Amsterdam E A
Division of Cardiovascular Medicine, University of California, Davis, Sacramento.
Cardiology. 1990;77(5):411-7. doi: 10.1159/000174630.
Although death during exercise is rare, vigorous physical activity is associated with increased risk for fatality, particularly in individuals with overt cardiac disease or a high coronary risk profile. The mechanism of death is usually a lethal ventricular arrhythmia, but this may vary depending on the underlying cardiac condition. Cardiac disease is present in the great majority of individuals who die during exercise. In young persons, hypertrophic cardiomyopathy and congenital coronary anomalies are most frequent, whereas older victims usually have coronary artery atherosclerosis. Cardiac disease is typically unrecognized before the fatal event in young individuals; in the older group, most have overt coronary disease or identifiable risk factors. Screening asymptomatic subjects to identify increased cardiac risk during exercise is problematical in terms of logistics, expense and accuracy. However, careful evaluation, including exercise testing, is mandatory before a program of increased physical activity is initiated in cardiac patients. For other individuals, firm guidelines are lacking, and the extent of the evaluation must be determined on an individual basis.
尽管运动期间死亡的情况很少见，但剧烈体育活动会增加死亡风险，尤其是在患有明显心脏病或高冠状动脉风险特征的个体中。死亡机制通常是致命性室性心律失常，但这可能因潜在的心脏状况而异。在运动期间死亡的大多数个体中都存在心脏病。在年轻人中，肥厚型心肌病和先天性冠状动脉异常最为常见，而老年受害者通常患有冠状动脉粥样硬化。在年轻个体中，心脏病通常在致命事件发生前未被识别；在老年组中，大多数人患有明显的冠状动脉疾病或可识别的风险因素。就后勤、费用和准确性而言，对无症状受试者进行筛查以确定运动期间增加的心脏风险存在问题。然而，在心脏病患者开始增加体育活动计划之前，必须进行仔细评估，包括运动测试。对于其他个体，缺乏明确的指导方针，评估的范围必须根据个体情况确定。
