Medical Issues in Athletes
Cardiac
Distinguish physiologic athlete's heart (sinus bradycardia, LV hypertrophy with normal function, early repolarization) from pathologic findings (T-wave inversion, prolonged QT, Brugada pattern, hypertrophic cardiomyopathy). Sudden cardiac death is most often from hypertrophic cardiomyopathy or congenital coronary anomalies in young athletes and coronary disease in older ones. Trap: attributing exertional syncope to dehydration-exertional syncope is cardiac until proven otherwise.
Pulmonary, neurologic, endocrine, hematologic
Exercise-induced bronchoconstriction responds to pre-exercise beta-agonists and warm-up; vocal cord dysfunction mimics asthma with inspiratory stridor. Concussion and seizure management, exertional heat stroke, and hyponatremia are recurring themes. In diabetes, know glucose targets before exercise and hypoglycemia risk with insulin. Iron deficiency without anemia still impairs performance; sickle cell trait raises risk of exertional collapse and rhabdomyolysis.
Renal, GI, infectious
Exertional rhabdomyolysis presents with dark urine, elevated CK, and risk of acute kidney injury-hold exercise and hydrate. GI complaints include runner's diarrhea and GI bleeding in endurance athletes. Mononucleosis requires splenic precautions and return-to-play guided by symptom resolution and organomegaly, not a fixed calendar.
Rule of thumb
Any athlete with exertional syncope, chest pain, or a family history of sudden death gets cardiac evaluation before return to play. For infection, fever and systemic symptoms mean no play.