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Ma JZ, Dai J, Sun B, Ji P, Yang D, Zhang JN. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death in China. J Sci Med Sport 2007; 10:227-33. [PMID: 16914373 DOI: 10.1016/j.jsams.2006.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2006] [Revised: 07/02/2006] [Accepted: 07/04/2006] [Indexed: 11/30/2022]
Abstract
The cardiovascular pre-participation screening proposal for young competitive athletes has the potential to save young lives. This study aimed to identify individuals at risk for potentially lethal cardiovascular diseases in athletes before competition. Between June 2005 and July 2005, 351 (170 male and 181 female) elite Chinese athletes from 21 sports were profiled. The 12-lead electrocardiogram and echocardiography were employed to evaluate cardiovascular diseases. The vast majority had no definitive evidence of cardiovascular disease. However, abnormal ECGs were identified in 16 athletes (4.5%), including 4 with distinctly abnormal and 12 with mildly abnormal patterns. Only 13 athletes (3.7%) had echocardiographic evidence of relatively mild valve regurgitation that had not been previously suspected. In three athletes with relatively mild ventricular septal hypertrophy (13-14 mm), it was not possible to discern with absolute certainty whether the wall thickening was a manifestation of hypertrophic cardiomyopathy or secondary to athletic conditioning ("athlete heart"). This screening protocol identified no athletes with definite evidence of hypertrophic cardiomyopathy, Marfan's syndrome or other cardiovascular diseases that convey a significant potential risk for sudden death or disease progression during athletic activity. This is largely due to the relative low prevalence of conditions resulting in sudden cardiac death in young athletes and high false positive/negative rates in the tests used as part of the screening process (due to a large overlap between cardiovascular changes due to pathology and those due to intense training).
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Affiliation(s)
- Ji Zheng Ma
- Institute of Cardiovascular Disease, First Affiliated Hospital of NanJing Medical University, China
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53
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Ouldzein H, Azzouzi F, Ayadi-Koubaa D, Bartagi Z, Cherradi R, Mechmeche R. Analyse de l'électrocardiogramme et de l'échocardiographie de 181 footballeurs professionnels tunisiens. Sci Sports 2007. [DOI: 10.1016/j.scispo.2006.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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54
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Shah AM, Estes NAM, Weinstock J, Homoud MK, Link MS. Treatment of athletes with cardiac disease or arrhythmias. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2006; 8:353-61. [PMID: 16939673 DOI: 10.1007/s11936-006-0039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ventricular arrhythmias and sudden cardiac death in the athlete are uncommon but extremely visible because of the high profile of amateur and professional athletes. In athletes under the age of 30 years, the incidence of sudden death is low and in most cases occurs in individuals with inherited heart disease. In the older athlete, sudden death is more common and is generally due to arrhythmias in the context of coronary artery disease. Many athletes with aborted sudden death, arrhythmia-related syncope, or high-risk genetic disorders benefit from therapy with implantable cardioverter-defibrillators (ICDs). Although ICD therapy can effectively abort sudden death, implantation of an ICD generally prohibits an individual from all competitive athletics except low-intensity sports. Recommendations for participation in competitive athletics generally follow the recently published 36th Bethesda Conference Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities.
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Affiliation(s)
- Amil M Shah
- Tufts-New England Medical Center, Cardiac Arrhythmia Service, Division of Cardiology, 750 Washington Street, Box # 197, Boston, MA 02111, USA
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55
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Heidbüchel H, Anné W, Willems R, Adriaenssens B, Van de Werf F, Ector H. Endurance sports is a risk factor for atrial fibrillation after ablation for atrial flutter. Int J Cardiol 2006; 107:67-72. [PMID: 16337500 DOI: 10.1016/j.ijcard.2005.02.043] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2004] [Revised: 02/14/2005] [Accepted: 02/19/2005] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Sports activity has been associated with the development of atrial arrhythmias. Atrial fibrillation (AF) is frequently observed after successful ablation for atrial flutter. Sports activity as a risk factor for AF development after flutter ablation has not been studied. METHODS We analyzed outcome in 137 patients (83% men) after ablation for isthmus-dependent atrial flutter (excluding patients with concomitant ablation for atrial tachycardia or fibrillation). Sports activity before and after ablation was evaluated by detailed questionnaires. Endurance sports was defined as (semi-)competitive participation in cycling, running or swimming for > or =3 h/week (and for > or =3 years pre-ablation). Median follow-up was 2.5 years. Survival free of AF was evaluated with Kaplan-Meier curves and log-rank statistics. Multivariate analysis was based on Cox proportional hazard evaluation. RESULTS Acute ablation success was 99% and flutter recurrence 4.4%. Thirty-one patients (23%) had been regularly engaged in endurance sports before ablation and 19 (14%) continued regular sports activity afterwards. Those performing sports were slightly younger. A history of endurance sports was a significant risk factor for post-ablation AF (univariate HR 1.96 (1.19-3.22), p<0.01, and multivariate HR 1.81 (1.10-2.98), p=0.02). Also continuation of endurance sports activity after ablation showed a trend for increased risk to develop AF despite a relatively small sample size (n=19; multivariate HR 1.68 (0.92-3.06), p=0.08). Cox proportional hazard calculations revealed a 10% and 11% increased risk for AF development per weekly hour sport performed before and after ablation respectively (p<0.01 for both). CONCLUSION A history of endurance sports activity is associated with the development of AF after ablation of atrial flutter.
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Affiliation(s)
- Hein Heidbüchel
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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56
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Swanson DR. Atrial fibrillation in athletes: Implicit literature-based connections suggest that overtraining and subsequent inflammation may be a contributory mechanism. Med Hypotheses 2006; 66:1085-92. [PMID: 16504414 DOI: 10.1016/j.mehy.2006.01.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 01/10/2006] [Indexed: 11/21/2022]
Abstract
Research on atrial fibrillation (AF), a common heart arrhythmia in the elderly, over many decades has resulted in a literature of more than 16,000 articles indexed in Medline. An exploratory Medline search was conducted in which the subheadings for epidemiology and etiology of AF were combined to form a small subset of the initial records. Further computer-assisted selection led to a few articles that reported an unexpectedly high prevalence of AF in groups of otherwise healthy middle-aged endurance runners and other athletes. Why athletes should be unusually susceptible to AF is mysterious and puzzling. Because relatively few articles are about both AF and endurance exercise, a computer was used first to create a list of important terms that these two separate literatures had in common. Several inflammation-related terms, including C-reactive protein (CRP) and interleukin-6, were on that list. Further searching and literature analysis revealed that excessive endurance exercise or overtraining can lead to chronic systemic inflammation and, separately, that there is a solid association between CRP and AF and that anti-inflammatory agents have been reported to lower CRP and ameliorate AF. No articles were found that brought together all three concepts - AF, inflammation, and exercise. The following hypothesis is plausible, readily testable, and apparently novel: Older athletes diagnosed with AF but otherwise healthy who have engaged in rigorous aerobic endurance exercise for more than a decade will have CRP levels that are higher than those of a similar population of athletes without AF. Corroboration of this hypothesis would then justify a prospective clinical trial of anti-inflammation therapy. It is of particular interest to extend recent studies of inflammation in AF to athletes; athletic behavior that can induce inflammation may contribute to understanding the origins of AF.
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Affiliation(s)
- Don R Swanson
- Division of the Humanities, The University of Chicago, IL 60637, USA.
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57
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Abstract
The electrocardiogram performed in the competitive athlete may manifest abnormal electrocardiographic findings; these findings may indicate either normal variant syndromes as well as true cardiac pathology. The normal variant syndromes include ST-segment and T-wave abnormalities, rhythm disturbances, and intraventricular conduction delay--it must be stressed that these electrocardiographic findings are, in fact, normal variants, not indicative of underlying pathology. Other presentations in these same competitive athletes describe significant cardiac pathology, including syndromes predisposing the patient to sudden cardiac death and other potentially dangerous dysrhythmias and diagnostic of acute coronary syndrome. This article reviews the various findings in this group of patients.
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Affiliation(s)
- Jeffrey Wu
- Department of Emergency Medicine, University of Virginia, Charlottesville, 22908-0699, USA
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Turkmen M, Barutcu I, Esen AM, Ocak Y, Melek M, Kaya D, Karakaya O, Saglam M, Basaran Y. Assessment of QT interval duration and dispersion in athlete's heart. J Int Med Res 2005; 32:626-32. [PMID: 15587756 DOI: 10.1177/147323000403200607] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
An athlete's heart is characterized by morphological and functional changes occurring as a consequence of regular physical exercise. We sought to determine if these physiological changes lead to ventricular repolarization abnormalities in trained athletes. Forty-four trained athletes and 35 sex- and age-matched healthy sedentary controls were included in the study. A 12-lead surface electrocardiogram (ECG) was obtained from all participants. Maximum QT (QTmax) and minimum QT (QTmin) interval durations, QT dispersion (QTd) and corrected QT dispersion (QTcd) were calculated for each ECG record. Heart rate, systolic and diastolic blood pressure values were found to be identical in both groups. QTmax and QTmin interval durations were not statistically different between the athletic and control groups. Similarly, QTd and QTcd did not differ significantly between the two groups. No association was observed between an athlete's heart and ventricular heterogeneity compared with healthy sedentary controls, despite physiological and structural changes.
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Affiliation(s)
- M Turkmen
- Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
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60
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Frost L, Frost P, Vestergaard P. Work related physical activity and risk of a hospital discharge diagnosis of atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Occup Environ Med 2005; 62:49-53. [PMID: 15613608 PMCID: PMC1740844 DOI: 10.1136/oem.2004.014266] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Excessive sporting activities have been associated with risk of atrial fibrillation. To study if work related physical activity also confers risk of atrial fibrillation or flutter, the association between work related physical strain and the risk of a hospital discharge diagnosis (inpatient as well as outpatient) of atrial fibrillation or flutter was examined. METHODS A population based prospective cohort study was conducted from December 1993 to December 2001 among 19 593 men and 18,807 women with a mean age at baseline of 56 years (range 50-65 years) in the Danish Diet, Cancer, and Health Study. The physical strain during working hours was categorised as sedentary, light, or heavy, and analysed using proportional hazard models. Subjects were followed up in the Danish National Registry of Patients and in the Danish Civil Registration System. RESULTS During follow up (mean 5.7 years) a hospital discharge diagnosis of atrial fibrillation or flutter occurred in 305 men and 113 women. When using the risk of atrial fibrillation or flutter associated with sedentary work at a sitting position as a reference, no excess risk (unadjusted as well as adjusted) was found of atrial fibrillation or flutter associated with sedentary work in a standing position, light workload, or heavy workload in men or women. CONCLUSION No evidence was found of an association between physical activities during working hours and risk of a hospital discharge diagnosis of atrial fibrillation or flutter for men and women in the age group of 50-65 years.
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Affiliation(s)
- L Frost
- Department of Cardiology A, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
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61
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Bader RS, Goldberg L, Sahn DJ. Risk of sudden cardiac death in young athletes: which screening strategies are appropriate? Pediatr Clin North Am 2004; 51:1421-41. [PMID: 15331292 DOI: 10.1016/j.pcl.2004.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Resources are not available to comprehensively evaluate all young athletes before participation in competitive sports. Therefore, the cardiovascular evaluation of young athletes needs to be targeted at high-risk areas and focus on the individuals who are at greatest possible risk: those who have suggestive, even if minor, symptoms, and those who have a family history of sudden death or premature cardiac disease.
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MESH Headings
- Adolescent
- Aneurysm, Ruptured/complications
- Aortic Aneurysm, Abdominal/complications
- Arrhythmogenic Right Ventricular Dysplasia/complications
- Arrhythmogenic Right Ventricular Dysplasia/pathology
- Athletic Injuries
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Child
- Coronary Vessel Anomalies/complications
- Coronary Vessel Anomalies/physiopathology
- Cost-Benefit Analysis
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Electrocardiography
- Ethics, Clinical
- Humans
- Myocarditis/complications
- Physical Examination
- Prevalence
- Sports
- Syndrome
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Affiliation(s)
- Rima S Bader
- Pediatric Cardiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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62
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Cava JR, Danduran MJ, Fedderly RT, Sayger PL. Exercise recommendations and risk factors for sudden cardiac death. Pediatr Clin North Am 2004; 51:1401-20. [PMID: 15331291 DOI: 10.1016/j.pcl.2004.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article reviews the risk factors that are associated with exercise that can lead to sudden cardiac death and what can be done to identify those who are at risk. Additionally, exercise recommendations to reduce the chance of sudden cardiac death and comments about restrictions and quality of life issues are addressed.
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Affiliation(s)
- Joseph R Cava
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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63
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Vallbona N, Llopart J, Martínez Burgui J. Bloqueo auriculoventricular de tercer grado o completo asintomático. Semergen 2004. [DOI: 10.1016/s1138-3593(04)74340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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64
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Abstract
The cardiopulmonary adaptations made to dynamic and static exercise show the amazing ability of the human body to alter physiological processes in order to meet metabolic demands. A remarkable partnership that allows individuals to maximize their abilities and obtain goals exists between the cardiovascular and pulmonary systems. The adaptations of the cardiopulmonary system depend heavily on the intensity, duration, frequency, and type of exercise being performed. Although most of this article examined dynamic and static exercise separately, the majority of individuals train using a combination of these two modes. The overall adaptations will vary with the chosen degree of each exercise mode. An appropriate exercise program allows for improvements in the cardiopulmonary system that help develop and maintain fitness levels.
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Affiliation(s)
- Mark A Booher
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7470, USA.
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65
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Biffi A, Pelliccia A, Verdile L, Fernando F, Spataro A, Caselli S, Santini M, Maron BJ. Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol 2002; 40:446-52. [PMID: 12142109 DOI: 10.1016/s0735-1097(02)01977-0] [Citation(s) in RCA: 216] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The aim of this study was to clarify the clinical relevance of ventricular tachyarrhythmias assessed by 24-h ambulatory electrocardiograms (ECG) in a large, unique, and prospectively evaluated athletic population. BACKGROUND For athletes with ventricular tachyarrhythmias, the risk of sudden cardiac death associated with participation in competitive sports is unresolved. METHODS; We assessed 355 competitive athletes with ventricular arrhythmias (VAs) on a 24-h ambulatory (Holter) ECG that was obtained because of either palpitations, the presence of > or = 3 premature ventricular depolarizations (PVDs) on resting 12-lead ECG, or both. RESULTS Athletes were segregated into three groups: Group A with > or = 2,000 PVDs/24 h (n = 71); Group B with > or = 100 <2,000 PVDs/24 h (n = 153); and Group C with only <100 PVDs/24 h (n = 131). Cardiac abnormalities were detected in 26 of the 355 study subjects (7%) and were significantly more common in Group A (21/71, 30%) than in Group B (5/153, 3%) or Group C athletes (0/131, 0% p < 0.001). Only the 71 athletes in Group A were excluded from competition. During follow-up (mean, 8 years), 70 of 71 athletes in Group A and each of the 284 athletes in Groups B and C have survived without cardiovascular events. The remaining Group A athlete died suddenly of arrhythmogenic right ventricular cardiomyopathy while participating in a field hockey game against medical advice. Frequent and complex ventricular tachyarrhythmias are common in trained athletes and are usually unassociated with underlying cardiovascular abnormalities. Such VAs (when unassociated with cardiovascular abnormalities) do not convey adverse clinical significance, appear to be an expression of "athlete's heart syndrome," and probably do not per se justify a disqualification from competitive sports.
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Affiliation(s)
- Alessandro Biffi
- Institute of Sports Science, Department of Medicine, Italian National Olympic Committee, Rome, Italy.
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66
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Affiliation(s)
- Joseph K Choo
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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67
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Stein R, Medeiros CM, Rosito GA, Zimerman LI, Ribeiro JP. Intrinsic sinus and atrioventricular node electrophysiologic adaptations in endurance athletes. J Am Coll Cardiol 2002; 39:1033-8. [PMID: 11897447 DOI: 10.1016/s0735-1097(02)01722-9] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES In the present study, we evaluated sinus and atrioventricular (AV) node electrophysiology of endurance athletes and untrained individuals before and after autonomic pharmacologic blockade. BACKGROUND Endurance athletes present a higher prevalence of sinus bradycardia and AV conduction abnormalities, as compared with untrained individuals. Previous data from our laboratory suggest that nonautonomic factors may be responsible for the longer AV node refractory period found in well-trained athletes. METHODS Six aerobically trained male athletes and six healthy male individuals with similar ages and normal rest electrocardiograms were studied. Maximal oxygen uptake (O(2)max) was measured by cardiopulmonary testing. The sinus cycle length (SCL), AV conduction intervals, sinus node recovery time (SNRT), Wenckebach cycle (WC) and anterograde effective refractory period (ERP) of the AV node were evaluated by invasive electrophysiologic studies at baseline, after intravenous atropine (0.04 mg/kg) and after addition of intravenous propranolol (0.2 mg/kg). RESULTS Athletes had a significantly higher O(2)max as compared with untrained individuals. The SCL was longer in athletes at baseline, after atropine and after the addition of propranolol for double-autonomic blockade. The mean maximal SNRT/SCL was longer in athletes after atropine and after propranolol. The WC and anterograde ERP of the AV node were longer in athletes at baseline, after atropine and after propranolol. CONCLUSIONS Under double-pharmacologic blockade, we demonstrated that sinus automaticity and AV node conduction changes of endurance athletes are related to intrinsic physiology and not to autonomic influences.
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Affiliation(s)
- Ricardo Stein
- Cardiology Division, Hospital de Clínicas de Porto Alegre, and Department of Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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68
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Abstract
Highly trained athletes show morphologic cardiac changes (ie, athlete's heart) that are the consequence of several determinants, including type of sport, gender, and, possibly, inherited genetic factors. The extent of physiologic cardiac remodeling may occasionally be substantial in highly trained athletes and may raise a differential diagnosis with structural cardiac disease, such as cardiomyopathies. In addition, athletes demonstrate a spectrum of alterations in the 12-lead electrocardiogram (ECG) pattern, including marked increase in precordial R-wave or S-wave voltages, ST segment or T-wave changes, and deep Q waves suggestive of left ventricular hypertrophy, that may raise the possibility of pathologic heart condition, but have also been viewed as a consequence of the cardiac morphologic remodeling induced by athletic conditioning. To evaluate the clinical significance of these abnormal ECGs, the authors compared ECG patterns to cardiac morphology and function (assessed by two-dimensional echocardiography in individual athlete) in a large population of 1005 elite athletes engaged in a variety of sporting disciplines. Forty percent of the athletes had abnormal ECGs, and a subgroup of about 15% showed distinctly abnormal and often bizarre patterns highly suggestive of cardiomyopathies, such as hypertrophic cardiomyopathy, in the absence of pathologic cardiac changes. Such alterations are likely the consequence of athletic conditioning itself and represent another potential component of athlete's heart syndrome. However, such false-positive ECGs represent a potential limitation to the efficacy of routine ECG testing in the preparticipation cardiovascular screening of large athletic populations.
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Affiliation(s)
- Antonio Pelliccia
- Institute of Sports Science, Italian National Olympic Committee, Rome, Italy.
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69
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Abstract
For decades the preparticipation physical examination (PPE) has been used to screen athletes prior to sports participation to prevent injury or illness. Evolution of the PPE, it is theorized, originated from the need to identify individuals with conditions that may predispose them to injuries or life-threatening situations. However, the effectiveness, practicality, and worthiness of the examination are a matter of debate. As members of a medical team, physicians are responsible for the health and safety of the athlete. The PPE is the first step in satisfying this responsibility. This article discusses the components of the PPE and presents the evidence-based model of knowledge behind the PPE.
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Affiliation(s)
- J A Lombardo
- Ohio State University Sports Medicine Center, Columbus, Ohio, USA
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70
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Matsuo S, Nakamura Y, Takahashi M, Matsui T, Kusukawa J, Yoshida S, Hamamoto H, Kinoshita M. Cardiac sympathetic dysfunction in an athlete's heart detected by 123I-metaiodobenzylguanidine scintigraphy. ACTA ACUST UNITED AC 2001; 65:371-4. [PMID: 11348038 DOI: 10.1253/jcj.65.371] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The athlete's heart is commonly characterized by an increase in left ventricular mass because of an increase in the left ventricular diastolic cavity dimensions or wall thickness or both. Endurance exercise also induces numerous cardiovascular adaptations, including increased vagal tone. However, the sympathetic function has not yet been precisely elucidated, so the present study evaluated cardiac sympathetic nerve function from metaiodobenzylguanidine (MIBG) images obtained 15 and 180 min after the injection of 123I-MIBG at a dose of 111 MBq. The ratio of heart/mediastinum count (H/M) and the washout rates of 123I-MIBG (WR) were calculated in 25 consecutive patients who were athletes (aged 52+/-13 years) and 23 normal subjects. There was a significant difference in the H/M between the athletic and normal hearts (2.3+/-0.3 vs 2.6+/-0.3, p<0.01, Scheffe's test). An increased WR was observed in the athletes group when compared with the normal group (34+/-4 vs 28+/-3, p<0.01), and there was a significant correlation between WR and the left ventricular mass index (r=0.578, p<0.01). Prolonged exercise training may alter cardiac sympathetic nerve function, which can be detected by MIBG imaging.
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Affiliation(s)
- S Matsuo
- First Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan.
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71
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72
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Somauroo JD, Pyatt JR, Jackson M, Perry RA, Ramsdale DR. An echocardiographic assessment of cardiac morphology and common ECG findings in teenage professional soccer players: reference ranges for use in screening. BRITISH HEART JOURNAL 2001; 85:649-54. [PMID: 11359746 PMCID: PMC1729780 DOI: 10.1136/heart.85.6.649] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess physiological cardiac adaptation in adolescent professional soccer players. SUBJECTS AND DESIGN Over a 32 month period 172 teenage soccer players were screened by echocardiography and ECG at a tertiary referral cardiothoracic centre. They were from six professional soccer teams in the north west of England, competing in the English Football League. One was excluded because of an atrial septal defect. The median age of the 171 players assessed was 16.7 years (5th to 95th centile range: 14-19) and median body surface area 1.68 m(2) (1.39-2.06 m(2)). MAIN OUTCOME MEASURES Standard echocardiographic measurements were compared with predicted mean, lower, and upper limits in a cohort of normal controls after matching for age and surface area. Univariate regression analysis was used to assess the correlation between echocardiographic variables and the age and surface area of the soccer player cohort. ECG findings were also assessed. RESULTS All mean echocardiographic variables were greater than predicted for age and surface area matched controls (p < 0.001). All variables except left ventricular septal and posterior wall thickness showed a modest linear correlation with surface area (r = 0.2 to 0.4, p < 0.001); however, left ventricular mass was the only variable that was significantly correlated with age (r = 0.2, p < 0.01). Only six players (3.5%) had structural anomalies, none of which required further evaluation. All had normal left ventricular systolic function. Sinus bradycardia was found in 65 (39%). The Solokow-Lyon voltage criteria for left ventricular hypertrophy were present in 85 (50%) and the Romhilt-Estes points score (five or more) in 29 (17%). Repolarisation changes were present in 19 (11%), mainly in the inferior leads. CONCLUSIONS Chamber dimensions, left ventricular wall thickness and mass, and aortic root size were all greater than predicted for controls after matching for age and surface area. Sinus bradycardia and the ECG criteria for left ventricular hypertrophy were common but there was poor correlation with echocardiographic left ventricular hypertrophy. The type of hypertrophy found reflected the combined endurance and strength based training undertaken.
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Affiliation(s)
- J D Somauroo
- The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK.
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73
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Abstract
Highly trained athletes show a variety of electrocardiographic (ECG) changes, including a striking increase of R or S wave voltage, either flat or deeply inverted T waves, and deep Q waves, that suggest the presence of structural cardiovascular disease, such as hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy, which represent the most common causes of sudden death in young competitive athletes. Despite a number of previous observational surveys, the determinants and clinical significance of these abnormal ECG patterns in trained athletes are still uncertain. Therefore, ECG patterns were compared with cardiac morphology (by echocardiography) in a large population of 1005 athletes, who were engaged in a variety of 38 sporting disciplines. We found abnormal ECGs in 40% of our athletes, but structural cardiac diseases were identified in only 5%. In the absence of cardiac disease, other determinants were recognized as responsible for abnormal ECG patterns, including the extent of morphologic cardiac remodeling, participation in an endurance type of sport, and male gender. Finally, a small but important subset of athletes showed striking ECG abnormalities that strongly suggested the presence of cardiovascular disease in the absence of pathologic cardiac conditions or morphologic changes, suggesting that these ECG alterations may be the consequence of athletic conditioning itself.
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Affiliation(s)
- A Pelliccia
- Institute of Sport Science, Via dei Campi Sportivi 46, 00197 Rome, Italy.
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74
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Abstract
Life-threatening ventricular arrhythmias in the athlete nearly always occur in the presence of structural heart disease. In the last few years, 2 new causes of life-threatening arrhythmias have been described in patients with normal hearts-that of the Brugada syndrome and that of commotio cordis. Non-life-threatening premature ventricular beats and even nonsustained ventricular tachycardia are not rare, and although usually benign, can be secondary to cardiomyopathies. Athletes with symptoms of syncope, especially if exertional, warrant a complete evaluation. The treatment of athletes and other individuals with life-threatening ventricular arrhythmias has been revolutionized by the implantable cardioverter defibrillator, a device that affords excellent protection from sudden death. Defining those athletes who would benefit from the implantable defibrillator is not always clear. Furthermore, participation in competitive athletics for athletes with life-threatening arrhythmias or structural heart disease known to put the athlete at risk for life-threatening arrhythmias is usually prohibited.
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Affiliation(s)
- M S Link
- The Cardiac Arrhythmia Service, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
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75
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Abstract
Cardiac arrhythmias in the athlete are a frequent cause for concern. Some arrhythmias may be benign and asymptomatic, but others may be life threatening and a sign that serious cardiovascular disease is present. Physicians often are consulted with regard to arrhythmias, or symptoms consistent with arrhythmias, in athletes. Sinus bradyarrhythmias are common and even expected in athletes. These bradyarrhythmias are rarely a cause for concern. Heart block is unusual and merits a thorough workup. Atrial fibrillation may be more common in the athlete. Supraventricular tachycardias other than atrial fibrillation generally warrant consideration of radiofrequency ablation for cure of the tachyarrhythmia. Ventricular arrhythmias in the athlete generally occur in the setting of structural heart disease that is genetically determined (hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, anomalous coronary arteries) or acquired (coronary artery disease, myocarditis, idiopathic dilated cardiomyopathies). In these conditions, the arrhythmia generally is life threatening. Ventricular arrhythmias that occur in the athlete without structural heart disease are not thought to be life threatening. Athletes with structural heart disease and syncope and those with exertional syncope merit a complete evaluation.
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Affiliation(s)
- M S Link
- The Center for Cardiovascular Evaluation of Athletes, The Cardiac Arrhythmia Center, New England Medical Center, Box 197, 750 Washington Street, Boston, MA 02111, USA
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76
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Drezner JA. Sudden cardiac death in young athletes. Causes, athlete's heart, and screening guidelines. Postgrad Med 2000; 108:37-44, 47-50. [PMID: 11043079 DOI: 10.3810/pgm.2000.10.1260] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sudden cardiac death of a young competitive athlete is a rare but tragic event. Hypertrophic cardiomyopathy and coronary artery anomalies are the most frequent causes. Most cardiovascular abnormalities go unrecognized until the time of death owing to the lack of preceding signs or symptoms suggestive of disease. Physicians responsible for the care of athletes should be familiar with the various causes of sudden cardiac death, the physiologic adaptations seen in so-called athlete's heart, and existing cardiovascular screening guidelines. The preparticipation evaluation, although it has limitations, is the major instrument readily available for prevention of sudden cardiac death. Effort should be made to follow established consensus guidelines.
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Affiliation(s)
- J A Drezner
- Department of Family Medicine, University of Washington School of Medicine, Seattle, USA.
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77
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Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A, Caselli G, Piovano P. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 2000; 102:278-84. [PMID: 10899089 DOI: 10.1161/01.cir.102.3.278] [Citation(s) in RCA: 306] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND-The prevalence, clinical significance, and determinants of abnormal ECG patterns in trained athletes remain largely unresolved. METHODS AND RESULTS-We compared ECG patterns with cardiac morphology (as assessed by echocardiography) in 1005 consecutive athletes (aged 24+/-6 years; 75% male) who were participating in 38 sporting disciplines. ECG patterns were distinctly abnormal in 145 athletes (14%), mildly abnormal in 257 (26%), and normal or with minor alterations in 603 (60%). Structural cardiovascular abnormalities were identified in only 53 athletes (5%). Larger cardiac dimensions were associated with abnormal ECG patterns: left ventricular end-diastolic cavity dimensions were 56. 0+/-5.6, 55.4+/-5.7, and 53.7+/-5.7 mm (P<0.001) and maximum wall thicknesses were 10.1+/-1.4, 9.8+/-1.3, and 9.3+/-1.4 mm (P<0.001) in distinctly abnormal, mildly abnormal, and normal ECGs, respectively. Abnormal ECGs were also most associated with male sex, younger age (<20 years), and endurance sports (cycling, rowing/canoeing, and cross-country skiing). A subset of athletes (5% of the 1005) showed particularly abnormal or bizarre ECG patterns, but no evidence of structural cardiovascular abnormalities or an increase in cardiac dimensions. CONCLUSIONS-Most athletes (60%) in this large cohort had ECGs that were completely normal or showed only minor alterations. A variety of abnormal ECG patterns occurred in 40%; this was usually indicative of physiological cardiac remodeling. A small but important subgroup of athletes without cardiac morphological changes showed striking ECG abnormalities that suggested cardiovascular disease; however, these changes were likely an innocent consequence of long-term, intense athletic training and, therefore, another component of athlete heart syndrome. Such false-positive ECGs represent a potential limitation to routine ECG testing as part of preparticipation screening.
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Affiliation(s)
- A Pelliccia
- Institute of Sports Science, Department of Medicine, Italian National Olympic Committee, Rome, Italy.
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78
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Estorch M, Serra-Grima R, Flotats A, Marí C, Bernà L, Catafau A, Martín JC, Tembl A, Narula J, Carrió I. Myocardial sympathetic innervation in the athlete's sinus bradycardia: is there selective inferior myocardial wall denervation? J Nucl Cardiol 2000; 7:354-8. [PMID: 10958277 DOI: 10.1067/mnc.2000.105550] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sinus bradycardia in trained athletes is predominantly a manifestation of increased vagal tone, but it is not known whether an alteration in the cardiac sympathetic system can contribute to blunted chronotropic response. This study assessed the integrity of the sympathetic system in trained athletes with sinus bradycardia by means of the iodine-123-metaiodobenzylguanidine (123I-MIBG) procedure. METHODS AND RESULTS Fourteen athletes with sinus bradycardia and 8 athletes with a normal heart rate were explored by means of planar and single photon emission computed tomography MIBG studies. The heart/mediastinum ratio, regional myocardial distribution, and percent of regional myocardial MIBG uptake were evaluated. The heart/mediastinum ratio in athletes with sinus bradycardia was 1.87+/-0.10, and in athletes with a normal heart rate, the heart/mediastinum ratio was 1.86+/-0.16 (P = not significant). In athletes with sinus bradycardia, the regional distribution of MIBG showed an inferior and apical uptake defect in 8 athletes, an inferior, apical, and septal defect in 3 athletes, an inferior defect in 1 athlete, and normal distribution in 2 athletes (14%). In athletes with a normal heart rate, the regional distribution of MIBG showed an apical uptake defect in 3 athletes and normal distribution in 5 athletes (63%). The percent of regional MIBG uptake in the inferior region was significantly reduced in athletes with sinus bradycardia (44%+/-13% vs. 72%+/-11%, P<.01). CONCLUSION These results show severely reduced myocardial MIBG distribution in the inferior region in athletes with sinus bradycardia, suggesting selective inferior myocardial wall sympathetic denervation, which may be related to increased vagal tone.
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Affiliation(s)
- M Estorch
- Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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79
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Constable PD, Hinchcliff KW, Olson JL, Stepien RL. Effects of endurance training on standard and signal-averaged electrocardiograms of sled dogs. Am J Vet Res 2000; 61:582-8. [PMID: 10803657 DOI: 10.2460/ajvr.2000.61.582] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effect of endurance training on QRS duration, QRS-wave amplitude, and QT interval. ANIMALS 100 sled dogs in Alaska. PROCEDURE Dogs were examined in early September (before training) and late March (after training). During the interim, dogs trained by pulling a sled with a musher (mean, 20 km/d). Standard and signal-averaged ECG were obtained before and after training. RESULTS Endurance training significantly increased mean QRS duration by 4.4 milliseconds for standard ECG (mean +/- SEM; 62.3 +/- 0.7 to 66.7 +/- 0.6 milliseconds) and 4.3 milliseconds for signal-averaged ECG (51.5 +/- 0.7 to 55.8 +/- 0.6 milliseconds) without changing body weight. Increase in QRS duration corresponded to a calculated increase in heart weight (standard ECG, 23%; signal-averaged ECG, 27%). Signal-averaged QRS duration was correlated with echocardiographically determined left ventricular diastolic diameter for the X orthogonal lead (r = +0.41), Y orthogonal lead (r = +0.33), and vector (r = +0.35). Training also increased QT interval (234 +/- 2 to 249 +/- 2 milliseconds) and R-wave amplitude in leads II and rV2, increased peak-to-peak voltage and S-wave amplitude in the Y orthogonal lead, and decreased Q-wave amplitude in the Y orthogonal lead. CONCLUSIONS AND CLINICAL RELEVANCE Electrocardiographic changes reflected physiologic cardiac hypertrophy in these canine athletes in response to repetitive endurance exercise. The QRS duration increases in response to endurance exercise training and, therefore, may be of use in predicting performance in endurance activities.
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Affiliation(s)
- P D Constable
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana 61802, USA
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80
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Abstract
Long-term athletic training is associated with morphologic left ventricular (LV) remodeling, that in elite athletes may be substantial and raise differential diagnosis with structural heart disease, ie, hypertrophic cardiomyopathy (HCM). Several criteria for differential diagnosis are discussed here, including the morphologic features of LV hypertrophy in athletes (ie, the symmetric distribution of LV wall thickening, the enlarged cavity with normal shape) and normal diastolic LV filling pattern. The most definitive criterion for differential diagnosis is the response to deconditioning, which is associated with a substantial reduction in LV wall thickness (by 2-5 mm, mean 3 mm) in athlete's heart; no substantial morphologic changes occur in patients with HCM. Finally, genetic screening for DNA abnormalities, although at present limited to research-oriented genotyping of family HCM pedigrees and are not yet available for clinical purposes, in the near future may offer the most definitive diagnosis of HCM, regardless of the morphologic expression and clinical presentation of the disease.
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Affiliation(s)
- A Pelliccia
- Institute of Sports Science, Department of Medicine, Via dei Campi Sportivi, 46, 00197 Rome, Italy.
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81
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Al-Sheikh T, Zipes DP. Guidelines for Competitive Athletes with Arrhythmias. DEVELOPMENTS IN CARDIOVASCULAR MEDICINE 2000. [DOI: 10.1007/978-94-017-0789-3_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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82
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Guías de práctica clínica de la Sociedad Española de Cardiología sobre la actividad física en el cardiópata. Rev Esp Cardiol 2000. [DOI: 10.1016/s0300-8932(00)75145-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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83
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Abstract
Hyponatremia is being increasingly recognized as a complication of participation in ultra-endurance sports. Reported is the case of an Ironman triathlete who collapsed at the end of the race, having gained 5% in body weight. His serum sodium concentration at the finish was 116 mmol/L. After an Intensive Care Unit course complicated by recurrent seizures, he eventually made a complete neurologic recovery. The pathogenesis of hyponatremia and its management in such cases is discussed.
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Affiliation(s)
- D B Speedy
- Department of General Practice and Primary Care, University of Auckland, New Zealand
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84
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Abstract
As a physician, coach, or trainer, we see athletes as healthy, physically fit, and able to tolerate extremes of physical endurance. It seems improbable that such athletes may have, on occasion, underlying life-threatening cardiovascular abnormalities. Regular physical activity promulgates cardiovascular fitness and lowers the risk of cardiac disease. However, under intense physical exertion and with a substrate of significant cardiac disease--whether congenital or acquired--athletes may succumb to sudden cardiac death. The deaths of high-profile athletes receive much attention through the national news media, but there are also deaths of other athletes. With repetitive, intense physical exercise, the heart undergoes functional and morphologic changes. Knowledge of those changes may help one identify cardiovascular abnormalities that can cause sudden death from the heart known as an "athlete's heart." This article will review cardiovascular diseases that may limit an athlete's participation in sports and that may put an athlete at risk for sudden cardiac death. It also reviews the extent and limitations of the cardiovascular preparticipation screening examination. Team physicians, coaches, and trainers must understand the process of evaluation of a symptomatic athlete that may indicate significant cardiac abnormalities. Finally, guidelines to determine eligibility of athletes with cardiovascular disease to return to sports will be reviewed.
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Affiliation(s)
- F C Basilico
- Center for Sports Cardiology, New England Baptist Hospital, Boston, Massachusetts, USA
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85
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Abstract
Athletes, although the healthiest segment of society, can develop cardiac arrhythmias. Benign bradycardias and atrial and ventricular premature contractions are common and seldom require treatment. Supraventricular tachycardias are less common and are usually not life-threatening, but do require treatment. Ventricular arrhythmias, although uncommon, are life-threatening and require treatment. Most athletes with ventricular arrhythmias have structural cardiac abnormalities, and further competitive play is usually prohibited. Commotio cordis, which is a recently described syndrome of sudden death caused by low-energy chest wall impact, may account for a significant percentage of the sudden deaths in athletes.
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Affiliation(s)
- M S Link
- Cardiac Arrhythmia Service, Boston, MA 02111, USA
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86
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Stepien RL, Hinchcliff KW, Constable PD, Olson J. Effect of endurance training on cardiac morphology in Alaskan sled dogs. J Appl Physiol (1985) 1998; 85:1368-75. [PMID: 9760330 DOI: 10.1152/jappl.1998.85.4.1368] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The cardiac morphology of 77 conscious Alaskan sled dogs before and after 5 mo of endurance training (20 km/day team pulling a sled and musher) was studied using two-dimensional and M-mode echocardiography. Subgroups included dogs with at least one season of previous training ("veterans") and dogs undergoing their first season of training ("rookies"). Training resulted in a significant (P < 0.05) decrease in resting heart rate (-15%) and significant increases in interventricular septal thickness (systole, 15%; diastole, 13%), left ventricular (LV) internal dimension in diastole (LVIDd, 4%), LV free wall thickness in systole (9%) and diastole (LVWd, 9%), and left atrial diameter (5%) in all dogs, but the increase in LVWd was greater in rookies (16%) than in veterans (7%). Training increased end-diastolic volume index (8%), LV mass index (24%), and heart weight index (24%) and decreased the LVIDd-to-LVWd ratio (-6%) but did not alter cardiac index. We conclude that increased LV mass attributable to LV dilation and hypertrophy is associated with endurance training in Alaskan sled dogs. Disproportionate LV wall thickening accompanying LV dilation suggests that cardiac morphological changes are due to volume and pressure loading. These training-induced changes are similar to those documented in human athletes undergoing combined isometric and isotonic training and differ from studies of dogs trained on treadmills.
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Affiliation(s)
- R L Stepien
- Department of Medical Sciences, University of Wisconsin School of Veterinary Medicine, Madison, Wisconsin 53706, USA
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87
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Ponce Vázquez J, Pascual Gómez F, Alvarez Badillo A, Dolz Luna JF, Rodríguez Rodríguez LP. [Cardiac arrhythmias induced by short-time maximal dynamic exercise (sprint): a study in greyhounds]. Rev Esp Cardiol 1998; 51:559-65. [PMID: 9711104 DOI: 10.1016/s0300-8932(98)74790-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES Physical exercise causes a significant increase in the incidence of cardiac arrhythmias in athletes, basically when maximal capacity is approached and during the period of early recovery. In this study the incidence of cardiac arrhythmias consecutive to maximal exercise (sprint) was studied using racing greyhounds as a biomodel. METHODS The study was done on 399 greyhounds taking part in programmed speed races at a greyhound track. For each animals two electrocardiograms where taken: the first before the race and the second between 90 and 150 seconds after finishing it. RESULTS 112 cases of abnormal arrhythmias were found, 32 before racing, and 80 afterwards. Of these 80 post-effort cases, 80% did not present any abnormalities in cardiac rhythm before racing. Only cases of electrical alternans, electrical alternans + sinus tachycardia, ventricular extrasystoles, sinus tachycardia and ventricular tachycardia were due to non-random phenomena. CONCLUSIONS Maximal physical exercise (sprint) provokes a significant increase (150%) in the incidence of abnormal cardiac arrhythmias during the period of early recovery: mainly electrical alternans, ventricular extrasystoles, sinus tachycardia and ventricular tachycardia. The class, sex, age, weight of greyhound and distance covered do not have a significant influence on the presentation of arrhythmias, except in cases of sinus tachycardia and distance.
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Affiliation(s)
- J Ponce Vázquez
- Departamento de Medicina Física y de Rehabilitación, Hidrología Médica, Facultad de Medicina, Universidad Complutense, Madrid
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88
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Constable P, Hinchcliff K, Demma N, Callahan M, Dale B, Fox K, Adams L, Wack R, Kramer L. Electrocardiographic consequences of a peripatetic lifestyle in gray wolves (Canis lupus). Comp Biochem Physiol A Mol Integr Physiol 1998; 120:557-63. [PMID: 9787834 DOI: 10.1016/s1095-6433(98)10066-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cardiac chamber enlargement and hypertrophy are normal physiologic responses to repetitive endurance exercise activity in human beings and domestic dogs. Whether similar changes occur in wild animals as a consequence of increased activity is unknown. We found that free-ranging gray wolves (Canis lupus, n = 11), the archetypical endurance athlete, have electrocardiographic evidence of cardiac chamber enlargement and hypertrophy relative to sedentary captive gray wolves (n = 20), as demonstrated by significant increases in QRS duration, QT interval, and QT interval corrected for heart rate, a tendency towards increased Q, R, and S wave voltages in all leads, and a significant decrease in heart rate. We conclude that exercise activity level and therefore lifestyle affects physiologic variables in wild animals. An immediate consequence of this finding is that physiologic measurements obtained from a captive wild-animal population with reduced exercise activity level may not accurately reflect the normal physiologic state for free-ranging members of the same species.
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Affiliation(s)
- P Constable
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana 61802, USA.
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89
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Boraita Pérez A, Serratosa Fernández L. ["The athlete's heart": most common electrocardiographic findings]. Rev Esp Cardiol 1998; 51:356-68. [PMID: 9644959 DOI: 10.1016/s0300-8932(98)74759-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The morphological and functional cardiac adaptations induced by physical training may be reflected in several athlete's electrocardiographic variants. Rhythm and heart rate disturbances are the most common findings, and sinus bradycardia is the most frequent adaptation. Non-specific intraventricular conduction delay and incomplete right bundle branch block are also frequent, but other bundle branch and fascicular blocks are extremely rare. While the atrioventricular conduction may be prolonged, the occurrence of first degree and type I second degree atrioventricular blocks depends on the individual's susceptibility. Advanced second and third degree atrioventricular blocks are exceptional, and when present, the possibility of underlying heart disease must be excluded. High QRS voltage is more frequent in male athletes, but its correlation with left ventricular hypertrophy is low. The ST segment elevation in the so called "early repolarization" pattern is typical of the athlete's electrocardiogram. Vagotonic or high T wave voltages and U waves are also frequent when sinus bradycardia is present. Tachyarrhythmias and increased automatism arrhythmias are rare and usually benign. The increased vagal tone is responsible for the suppression of the physiological and ectopic pacemakers. While Wolff-Parkinson-White syndrome per se does not exclude an athlete from sports activity, the risk of a sudden death makes it mandatory to perform an exhaustive cardiac evaluation. We may conclude that no sport can be considered arrhythmogenic or as a predisposing factor for malignant ventricular arrhythmias.
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Affiliation(s)
- A Boraita Pérez
- Centro Nacional de Medicina del Deporte, Consejo Superior de Deportes, Madrid
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90
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Affiliation(s)
- N R Soni
- Cardiothoracic Unit, Great Ormond Streat Hospital for Children, London
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91
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Pelliccia A, Maron BJ. Outer limits of the athlete's heart, the effect of gender, and relevance to the differential diagnosis with primary cardiac diseases. Cardiol Clin 1997; 15:381-96. [PMID: 9276164 DOI: 10.1016/s0733-8651(05)70347-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Two concepts from pathologic descriptions of myocardial hypertrophy in trained individuals merit consideration: (1) The heart of the trained athlete can be twice the normal size, but histologic structure remains intact, and (2) the weight of the trained heart does not usually surpass the limit of 500 g, defined as the critical heart weight. Even though this threshold cannot be accepted dogmatically, the concept of an upper limit for physiologic cardiac remodeling is nevertheless relevant to the clinical question of distinguishing extreme expressions of athlete's heart from primary pathologic conditions. This morphologic distinction depends on whether the magnitude of cardiac remodeling in athletes exceeds that expected as a result of athletic conditioning alone. There has also been a great interest in understanding the impact that types of athletic conditioning and gender have on defining the upper limits to which such physiologic hypertrophy may extend.
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Affiliation(s)
- A Pelliccia
- Department of Medicine, Institute of Sports Medicine, Italian National Olympic Committee, Rome, Italy
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92
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Abstract
There has been heightened interest in the design and role of preparticipation screening for high school and college athletes. An American Heart Association consensus panel, composed of cardiovascular specialists and other physician experts having extensive clinical experience with athletes of all ages as well as a legal expert, assessed the benefits and limitations of preparticipation screening for early detection of cardiovascular abnormalities in competitive athletes. The panel addressed cost-efficiency and feasibility issues as well as the medicolegal implications of screening; and developed consensus recommendations and guidelines for the most prudent, practical, and effective screening procedures and strategies.
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Affiliation(s)
- B J Maron
- Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minnesota, USA
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93
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Bharati S, Cantor GH, Leach JB, Schmidt KE, Blake J. The conduction system in sudden death in Alaskan sled dogs during the Iditarod race and/or during training. Pacing Clin Electrophysiol 1997; 20:654-63. [PMID: 9080492 DOI: 10.1111/j.1540-8159.1997.tb03884.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Using serial section examination, we studied the conduction system in five Alaskan sled dogs that died suddenly; four during the Iditarod race and one during training. We compared our findings with the conduction system of three sled dogs of similar age that died of natural causes unrelated to the cardiovascular system. The conduction system of sudden death dogs revealed marked fibrosis of the sinoatrial (SA) node and/or its approaches and narrowing of the SA nodal artery in 3 dogs, fibrosis and marked fatty infiltration in and around the AV node in all 5, total isolation and/or tenuous connection of the AV node with its approaches in 4, fat and fibrosis in the AV bundle and bundle branches to a varying degree in all, and focal fibrotic scars in the left ventricle with fat and/or some disarray in 3. The control group revealed mild fibro-fatty changes in the conduction system without fibrotic scar areas in the heart. These findings are similar to the pathological findings in and around the conduction system in cases of sudden death in humans, especially trained athletes. These changes may form an anatomical substrate for an arrhythmic event in susceptible dogs during an altered physiological state.
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Affiliation(s)
- S Bharati
- Maurice Lev Congenital Heart and Conduction System Center, Palos Heights, IL 60463, USA
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94
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Cardiovascular preparticipation screening of competitive athletes. American Heart Association. Med Sci Sports Exerc 1996; 28:1445-52. [PMID: 8970136 DOI: 10.1097/00005768-199612000-00001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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95
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Peters S, Weber B, Reil GH. Conventional Electrocardiogram in Arrhythmogenic Right Ventricular Dysplasia-Cardiomyopathy and Idiopathic Right Ventricular Outflow Tract Tachycardia. Ann Noninvasive Electrocardiol 1996. [DOI: 10.1111/j.1542-474x.1996.tb00296.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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96
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Maron BJ, Thompson PD, Puffer JC, McGrew CA, Strong WB, Douglas PS, Clark LT, Mitten MJ, Crawford MH, Atkins DL, Driscoll DJ, Epstein AE. Cardiovascular preparticipation screening of competitive athletes. A statement for health professionals from the Sudden Death Committee (clinical cardiology) and Congenital Cardiac Defects Committee (cardiovascular disease in the young), American Heart Association. Circulation 1996; 94:850-6. [PMID: 8772711 DOI: 10.1161/01.cir.94.4.850] [Citation(s) in RCA: 312] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- B J Maron
- Office of Scientific Affairs, American Heart Association, Dallas, TX 75231-4596, USA
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97
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Maron BJ, Pelliccia A, Spirito P. Cardiac disease in young trained athletes. Insights into methods for distinguishing athlete's heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation 1995; 91:1596-601. [PMID: 7867202 DOI: 10.1161/01.cir.91.5.1596] [Citation(s) in RCA: 261] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- B J Maron
- Cardiovascular Research Division, Minneapolis Heart Institute Foundation, MN 55407
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98
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Zipes DP, Garson A. 26th Bethesda conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. Task Force 6: arrhythmias. J Am Coll Cardiol 1994; 24:892-9. [PMID: 7523472 DOI: 10.1016/0735-1097(94)90847-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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99
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Abstract
SCD is a tragic-event that rarely affects exercising individuals. It is important for the practitioner to recognize the normal physiologic changes that occur in the exercising athlete that correspond to AHS so as to differentiate them from conditions placing an athlete at risk for SCD. Different clinical entities account for SCD in athletes under age 30 as opposed to over age 30, although there is some overlap. Comprehensive and expensive screening tests have not proved to be cost-effective, nor are they able consistently to identify athletes at risk. A quality history and thorough cardiac screening examination are the best means to identify athletes at risk for SCD and lead to a cost-effective means to pursue further workup. Table 7 lists a screening battery of tests and what the tests detect and miss. In general, a history and physical examination detect aortic stenosis and a portion of HCM and Marfan's syndrome. If the physical examination is suggestive of Marfan's syndrome and a chest roentgenogram is done, a larger portion of cystic medial necrosis will be found. When an ECG is added to the series, most of the HCM patients at risk for SCD can be diagnosed. In addition, if echocardiography is added, most patients with HCM and cystic medial necrosis can be identified. If an exercise stress test is then performed, 20% of coronary artery disease and congenital artery anomalies are identified. Additional studies, including Holter monitoring, electrophysiologic studies, and thallium scintigraphy, can be added to identify further at-risk patients. Because some asymptomatic patients present with SCD, it is virtually impossible to identify comprehensively all patients at risk. By knowing what questions to ask, performing a thorough cardiac screening examination, and being more aware of potential diagnostic clues, the practitioner can feel comfortable in identifying most patients at risk for SCD. Specific history and physical examination guidelines regarding screening for competition are included. Supplemental information is found in the 16th Bethesda Conference. In addition, a well-outlined emergency plan needs to be established when physicians, athletic trainers, or coaches are working with athletes. Proper recognition of cardiac symptoms is a key point. Appropriate education including basic first aid and cardiopulmonary resuscitation training should be encouraged for anyone working extensively with athletes. The emergency plan should include on-site treatment, mechanism to contact emergency personnel, and proper transport to a qualified facility.
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Abstract
In brief Athletes who have heart symptoms need the same type of evaluation as nonathletes who have such symptoms, except that the evaluation generally should include testing during exercise. In history taking, be aware that an athlete may try to minimize heart symptoms in an effort to avoid restrictions on participation. Syncope and related symptoms are Important in that they may reflect an arrhythmia caused by a potentially fatal condition. Syncope or near syncope also may be caused by cat- echolamine-dependent tachycardia, which usually responds to treatment with β-blockers.
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