4. DİSCUSSİON
When the distribution of the participants was examined according to
their sports branch, football was the most preferred branch with 16.6%,
followed by volleyball and swimming. When the data were compared in
terms of dependent variable, there was a statistically significant
difference in terms of cardiac rate, HDL, LDL, calcium, ALT, diastolic
blood pressure, and the number of training times per week, there was no
significant difference in other variables. When the categorical
variables were compared according to the main outcome measures of the
participants, a statistically significant difference was found in terms
of ventricular hypertrophy, T wave, and deviation in cardiac axis.
Sudden athlete deaths, injuries during sports and variability in athlete
performances have led to the discussion of the examination of athletes.
The athletes underwent an evaluation including potential personal health
history, family history, history of drug use, physical examination and
possible diagnostic tests to identify potential risks for heart disease,
musculoskeletal disease, neurological diseases, respiratory disease,
bleeding disorders and psychiatric disorders, they kept.
The athletes underwent an evaluation including potential personal health
history, family history, history of drug use, physical examination and
possible diagnostic tests to identify potential risks for heart disease,
musculoskeletal disease, neurological diseases, respiratory disease,
bleeding disorders and psychiatric disorders. they kept.
Blood tests and ECG can be used to assess the structure and function of
the heart and the health status of the organs. Abnormal findings
detected in history, physical examination, blood tests or ECG may lead
to further diagnostic tests and evaluations.18 In our
study, pathology was detected in the light of these findings in 13.8%
of the participants (25 people) and referred to internal medicine,
cardiology and pediatric hematology departments for further diagnostic
tests and evaluations. However, it was concluded that the pathologies
identified as a result of the analyzes did not prevent the participants
from doing sports.
An important issue that limits physical examinations before
participation in sports is the potential to cause unnecessary
tests.19 False positive findings in tests may cause
unnecessary anxiety in the patient and may lead to further tests. In
order to ensure that unnecessary testing and treatment are minimized, it
is important for the physician to evaluate each athlete according to his
condition.20
The fact that there are many interested in football among the
participants may be due to the interest in football in our country as
well as the fact that it requires more team players compared to other
branches. The fact that the number of those who were interested in
swimming was relatively high among those who participated in the study
suggested that health awareness might be higher among those who
preferred this branch.
The use of doping is known to increase hemoglobin
levels.21 In our study, hemoglobin level was found to
be significantly higher in the group with pathology. This increased the
suspicion that the higher pathological findings may be due to doping in
the group with high number of training sessions per week. In addition,
it was evaluated that both the intensity of training and the desire to
use doping may be higher in individuals with high ambition to win.
An important reason for pre-accession screening in athletes is the
effort to prevent sudden deaths. The main cardiac causes of sudden death
in athletes are; hypertrophic cardiomyopathy, cardiac conduction
problems, coronary artery anomalies, cardiac arrest due to severe blows
to the chest and upper respiratory tract infection may be considered as
carditis.22 Hypertrophic cardiomyopathy (36%),
coronary anomalies (19%) and cardiac mass increase (10%) were found in
the top three in a study that investigated sudden deaths in 158
competing athletes in the United States between 1985 and
1995.23
Both the American Heart Association (AHA) and the European Cardiology
Association (ESC) panel recommendations agreed that young competing
athletes should be screened for cardiac exposure.24,25However, there are differences in screening methods. While AHA
recommends a complete medical history and family history with physical
examination, ESC recommends the routine use of a 12-lead ECG in the
initial screening.26
Hypertrophic cardiomyopathy or right ventricular cardiomyopathy shows
various ECG changes, including straight or deeply inverted T waves and
deep Q waves (including a dramatic increase in R or S wave voltage)
indicating the presence of structural cardiovascular disease. In a study
conducted with 1005 individuals from 38 different sports branches
comparing ECG with echocardiography, 40% of the participants had
abnormal ECG findings and 5% had structural heart
problems.27
In our study, ECG findings were interpreted pathologically in 4 people
(2.2%); one person had delta wave, two had right bundle branch block
(one with axial deviation), and one had short QTc. It appears that the
pathological ECGs interpreted as belonging to men. This may be due to
the fact that most of the participants (81.8%) are men. On the other
hand, it has been considered that male gender is a risk factor in itself
for sudden cardiac death.22 However, it was understood
that these findings did not predict the important pathologies that would
prevent the individuals from continuing their sports life.
There are different applications for screening methods. The main reason
for this difference is the variability in cost approach. According to a
study conducted in the USA in 2012, the cost of more than $ 10 million
is saved in every case where sudden death is prevented by
ECG.28 In the same study, it is strangely argued that
ECG is a financial burden on the US economy and may hinder the
implementation of some methods that can be used to prevent cardiac
death. In addition, according to another study led by Italian
researchers, a screening program in which ECG will not be used will be
both more expensive and insufficient to identify heart
disease.29 It is thought that this difference in
opinion on cost effectiveness depends on different structuring of health
systems. In this regard, the health system in terms of
cost-effectiveness of screening with ECG in Turkey closer to European
Union countries that have been evaluated would be more useful.
The existence of family medicine practice in our country can be used as
a great advantage in this respect. From birth to death, it will be very
easy for a family physician to monitor and record at least one ECG
record for participation in sports to a person with records. In
addition, 12-lead ECG is not widely used and interpretable in our
country. It is considered that it would be beneficial to take measures
to eliminate the lack of education in this regard.
It will be necessary to interpret this research with some limitations.
First, the age range of athletes is distributed over a wide range. The
possibility of such a wide range of influences should be kept in mind.
On the other hand, muscle building protein contents, anabolic steroids
that athletes may use are not considered. In addition, the lack of
examination and laboratory data of athletes before starting sports can
be considered a limitation.
5. CONCLUSİON
The presence of conditions that may pose a risk to the health of
athletes in people who are engaged in active sports suggests that some
findings have been missed in the examinations for entry to sports. This
research shows that health screening is important for the health of the
athlete, although a health report is obtained to start sports in the
current practice, some pathologies can be omitted, on the other hand,
only anamnesis and physical examination may not be sufficient to
determine the health problems and basic laboratory tests should be
performed. Based on this research, a national guide for sports entry
examinations and screening of athletes should be developed with larger
sample and multi-center studies.