Cardiac Chest Pain

Cardiac Chest Pain

Chest pain in athletes can be from a number of causes, although cardiac or heart problems should always be considered. The chest pain could originate from the muscles, but it could also signify a more serious cardiac problem, even in young athletes. We describe some of the cardiac causes of chest pain and what you should do about them.

Chest pain in athletes

Chest pain in athletes may be caused by a wide range of conditions including muscular pain and pain referred from the thoracic spine. Whilst cardiac causes may not be suspected in young, healthy athletes, they should always be considered. Possible causes of chest pain in young athletes include:

If following a history and examination, a cardiac cause of chest pain is suspected, then the athlete should be referred for a resting Electrocardiogram (ECG). If this is normal an exercise test may be performed.

Sudden cardiac death syndrome

Sudden cardiac death syndrome (also known as sudden arrhythmic death syndrome - SADS) is uncommon, especially in athletes or those that exercise regularly. In younger athletes (under 35), the most common cause of sudden cardiac death is Hypertrophic cardiomyopathy or other structural congenital conditions. Marfan syndrome is another cause of sudden cardiac death in young athletes, although this will usually be diagnosed at a young age and should avoid high-intensity exercise.

In older athletes, Coronary heart disease is the most common cause, followed by mitral valve prolapse.

Hypertrophic cardiomyopathy

As already mentioned, Hypertrophic Cardiomyopathy (HCM) is the most common cause of sudden cardiac death in the sporting population. HCM is a disease of the cardiac (heart) muscle resulting in an enlarged (hypertrophied) left ventricle wall. HCM is divided into two types - obstructive and non-obstructive. Obstructive HMC refers to the obstruction of the blood flow to the left ventricle.

There are rarely any symptoms to indicate the presence of this condition before a sudden collapse during exercise. In those who do demonstrate early symptoms, these may include:

If HMC is suspected, an ECG may demonstrate ST segment and T wave abnormalities and a prominent Q wave. The investigation of choice, however, is an Echocardiogram. A hypertrophied left ventricle which is not dilated and no evidence of other conditions indicates the presence of HCM.

The vast majority of cases of sudden death caused by HCM occur in males.

Related articles:

Costochondral Separation

A Costochondral separation, sometimes known as a rib separation, usually occurs after a direct impact. This injury occurs when a rib becomes separated from the costochondral joint (made from...

Bruised Ribs (Rib Contusion)

Bruised ribs or a rib contusion occurs following a direct impact to the chest. This may be because of a fall or direct impact from a hard object, but the most common cause is a car accident. Chest...

Pec Strain

The pectoralis major muscle is a large powerful muscle at the front of the chest. It is used to rotate the arm inwards. Its weak point is at the tendon where it attaches to the arm bone. The front...

Bruised Sternum

A bruised sternum, or sternum contusion as it is also known, occurs after an impact to the sternum or breastbone. This most frequently occurs after road traffic accidents, although collision sports...