The sudden death of a completive athlete is a personal tragedy that has a great impact on medical communities, families, and friends. Such an event often assumes a high public profile because of the generally held perception that athletes are among the healthiest people in our society. There is also a general consensus that within a civilized society there is a responsibility on the part of physicians to make sufficient efforts to identify life threatening cardiovascular diseases in competitive athletes. The differential diagnosis between athlete's heart syndrome and HCM represents a vital clinical dilemma that is not easily solved. .
The heart undergoes profound changes in response to athletic training, producing in well-conditioned athletes morphologic, functional, and electrophysiologic alterations. But a perplexing situation for the clinician is the athlete whose problem cannot be attributed to the athletic heart syndrome. The usual clinical situation is one in which exercise-associated collapse, near-syncope, or syncope is the presenting complaint, and a carefully taken history and physical examination reveal little. Further workup will usually include an electrocardiogram (ECG) and/or an echocardiogram. If the ECG demonstrates abnormal findings or the echocardiogram reveals septal or wall measurements that fall within the diagnostic gray zone, the dilemma becomes whether these findings represent underlying pathology or the athletic heart syndrome.(36) .
In young competitive athletes, the differential diagnosis between non pathological changes in cardiac morphology associated with training, athletic heart syndrome, and certain cardiac diseases with the potential for sudden death is an important and not uncommon clinical problem.(37) Several cardiovascular disorders have been implicated as the principal causes of death on the athletic field, the most common being HCM.(38) Others, which are very rare include coronary artery anomalies, arrhythmic right ventricular dysphasia, long QT syndrome, or Marfan's syndrome.
