Background
Participation in sports and other physical activity has many health benefits, and is an important part of staying healthy as a person gets older. However, for some people with underlying heart problems, the stress to the heart during exercise can also be dangerous. Older athletes are at increased risk of having a heart condition called coronary artery disease, which is narrowing of the blood vessels on top of the heart that supply oxygen containing blood to the muscle walls of the heart.

Symptoms
Many masters athletes with underlying heart problems have no symptoms. Occasionally there will be warning signs, such as a decrease in athletic performance, passing out, unusually significant shortness of breath, and chest pain during exercise.

Sports Medicine Evaluation and Treatment
A sports medicine physician will begin by exploring risk factors for heart disease, which includes reviewing family history, asking about possible symptoms, measuring blood pressure, and listening for heart murmurs (an irregular sound of the beating heart). When someone has symptoms or risk factors for heart disease, additional testing may be needed. Additional tests may include a resting ECG (electrocardiogram), a stress test (an ECG while exercising), and/or an echocardiogram (an ultrasound of the heart). Treatment can include reducing the risk of heart disease through lifestyle changes including diet and exercise, and treatment of high blood pressure with medications.

Injury Prevention
The main goal of screening for underlying heart problems by ECGs and stress tests is to prevent a masters athlete from experiencing a heart attack or sudden death from an irregular heart rhythm causing the heart to stop beating. In the event of a sudden death, survival is possible with early CPR (cardiopulmonary resuscitation) and an electric shock from an AED (automated external defibrillator).

Return to Play
If a masters athlete is found to not have underlying heart problems, there are no restrictions on sports participation. However, for those who have had a prior heart attack or who have significant heart disease, participation in high-intensity competitive sports are not advised. A sports medicine physician will assist with determining which sports are safe to play. If at any time symptoms of an underlying heart problem are experienced, an athlete must return for addition testing and refrain from physical activity in the meantime.

AMSSM Member Authors
Brett Toresdahl, MD and Chad Carlson, MD

References
Maron BJ, Araújo CG, Thompson PD, et al. Recommendations for preparticipation screening and the assessment of cardiovascular disease in masters athletes: an advisory for healthcare professionals from the working groups of the World Heart Federation, the International Federation of Sports Medicine, and the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation. 2001;103(2):327.