Download athlete`s heart

THE ATHLETE AND
THE
CARDIOVASCULAR
SYSTEM
ABNORMALITIES FOUND ON
SCREENING
• Well-trained endurance athletes have a
• slow HR and large SV, which can produce normal
pulmonic flow murmurs in young athletes,
• Such murmurs typically disappear in sitting positon
• Older athletes with hemodynamically insignificant
aortic sclerosis may have aortic flow murmurs.
ECG
• Athletes can also have evidence on the of biatrial
hypertrophy, LVH, incomplete right bundle branch
block, ST-T wave abnormalities, and conduction
abnormalities.
• Most of these abnormalities occur in endurance
athletes undergoing intense training.
• Such changes in strength-trained athletes or in
endurance athletes with low training volumes should
raise suspicion of a cardiac problem
ELEVATED “CARDIAC ENZYMES” I
• endurance athletes may have elevated cTn levels after
exertion
• the possibility that prolonged exercise training produces
myocardial fibrosis
THE ATHLETE'S HEART
• The athlete's heart refers to the clinical syndrome of
• cardiac chamber enlargement,
• hypertrophy,
• normal or augmented ventricular systolic function
• commonly accompanied by
• sinus arrhythmia,
• sinus bradycardia
• systolic flow murmur
SUDDEN CARDIAC DEATH IN
THE ATHLETE
• these events occur with an incidence of 2.3 per 100,000
athletes
• The frequency of sudden death in female is lower than
in males
• < 35 years of age : HCM, ARVD, and congenital
coronary artery abnormalities
• > 35 years : CAD
SUDDEN CARDIAC ARREST
IN ATHLETES WITH HCM
• ventricular tachyarrhythmias mediated by multiple
factors
• hemodynamic compromise or
• primary ventricular arrhythmias
CAD
• If an athlete is identified as being at risk for coronary
artery disease or if symptoms suggest ischemia, an
exercise stress test should be performed.
• Stress testing is also recommended in males older than
40 years of age or females older than 50 years of age
on the presence of at least two risk factors other than
age and sex or one marked abnormal finding
• In older athletes without chest pain and risk factors, the
routine use of exercise testing is limited by its low
specificity and pretest probability
• Approximately 10% of young athletes who die suddenly
with exercise have no evidence of structural heart
diseases
• in many such patients, the cause of sudden death is
likely a primary electrical heart disease.
• WPW ,
• long QT syndrome,
• short QT syndrome,
• Brugada syndrome,
• catecholaminergic polymorphic VT
CLINICAL EVALUATION OF THE
ATHLETE WITH SYMPTOMS
CHEST PAIN
• is a common complaint
• Chest discomfort in athletes should never be dismissed
summarily.
• The sensation of momentary chest pain may
accompany
• premature atrial or ventricular beats.
• muscle and joint issues
ARRHYTHMIA
• the presence or absence of structural heart disease,
• family medical history
• palpitations are frequently benign;
• presyncope and certainly syncope are more
concerning,
• resuscitated sudden death is a major concern.
SYNCOPE
• common symptom
• Syncope without prodromal symptoms or occurring at
peak exercise is more concerning
• Injury secondary to syncope is more often seen in
arrhythmic disorders.
WORKUP FOR SYNCOPE
• ECG
• echocardiogram.
• exercise tolerance test :
• In athletes older than 35 years of age and
• those with syncope during exertion
FAMILIAL HISTORY
• the presence of early sudden death or hereditary
cardiac abnormality in the family of an athlete should
prompt a thorough cardiac workup regardless of the
presenting symptoms
DECREASED EXERCISE
CAPACITY
• Decrements in any of these components can adversely
affect exercise performance
•
•
•
•
CV components (HR and the A-V O2 difference)
central nervous system
lungs
skeletal muscle
DECREASED EXERCISE
CAPACITY
• hyperthyroidism
• exercise-induced asthma,
• diseases of skeletal muscle,
• anemia
• arrhytmia
• viral illnesses
DECREASED EXERCISE
CAPACITY
• occult coronary disease
• LV diastolic dysfunction
• “borderline hypertension”
• Psychological factors
• overtraining
OVERTRAINING
• is a complex interaction of psychological and
physiologic fatigue
• Diminished exercise tolerance (sometimes with an
elevated resting HR), the sensation of nocturnal fevers,
and insomnia all characterize overtraining.
• Overtraining should be diagnosed only when other
conditions are excluded
• requires a therapeutic trial of markedly reduced
training
PERFORMANCEENHANCING SUBSTANCES
• The dietary supplement ephedra (Ma-huang), for
example, is associated with life-threatening toxicity and
death
• Anabolic steroids are associated with premature
coronary disease and sudden death.
• cocaine are associated with fatal myocardial
infarction, sudden death, and stroke.
VALVE DISEASE IN ATHLETES
AORTIC STENOSIS
• careful evaluation
• “warm-up dyspnea” frequently indicates clinically
important AS.
AORTIC REGURGITATION
• generally tolerate well
• Not restrict athletic competition and resistance exercise
severe AR
• restrict if evidence of ventricular deterioration.
BICUSPID AORTIC VALVE
(BAV)
• restrict activity if the aortic diameter is greater than 45
mm,
• evaluate athletes annually with an aortic size of 40 to
45 mm.
• Athletes found to have a BAV valve should undergo
some form of imaging and then serial imaging
THE CARDIOVASCULAR
RISKS OF EXERCISE
• evidence has shown that vigorous physical activity,
generally defined as six or more METS, transiently
increases the risk for (SCD) and (AMI)