Experts push for targeted screening to prevent sudden cardiac deaths in athletes

Experts are calling for more targeted cardiovascular screening methods to help prevent sudden cardiac death (SCD) among athletes.

According to the Philippine Heart Association, schools and institutions in the country follow American Heart Association (AHA) and American Academy of Pediatrics (AAP) cardiovascular screening guidelines due to the absence of a national standard, especially for children.

The screening focuses on warning signs like chest pain during exercise, palpitations, family history, and physical signs such as heart murmurs or other heart abnormalities.

Meanwhile, the Philippine Pediatric Society has created a task force to create clearer guidance on screening patients.

Dr. Jonas Del Rosario, former chairperson of the PHA Council on Congenital Heart Disease, said many schools and parents already require screening forms, especially for students involved in organized sports, varsity programs, and scholarship applications.

For adults and competitive athletes, PHA Council on Precision Cardiovascular Medicine chair Dr. Maria Teresa Abola said, the association has already started developing a national framework.

“Through the efforts of three councils—the Council on Cardiac Rehabilitation and Sports Cardiology, Congenital Heart Disease, and Preventive Cardiology—had released a statement, a position statement at least, last February,” Abola said.

The statement recommends a national framework for athlete cardiovascular screening, including medical history, physical exam, family history, and 12-lead Electrocardiogram per AHA guidelines.

Abola, however, said mandatory ECG screening remains controversial due to cost, access, interpreter shortages, automated external defibrillator availability, ECG interpretation in adolescents, and unclear local cardiovascular disease prevalence.

Hypertrophic cardiomyopathy (HCM) remains the leading cause of sudden cardiac death among young athletes, according to Dr. Lauren Kay Evangelista-Galindez, University of the Philippines-Philippine General Hospital Heart Failure and Cardiomyopathy Section Head.

The United States National Institute of Health described HCM as a genetic heart disease caused by mutations in protein genes encoding elements of the heart muscles that pump blood.

Evangelista-Galindez said structural heart disease accounts for 70% of sudden cardiac deaths in sports populations, while HCM has an estimated global prevalence of about 0.2%.

This is especially notable in the case of basketball and football players.

She also cited a 2024 study tracking 1,102 National Collegiate Athletic Association (NCAA) athletes that underscored the statistical burden of cardiac events.

While perinatal accidents made up most deaths at 50.8%, heart-related causes accounted for 13% of deaths.

Among heart-related deaths confirmed by autopsy, idiopathic left ventricular hypertrophy (LVH), possible cardiomyopathy, and confirmed HCM made up the largest share at 12.7%, followed by coronary artery problems at 8.5%.

An LVH is an unexplained thickening of the heart muscle, particularly the left ventricle, which the heart’s main pumping chamber.

"If you look at the exertional status at the time of death of these patients, highest is exertional status for coronary artery anomaly, arrhythmogenic cardiomyopathy, CAD and hypertrophic cardiomyopathy composed of around 53%," Evangelista-Galindez said.

She added that medical guidelines that automatically ban people with HCM from competitive sports have changed.

Data from the Lifestyle and Exercise Hypertrophic Cardiomyopathy study showed that the risk of major heart problems was about the same in HCM patients who did vigorous exercise and those who did not.

Based on the updated clinical considerations published in December 2025, restrictions on competitive sports are no longer applied as a general rule.

"Vigorous physical activity or competitive sports restriction is actually not indicated for patients with hypertrophic cardiomyopathy," Evangelista-Galindez said.

"It's reasonable to consider competitive sports participation for athletes with hypertrophic cardiomyopathy after comprehensive expert assessment with shared decision-making," she added.

The experts made their statements and presentation during the Philippine Heart Association's 56th Annual Convention and Scientific Meeting. — BM, GMA News