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Abstract
Despite the inherent risks associated with exercise in general and boxing in particular, the sport has had a limited number of catastrophic cardiovascular events. Screening should be based on risks involved and become more extensive with the advancement of the athlete. Anatomic and electrophysiologic risks need to be assessed and may preclude participation with resultant life style and economic complications. There should be adequate preparation for the rare potential cardiovascular complication at all events, with the ability to rapidly assess and treat arrhythmias.
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Affiliation(s)
- Stephen A Siegel
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, 245 East 35th Street, New York, NY 10016, USA.
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2
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Daniel WG, Baumgartner H, Gohlke-Bärwolf C, Hanrath P, Horstkotte D, Koch KC, Mügge A, Schäfers HJ, Flachskampf FA. Klappenvitien im Erwachsenenalter. Clin Res Cardiol 2006; 95:620-41. [PMID: 17058154 DOI: 10.1007/s00392-006-0458-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- W G Daniel
- Med. Klinik 2, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
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3
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Affiliation(s)
- Paul D Thompson
- The Cardiac Rehabilitation and Cardiovascular Research, Henry Low Heart Center, Hartford Hospital, Hartford, CT 06102, USA.
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4
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Freitas A, Zehr KJ, Pellikka PA, Morais C, Esteves F. Athlete with traumatic tricuspid regurgitation: return to competition after tricuspid valve repair. Clin J Sport Med 2005; 15:106-8. [PMID: 15782057 DOI: 10.1097/01.jsm.0000152711.20344.5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A Freitas
- Cardiology Department, Sports Medicine Center, Lisbon, Portugal
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5
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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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6
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Thompson PD. Aortic valvular disease in active patients: overcoming diagnostic and management challenges. PHYSICIAN SPORTSMED 2002; 30:19-35. [PMID: 20086505 DOI: 10.3810/psm.2002.12.577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Valvular heart disease in physically active patients can present a diagnostic challenge, because adaptations to exercise may mimic abnormalities. Electrocardiograms may be used to follow asymptomatic or mildly symptomatic athletes but are not very useful for those with valve disorders. Moderate-to-severe aortic insufficiency requires careful follow-up and periodic echocardiograms to monitor changes. Athletes with mild aortic stenosis can participate in all sports if they are asymptomatic and have a normal exercise response. Those with moderate disease should be restricted to sports with low static and dynamic requirements. Symptoms of severe aortic stenosis include exercise-induced syncope, angina, heart attack, and, rarely, sudden death; these athletes should not compete and should have aortic valve replacement.
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7
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Abstract
Accurate assessment of the cardiac system in pediatric and adolescent youth is important. The hemodynamic demands associated with exercise, training, and sport participation are usually positive and beneficial; however, when an underlying cardiac problem exists, it is imperative that such cardiac problems be identified. Safe sport-related cardiac participation guidelines should be provided for young athletes and their families and coaches. This chapter provides a physician perspective on the recognition and current cardiac management considerations for young athletes participating in both static and dynamic types of sports. The most recent guidelines for hypertension in youth are also provided.
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Affiliation(s)
- Eugene F Luckstead
- Department of Pediatrics, Texas Tech Medical School-Amarillo, 79106-1788, USA.
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8
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Salim MA, Alpert BS. Sports and marfan syndrome: awareness and early diagnosis can prevent sudden death. PHYSICIAN SPORTSMED 2001; 29:80-93. [PMID: 20086576 DOI: 10.3810/psm.2001.05.786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Marfan syndrome is an autosomal dominant disorder of the connective tissues. Its major manifestations are in the cardiovascular, musculoskeletal, and ocular systems. Recognizing the phenotypic presentation of tall stature, long limbs and fingers, chest deformity, myopia, midsystolic click, and systolic or diastolic murmur can lead to early diagnosis. Morbidity and mortality are primarily caused by cardiovascular involvement. The goal of medical therapy is to retard the aortic root dilation that leads to sudden death from dissection or rupture. Surgical interventions for mitral valve regurgitation and resection of aortic aneurysms are highly effective. In addition, individuals with Marfan syndrome should be restricted from participation in certain sports.
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Affiliation(s)
- M A Salim
- Department of Pediatrics, Division of Cardiology, University of Tennessee Memphis, Memphis, TN, 38105, USA.
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9
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Guidelines for the management of patients with valvular heart disease: executive summary. Indian J Thorac Cardiovasc Surg 2000. [DOI: 10.1007/s12055-000-0010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Abstract
Left ventricular (LV) systolic function is an important determinant of long-term prognosis in patients with chronic aortic regurgitation (AR). Impaired LV systolic function identifies a group of patients who are at risk of developing postoperative congestive heart failure and death after aortic valve replacement (AVR). Hence, asymptomatic patients with definite evidence of impaired LV function should undergo operation without waiting for the development of symptoms or more severe LV dysfunction. Among asymptomatic patients with normal LV systolic function (normal ejection fraction), prognosis is excellent, and fewer than 5% per year require surgery because of symptom development or LV dysfunction. Patients likely to require surgery can be identified on the basis of age, severity of LV dilatation, and progressive increase in LV dimensions or decrease in resting ejection fraction during the course of serial follow-up studies. Afterload-reducing therapy in asymptomatic patients with severe AR and normal LV function has beneficial hemodynamic effects; chronic therapy may reduce the likelihood of symptoms or LV systolic dysfunction. Aortic valve replacement should be performed once significant symptoms develop. In the absence of important symptoms, the operation should also be performed in patients with AR who manifest consistent and reproducible evidence of either LV contractile dysfunction at rest or extreme LV dilatation. Noninvasive imaging should play a major role in evaluation. An important clinical decision--such as recommending AVR in the asymptomatic patient--should not be based on a single echocardiographic or radionuclide angiographic measurement. When these data consistently indicate impaired contractile function at rest or extreme LV dilatation on repeat measurement, however, operation is indicated in the asymptomatic patient. This strategy should reduce the likelihood of irreversible LV dysfunction in these patients and enhance long-term postoperative survival.
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Affiliation(s)
- RO Bonow
- Division of Cardiology, Northwestern University Medical School, 250 East Superior Street, Suite 524, Chicago, IL 60611, USA
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11
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Abstract
Chronic severe mitral regurgitation is a surgically correctable disorder. Advances in cardiac surgery (including mitral valve repair and less invasive operations), a low postoperative complication rate, and improved long-term prognosis have reduced the threshold for surgical referral. Choosing the optimal timing for surgery remains the cardinal problem. Clinical and diagnostic imaging information is essential to the detection of occult myocardial decompensation, for which surgical correction should be sought. Surgery is not generally recommended in asymptomatic patients without signs of progressive disease. The final decision regarding timing of surgery should be made based on all the clinical data, the patient's choice, and the available surgical expertise. The use of medical therapy to delay the time to surgery is not supported by large trials; however, small short-term studies of chronic vasodilator therapy show favorable hemodynamic effects.
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12
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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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14
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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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15
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Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD, Gaasch WH, McKay CR, Nishimura RA, O'Gara PT, O'Rourke RA, Rahimtoola SH, Ritchie JL, Cheitlin MD, Eagle KA, Gardner TJ, Garson A, Gibbons RJ, Russell RO, Ryan TJ, Smith SC. Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation 1998; 98:1949-84. [PMID: 9799219 DOI: 10.1161/01.cir.98.18.1949] [Citation(s) in RCA: 562] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol 1998; 32:1486-588. [PMID: 9809971 DOI: 10.1016/s0735-1097(98)00454-9] [Citation(s) in RCA: 540] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Affiliation(s)
- B A Carabello
- Department of Medicine, Gazes Cardiac Research Institute, Medical University of South Carolina, Charleston, USA
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18
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Alonso Gómez AM, Belló Mora MC, Arós Borau F, Torres Bosco A, Martínez Ferrer JB, Camacho Azcargorta I. [Usefulness of exercise Doppler in the diagnosis of severe mitral stenosis]. Rev Esp Cardiol 1997; 50:98-104. [PMID: 9092009 DOI: 10.1016/s0300-8932(97)73186-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Exercise in mitral stenosis produces an increase in cardiac output and heart rate which determines the increment in the transmitral gradient. However, it has not yet been established what level is reached by the gradients on exercise in severe mitral stenosis nor whether the rise in the gradient during such exercise is different to that occurring in non-severe stenosis. OBJECTIVE To evaluate the effect of exercise in patients with severe mitral stenosis on the mitral valve gradients in absolute values and on the increment with respect to base values. METHODS Forty-eight mitral stenosis patients (mean age: 48.8 +/- 11 years) underwent 50 exercise Doppler echocardiographic studies using supine bicycle ergometry in two stages with increases of 25 W every 3 minutes; from each of these we obtained the peak and mean mitral gradient using a non-imaging continuous-wave Doppler probe. We also conducted this procedure on 14 patients with a mean age of 50 +/- 6 who had Bjork mitral prostheses which were functioning normally. RESULTS We defined a hemodynamic profile of severity based on the data from 18 patients whose basal mitral valve areas was < 1.2 cm2 (group I), and compared them with the data from the 32 studies of mitral stenosis patients with an area > 1.1 cm2 (group II) and with the patients with mitral prostheses (group III). The mean mitral gradient (mmHg) in group I was greater than in group II at rest (9.3 +/- 3.2 and 6.6 +/- 2.7; p < 0.001), at 25 W (20.6 +/- 4.8 and 14.1 +/- 5; p < 0.001) and at 50 W (25.9 +/- 5.4 and 17.3 +/- 5.8; p < 0.001). The increase in mean mitral gradient from the baseline to 50 watts was 16.7 +/- 4.5 mmHg in group I, which was greater than in group II and III (11.1 +/- 4.1 and 6.8 +/- 2.6 mmHg; p < 0.001). CONCLUSIONS Exercise Doppler echocardiography enabled us to define a differential hemodynamic profile in patients with severe mitral stenosis which can be used in isolation as an indicator of severity in this condition.
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