Greene Elizabeth Anne, Punnoose Ann
Adolesc Med State Art Rev. 2015 Dec;26(3):507-27.
Symptoms such as syncope and chest pain, especially if they are accompanied by palpitations or occur with exercise in any combination, require cardiac evaluation before adolescent athletes are allowed to return to the sports field. Some life-threatening conditions will likely be associated with a family history of HCM or LQTS, but the family history may not be discovered at the first medical visit. A family history of CPVT, for example, is hard to elicit unless this diagnosis has already been established in an affected family member. The keys will be the timing of symptoms and the documentation of arrhythmia with exercise. The ECG at baseline in CPVT may be deceptively normal. Hypertrophic cardiomyopathy is progressive, so evaluation during early childhood may be negative. Long QT syndrome may not always result in an abnormal ECG, even in genetically positive individuals. A high index of suspicion is needed to make these diagnoses, especially if the family history is not available.
诸如晕厥和胸痛等症状，尤其是伴有心悸或在运动时以任何组合形式出现时，在青少年运动员获准重返运动场之前需要进行心脏评估。一些危及生命的疾病可能与肥厚型心肌病（HCM）或长QT综合征（LQTS）家族史有关，但家族史可能在首次就诊时未被发现。例如，除非在受影响的家庭成员中已经确诊儿茶酚胺敏感性多形性室性心动过速（CPVT），否则很难询问出家族史。关键在于症状出现的时间以及运动时心律失常的记录。CPVT患者基线心电图可能看似正常。肥厚型心肌病是进行性的，所以在幼儿期进行评估可能结果为阴性。长QT综合征即使在基因检测呈阳性的个体中也并非总是导致心电图异常。做出这些诊断需要高度的怀疑指数，尤其是在没有家族史的情况下。
