Causes of SCD in older (>35 years) individuals

Objectives of pre-participation screening on >35 year olds

• To identify (or raise the suspicion of) occult cardiovascular disease that has the potential to cause sudden cardiac death, nonfatal myocardial infarction, stroke, angina, acute coronary syndromes, or heart failure; this warrants further evaluation and recommendations regarding future participation
• In athletes with known cardiovascular disease, the purpose of this preparticipation evaluation is to determine whether continued sports participation is judicious and consistent with the severity and status of their disease.
• Asymptomatic status does not confer immunity from cardiac events and subsequent periodic clinical examinations may be prudent in this population.

Screening protocol

• Evaluation varies according to
  • individuals’ cardiac risk profile
  • intended level of physical activity
• Look at the physical activity of the last 3 months to see if the patient has been physically inactive or not
  • physical activity is a preventative measure
• Active individuals: history of performing regular, planned structured exercise at moderate intensity for at least 30 minutes on three or more days per week during the past 3 months
  • always start with a low intensity exercise -> less risk

Intended level of physical activity

• What does he/she plan to do?
  • 
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Individual cardiac risk profile

• ESC-risk SCORE: estimates absolute risk of atherosclerotic cardiovascular death within 10 yrs based on age, sex, BP, cholesterol and smoking history) + assessment of additional major accepted risk factors to define whether individuals have a
  • very high
  • high
  • moderate
  • low risk profile

Individual CV risk

"Qualifiers"

• sedentary , (abdominal) obesity
• familial history of premature cardiovascular disease (men < 50 yrs. and women < 60 yrs.)
• poor socio-economical situation, social isolation, lack of social support
• low HDL cholesterol (<40 mg/dl) or high triglycerides(>150 mg/dl)
• preclinical atherosclerosis (ABI, carotid intima media thickness,…)
  • 
• from the moment you want to increase the exercise intensity and you have a risk factor, you should be kept under control