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Ask the Expert: Sports Cardiology

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In this week’s installment of Ask the Expert, Dr. Brett Toresdahl, Sports Medicine Physician, answers questions in relation to sports cardiology.


If exercise is good for the heart, why should young athletes be concerned about their heart?

Exercise is able to reduce the risk of a heart attack caused coronary artery disease, but it can also increase the risk of sudden cardiac arrest when an athlete has an underlying heart condition. A heart attack is different from sudden cardiac arrest, a heart attack is an injury to the muscle wall of the heart when not enough oxygen is delivered to it whereas a sudden cardiac arrest is when the heart stops beating often due to either an electrical or structural heart problem. Exercise puts extra stress on the heart, which can trigger a sudden cardiac arrest. As a result, sudden cardiac arrest is the leading cause of death in young athletes during sports.

What are the signs of a potential heart problem in a young athlete?

Chest pain, excessive shortness of breath, a racing or irregular heartbeat, lightheadedness, unexplained seizures, or fainting during exercise can be a sign of an underlying heart problem. Although other conditions can cause some of these symptoms, such as exercise-induced asthma or dehydration, it is important to discuss these symptoms with a primary care or sports medicine physician to help determine the cause.

Is a sports physical able to detect a heart problem in a young athlete?

A sports physical typically includes a questionnaire about an athlete’s health and current symptoms as well as his or her family’s health because some heart problems can be inherited. It also includes a physical exam to listen for an irregular heartbeat or heart murmur. However, recent studies have shown this to only detect about 50% of potentially lethal heart conditions and that the most effective way of detecting an underlying heart problem is by combining this with an electrocardiogram, or ECG, which measures the electrical signal from the heart.

What else can be done to prevent tragedies in sports caused by sudden cardiac arrest?

Even with proper screening for underlying heart problems, being prepared to respond to a sudden cardiac is critically important. A sudden cardiac arrest can even occur in young athletes with normal hearts if they are hit hard in the chest during a specific time in the heart’s rhythm cycle, such as by a baseball, hockey puck, or lacrosse ball. Having an AED readily available makes it possible to shock the heart to restart it, which has the best chance of success if done within 3-5 minutes. Coaches and other staff should be trained to recognize sudden cardiac arrest, know how to perform CPR, and be able to use an AED.


Dr. Brett Toresdahl, primary care sports medicine physicianDr. Brett Toresdahl is a Primary Sports Medicine Physician at Hospital for Special Surgery. His research focus has been in the prevention and treatment of sudden cardiac arrest in young athletes. He enjoys staying active outdoors with his family with snowboarding, biking, running, and hiking.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.