Firor W B, Faulkner R A
Department of Medicine, University of Saskatchewan, Saskatoon.
Can J Cardiol. 1988 Sep;4(6):251-4.
The literature dealing with sudden cardiac death in relation to exercise, particularly sport, is reviewed. The exact incidence of unexpected sudden cardiac death during physical activity in persons previously presumed healthy is difficult to determine due to the wide variation in reporting methods; by all indications, it is extremely low. The most common cardiac condition underlying sudden cardiac death in persons over age 30 years is, overwhelmingly, coronary artery disease. In younger athletes it is much less common and is usually due to hypertrophic cardiomyopathy, congenital anomalies or inherent abnormalities of the conducting system. The PAR-Q (Preparation for Activity Readiness Questionnaire) appears to be an adequate pre-exercise screening tool for recreational and middle-aged athletes. A (cost) effective pre-exercise screening strategy for the younger and highly competitive athlete remains elusive. Extensive and costly screening methods (eg, ECG, echocardiography, treadmill studies) do not seem warranted for any asymptomatic, presumed healthy groups. Although the risk of sudden cardiac death is measurably higher during exercise than during sedentary activity, the overall risk is demonstrably lower in habitually active and physically fit persons. The resolution of this paradox is that even the most active persons rarely spend more than an hour or two a day at vigorous exercise, while the protective effects against sudden cardiac death operate for the remainder of the day.
本文综述了与运动，尤其是体育活动相关的心脏性猝死的文献。由于报告方法差异很大，很难确定先前被认为健康的人在体育活动期间意外心脏性猝死的确切发生率；但种种迹象表明，这一发生率极低。30岁以上人群心脏性猝死最常见的潜在心脏疾病绝大多数是冠状动脉疾病。在年轻运动员中，这种情况则要少见得多，通常是由于肥厚型心肌病、先天性异常或传导系统的固有异常。PAR-Q（运动准备情况调查问卷）似乎是休闲和中年运动员合适的运动前筛查工具。对于年轻且竞争激烈的运动员，一种（经济）有效的运动前筛查策略仍然难以捉摸。对于任何无症状、被认为健康的群体，广泛且昂贵的筛查方法（如心电图、超声心动图、跑步机研究）似乎并无必要。尽管运动期间心脏性猝死的风险明显高于久坐不动时，但习惯运动且身体健康的人的总体风险明显较低。这个矛盾的解决办法是，即使是最活跃的人每天进行剧烈运动的时间也很少超过一两个小时，而对心脏性猝死的保护作用在一天中的其余时间都在发挥作用。
