of concern in the society. Almost all sudden deaths in athletes are of cardiac origin. The reason why the risk of sudden cardiac death is higher in young people who do sports compared to those who live sedentary lives is explained by the fact that the underlying heart disease is revealed during sports activity.
By definition, sudden cardiac death; Death is caused by cardiac causes and occurs within one hour after the onset of symptoms. Pre-adolescent competitive sports education is based on basic skills and coordination. Endurance and strength are in the background, the football activity of a 7-year-old is not the same as the football activity of a 17-year-old. Therefore, as the child gets older, cardiovascular effects increase due to the intensity of participation in sports activities. Under the age of thirty-five, almost all deaths during and immediately after exercise result from structural and functional heart disease. Frequency studies in the population report very different results. Very different incidences are reported for sudden cardiac death. Since there is no mandatory reporting, the annual incidence in competitive athletes between the ages of 12 and 35 in the USA is estimated to be 1 in 160 000 to 300 000. On the other hand, in Italy, where there is mandatory notification, it has been reported as 1 in 28 000 among competitive athletes in the same age range. There is no definitive data for the frequency of sudden cardiac death in our country.
WHAT SHOULD BE CONSIDERED DURING THE EXAMINATION OF ATHLETES IN CHILDREN AND YOUTH? WHAT KIND OF A MOTHER? SHOULD A HISTORY BE TAKEN, WHICH EXAMINATIONS SHOULD BE REQUESTED?
Due to the increasing number of sporting activities in recent years, pediatricians are increasingly asked to perform an evaluation before sports for suitability for this activity. This evaluation must first of all be feasible, but it must also meet the expectations of parents, athletes and clubs. While parents expect their children to be healthy and safe, physicians must apply protective and predictive guidelines. Clubs, on the other hand, often expect to be relieved of their responsibilities due to injuries and illnesses resulting from sporting activities. Athlete children, on the other hand, expect their documents to be approved as soon as possible so that they can play with their friends. Although there is no standard form for those who do sports in amateur clubs, there are ready-made anamnesis forms containing various questions for the athletes of sports federations. Taking detailed anamnesis and full physical examination, which includes not only cardiac problems but also detailed general health problems, are the most basic and most basic in athlete screening. There are two important elements. Anamnesis and examination results provide guidance regarding the need for another examination. For example, in the anamnesis of an athlete whose physical examination is completely normal; Having a history of sudden death at an early age for an unknown reason or while doing sports, even in one of the relatives, a genetically inherited rhythm disorder, or even one of the athlete's complaints such as dizziness, fainting, or chest pain while exercising, is the only clue to hypertrophic cardiomyopathy, which is the most common cause of cardiac death in athletes. it could be. Consensus and common recommendations have been established, except for the inclusion of electrocardiography (ECG) in the US and European practices in athlete screening. Due to the high rate of false positive ECG results and the increase in patient burden and cost caused by unnecessary advanced examination practices, the stress and loss of time caused by this process for parents and athletes, and most importantly, with the influence of studies showing that including ECG in screening is ineffective on the rate of sudden cardiac death, the US In Turkey, medical authorities do not routinely recommend the use of ECG in screening children and adolescent athletes. On the other hand, it has been done for many years, especially in Italy. According to the published screening results, it has been reported that sudden cardiac death is significantly reduced with the inclusion of ECG. In our country, there is no ECG requirement either in legislation or in practice. I believe that putting it into routine practice without providing a pre-training process to distinguish hemodynamic changes in the athlete's heart and their reflections on the ECG will inevitably cause excessive crowding that will render the pediatric and child cardiology outpatient clinics in our country inoperable.
In what cases should a referral to a cardiologist be made? Is there any excess in referral?
When a detailed anamnesis is taken; Those who develop chest pain, fainting and extreme fatigue especially during exercise, those who have a family history of heart disease or sudden death due to an unexplained reason at an early age, especially under the age of 50, and athlete children whose relatives have genetically inherited heart disease or rhythm disorders are at risk until they are detected. In physical examination; Those with hypertension or murmur, and those at risk of rupture as a result of progressive expansion of the aortic root, such as Marfan syndrome, should be evaluated by a pediatric cardiologist. The most common routine practice in pre-sports license application is to fill out a form that includes physician approval. This form is mostly approved by family physicians or pediatricians. In addition to the lack of a certain guide and training for the service, we observe that physicians sometimes refer more than necessary to pediatric cardiology due to many factors such as suggestions from families and the effect of intensive outpatient clinic service. Development of a certain standard practice and short-term in-service training; I believe that it will prevent unnecessary examinations, anxiety in the child and family caused by referral, loss of workforce, disruption of school education and sports activities, congestion in the pediatric cardiology outpatient clinic and prolongation of appointment times.
Sudden cardiac arrest in sports. Which diseases mainly cause deaths?
Considering the frequency, we can divide the causes of sudden cardiac death into two main groups. In the first group, approximately 70-80% are caused by structural diseases of the heart. For this group The most common cause is heart muscle diseases. In particular, the disease that causes severe thickening of the heart muscle, which we call hypertrophic cardiomyopathy, and is mostly genetically inherited, accounts for approximately 40% of all cardiac deaths. In addition, less than heart muscle diseases, congenital heart diseases such as coronary artery anomalies and valve stenosis of large vessels are among the causes of sudden cardiac death. In the second group, there are disorders in the ion channels of the heart, which are much less common but have strong genetic inheritance characteristics and cause rhythm disorders that often occur without symptoms. The best-known example in this group is the disease detected by prolongation of QT interval on ECG. However, even if there is no underlying disease, sudden cardiac death may occur in commotion cordis, which is the agitation of the heart caused by a fist blow while doing karate or a ball hitting the chest at heart level in baseball. Here, due to the impact, a very rapid rhythm disorder develops that causes the heart muscle to tremble rather than contract, which we call ventricular fibrillation, which puts people into shock. Although cardiac agitation (Commotio cordis) is very rare, the risk of death is very high.
WHAT PRECAUTIONS SHOULD BE TAKEN AGAINST SUDDEN DEATHS IN SPORTS?
Every year, millions of children and Considering that the young person does sports, I believe that guidelines should be developed and effective in-service training should be provided in primary care, with priority given to their feasibility, in other words, guidelines that will not unnecessarily increase the burden on hospitals but will also minimize the risk of sudden cardiac death. In addition, informative activities should be carried out to ensure early recognition of symptoms by parents and athletes during sports. Another important issue is to develop emergency resuscitation conditions until medical help arrives. Sports trainers and coaches should receive heart massage training in emergency situations.
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