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Trejo-Paredes C, Lampert R. The Science Behind the Standardization of Chest Protectors: Is Marketing Alone Enough to Sell Chest Protectors?.. Not Anymore! Circ Arrhythm Electrophysiol 2024; 17:e012844. [PMID: 38497218 DOI: 10.1161/circep.124.012844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
| | - Rachel Lampert
- Division of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
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2
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Bragg S, Brown B, DeCastro AO. Arrhythmias and Sudden Cardiac Death. Prim Care 2024; 51:143-154. [PMID: 38278568 DOI: 10.1016/j.pop.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Ventricular tachyarrhythmias remain a major cause of sudden cardiac arrest (SCA) that leads to sudden cardiac death (SCD). Primary prevention strategies to prevent SCD include promoting a healthy lifestyle, following United States Preventive Service Task Force recommendations related to cardiovascular disease, and controlling comorbid conditions. For a patient experiencing SCA, early cardiopulmonary resuscitation and defibrillation should be performed. Implantable cardioverter defibrillators are more effective at secondary prevention compared with drug therapy but medications such as amiodarone, beta-blockers, and sotalol may be helpful adjuncts to reduce the risk of SCD or improve a patient's symptoms (eg, palpitations and inappropriate defibrillator shocks).
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Affiliation(s)
- Scott Bragg
- Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina (MUSC) College of Pharmacy and MUSC College of Medicine, 173 Ashley Avenue, CP 240, MSC 141, Charleston, SC 29425, USA; Medical University of South Carolina (MUSC) College of Medicine, MUSC Department of Family Medicine, 135 Cannon Street, Suite 405, Charleston, SC 29425, USA.
| | - Brandon Brown
- Medical University of South Carolina (MUSC) College of Medicine, MUSC Department of Family Medicine, 135 Cannon Street, Suite 405, Charleston, SC 29425, USA
| | - Alexei O DeCastro
- Medical University of South Carolina (MUSC) College of Medicine, MUSC Department of Family Medicine, 135 Cannon Street, Suite 405, Charleston, SC 29425, USA
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3
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Boden BP, Anderson SA, Sheehan FT. Catastrophic Sports Injuries: Causation and Prevention. J Bone Joint Surg Am 2024; 106:62-73. [PMID: 37988459 DOI: 10.2106/jbjs.23.00335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
➤ Catastrophic injuries in U.S. high school and college athletes are rare but devastating injuries.➤ Catastrophic sports injuries are classified as either traumatic, caused by direct contact during sports participation, or nontraumatic, associated with exertion while participating in a sport.➤ Football is associated with the greatest number of traumatic and nontraumatic catastrophic injuries for male athletes, whereas cheerleading has the highest number of traumatic catastrophic injuries and basketball has the highest number of nontraumatic catastrophic injuries for female athletes.➤ The incidence of traumatic catastrophic injuries for all sports has declined over the past 40 years, due to effective rule changes, especially in football, pole-vaulting, cheerleading, ice hockey, and rugby. Further research is necessary to reduce the incidence of structural brain injury in contact sports such as football.➤ The incidence of nontraumatic catastrophic injuries has increased over the last 40 years and requires additional research and preventive measures. Avoiding overexertion during training, confirming sickle cell trait status in high school athletes during the preparticipation physical examination, and developing cost-effective screening tools for cardiac abnormalities are critical next steps.
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Affiliation(s)
- Barry P Boden
- The Orthopaedic Center, The Centers for Advanced Orthopaedics, Rockville, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Frances T Sheehan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland
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4
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Kean KA, Fitzgerald DJ, Ayers MD, Kean AC. The Effects of Cardiac Implantable Electronic Device Personal Protective Equipment Use in Patients with Pediatric and Adult Congenital Heart Disease. Pediatr Cardiol 2023; 44:1721-1725. [PMID: 37573512 DOI: 10.1007/s00246-023-03264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
Pediatric and adult congenital heart disease (ACHD) patients encounter physical and emotional barriers. Cardiac implantable electronic devices (CIEDs), including pacemakers and implantable cardiac defibrillators (ICD) often compound these issues. Patient fear associated with damaging the CIED system can lead to avoidance of physical activity and reduced quality of life (QOL). CIED personal protective equipment (PPE) is a potential treatment for decreasing this fear. We sought to determine the effects of CIED PPE use in the pediatric and ACHD population. Patients 5 years or older with a CIED at a single pediatric and ACHD heart rhythm center received a CIED protector and customized athletic shirt. QOL was assessed using the PedsQL TM 4.0 SF15 prior to and after 6-12 months. Of the 77 patients enrolled, 26 completed repeat assessment. The mean age at enrollment was 15.6 years (range 5-36) with a mean device age of 2.2 years (< 1-10 years). Pacemakers were present in 77% and 23% had ICDs. The PPE was used in 92% with no PPE malfunction. Fear associated with physical activity was reduced, z = - 4, p < 0.001, with a large effect size (r = 0.55). There was a trend toward increased physical activity. Total QOL scores improved, z = - 2.771, P < 0.05, with a medium effect size (r = 0.4). This first study of CIED PPE in children shows that providing CIED PPE to pediatric and ACHD patients may decrease their fear of damaging their device system, increasing physical activity levels, and improving quality of life.
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Affiliation(s)
- Kelly A Kean
- School of Nursing, Purdue University College of Health and Human Science, West Lafayette, IN, USA
| | - Donna J Fitzgerald
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Mark D Ayers
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Adam C Kean
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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5
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Okorare O, Alugba G, Olusiji S, Evbayekha EO, Antia AU, Daniel E, Ubokudum D, Adabale OK, Ariaga A. Sudden Cardiac Death: An Update on Commotio Cordis. Cureus 2023; 15:e38087. [PMID: 37252546 PMCID: PMC10209547 DOI: 10.7759/cureus.38087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Sudden cardiac death (SCD) is one of the leading causes of cardiovascular mortality, and it is caused by a diverse array of conditions. Among these is commotio cordis, a relatively infrequent but still significant cause, often seen in young athletes involved in competitive or recreational sports. It is known to be caused by blunt trauma to the chest wall resulting in life-threatening arrhythmia (typically ventricular fibrillation). The current understanding pertains to blunt trauma to the precordium, with an outcome depending on factors such as the type of stimulus, the force of impact, the qualities of the projectile (shape, size, and density), the site of impact, and the timing of impact in relation to the cardiac cycle. In the management of commotio cordis, a history of preceding blunt chest trauma is usually encountered. Imaging is mostly unremarkable except for ECG, which may show malignant ventricular arrhythmias. Treatment is focused on emergent resuscitation with the advanced cardiac life support protocol algorithm, with extensive workup following the return of spontaneous circulation. In the absence of underlying cardiovascular pathologies, implantable cardiac defibrillator insertion is not beneficial, and patients can even resume physical activity if the workup is unremarkable. Proper follow-up is also key in the management and monitoring of re-entrant ventricular arrhythmias, which are amenable to ablative therapy. Prevention of this condition involves protecting the chest wall against blunt trauma, especially with the use of safety balls and chest protectors in certain high-risk sporting activities. This study aims to elucidate the current epidemiology and clinical management of SCD with a particular focus on a rarely explored etiology, commotio cordis.
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Affiliation(s)
- Ovie Okorare
- Internal Medicine, Nuvance Health Vassar Brothers Medical Center, New York, USA
| | | | - Soremi Olusiji
- Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | | | - Akanimo U Antia
- Medicine, Lincoln Medical and Mental Health Center, New York, USA
| | | | | | | | - Anderson Ariaga
- Internal Medicine, Nuvance Health Vassar Brothers Medical Center, New York, USA
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6
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Pollevick ME, Wan EY. Editorial: The role of sex in cardiac arrhythmias and sudden cardiac death. Front Cardiovasc Med 2023; 10:1158376. [PMID: 36937918 PMCID: PMC10021107 DOI: 10.3389/fcvm.2023.1158376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Matias E. Pollevick
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Elaine Y. Wan
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
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7
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Dickey GJ, Bian K, Liu X, Khan HR, Mao H. Identifying Vulnerable Impact Locations to Reduce the Occurrence of Deadly Commotio Cordis Events in Children's Baseball: A Computational Approach. J Biomech Eng 2022; 144:1122991. [PMID: 34729591 DOI: 10.1115/1.4052886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Indexed: 11/08/2022]
Abstract
Commotio cordis is the second leading cause of sudden cardiac death in young athletes. Currently available chest protectors on the market are ineffective in preventing cases of commotio cordis in young athletes who play baseball. This study focused on using contour maps to identify specific baseball impact locations to the chest that may result in instances of commotio cordis to children during baseball games. By identifying these vulnerable locations, we may design and develop chest protectors that can provide maximum protection to prevent commotio cordis in young athletes. Simulation cases were run using the validated CHARM-10 chest model, a detailed finite element model representing an average 10-year-old child's chest. A baseball model was developed in company with the chest model, and then used to impact the chest at different locations. A 7 × 8 impact location matrix was designed with 56 unique baseball impact simulations. Left ventricle strain and pressure, reaction force between the baseball and chest, and rib deformations were analyzed. Left ventricle strain was highest from baseball impacts directly over the left ventricle (0.34) as well as impacts slightly lateral and superior to the cardiac silhouette (0.34). Left ventricle pressure was highest with impacts directly over the left ventricle (82.94 kPa). We have identified the most dangerous impact locations resulting in high left ventricle strain and pressure. This novel study provided evidence of where to emphasize protective materials for establishing effective chest protectors that will minimize instances of commotio cordis in young athletes.
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Affiliation(s)
- Grant J Dickey
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Kewei Bian
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Xingyu Liu
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Habib R Khan
- Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Haojie Mao
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, ON N6A 3K7, Canada; Department of Biomedical Engineering, University of Western Ontario, London, ON N6A 3K7, Canada
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8
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Garg N, Brave M, Dym A, Gupta S, Becker LB. The Effect of Athletic Chest Protectors on the Performance of Manual and Mechanical CPR: A Simulation Study. Pediatr Emerg Care 2021; 37:e1491-e1493. [PMID: 32358459 PMCID: PMC8667796 DOI: 10.1097/pec.0000000000002090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Sudden cardiac arrest is a leading cause of death in athletes. Although athletes wear various athletic chest protectors (ACPs) to prevent commotio cordis (CC), cardiac arrest cases still occur. Although it is established that cardiopulmonary resuscitation (CPR) quality affects outcome, little research has evaluated the effect of ACPs on CPR compressions quality. This study aimed to observe whether: (1) ACPs impact depth, rate, and hand positioning of both bystander and LUCAS CPR. (2) LUCAS devices affect CPR performance compared with traditional compressions. METHODS An observational, prospective, convenient sample of 26 emergency medicine residents performed CPR on a high-fidelity Laerdal mannequin, which recorded real-time performance data. Baseline CPR for 1- and 2-minute cycles, CPR on a mannequin wearing the ACP, and ACP removal time was recorded. LUCAS CPR performance was measured at baseline and over the ACP. RESULTS Bystander CPR had a statistically significant difference in both hand placement and compression rate for baseline versus ACP compressions (85% vs 57%, P < 0.05; 138 vs 142, P < 0.05, respectively), but not in compression depth (51.08 vs 50.05 mm, P = 0.39). LUCAS CPR had no significant difference in CPR performance. Bystander versus LUCAS CPR had a significant difference in compression rate (138 vs 101, P < 0.01), but not in depth or hand placement. CONCLUSIONS Athletic chest protectors significantly impacted hand placement during bystander CPR, which may diminish CPR quality. Considering ACP removal required only 5.4 seconds, removing the ACP before standard CPR may improve quality.
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Affiliation(s)
- Nidhi Garg
- From the Southside Hospital, Northwell Health, Bay Shore
| | - Martina Brave
- Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY
| | - Akiva Dym
- Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY
| | - Sanjey Gupta
- From the Southside Hospital, Northwell Health, Bay Shore
| | - Lance B. Becker
- Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY
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9
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Yu C, Yu P, Ma G, Zhou L, Deng F, Wang F, Zhu X. Preparation of aramid-based epoxy resin from low-grade aramid. RSC Adv 2021; 11:36265-36272. [PMID: 35492742 PMCID: PMC9043422 DOI: 10.1039/d1ra07602g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/01/2021] [Indexed: 11/21/2022] Open
Abstract
Low-grade aramid fibers, an unavoidable by-product in the industrialized process of aramid fiber production, are difficult to utilize and harmful to the environment. In this study, low-grade aramid fibers were recycled to assemble a high-quality epoxy resin through an epoxidation modification. Triggered by the epichlorohydrin, the molecular configuration of the low-grade aramid fibers was altered through crosslinking and chain-extension processes. bisphenol-A epoxy resin (E-51) with 5% aramid-based epoxy resin cured product exhibited improved mechanical and thermal properties, outperforming pure E-51 and pure aramid. This improvement is caused by the increased percentage of epoxide groups and flexible ether bonds. This work opens up new possibilities to maximize the reclamation of low-grade aramid fibers, which currently poses an obstacle in waste recycling. Low-grade aramid fibers are transformed to high value-added aramid-based epoxy resin. Bisphenol-A epoxy resin with aramid-based epoxy resin cured products exhibited improved mechanical properties, outperforming pure E-51 and pure aramid.![]()
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Affiliation(s)
- Changlei Yu
- Anhui Epoxy Resin and Additives Engineering Technology Research Center Huangshan 245000 People's Republic of China
| | - Pengda Yu
- College of Chemical Engineering, Nanjing Forestry University Nanjing 210037 People's Republic of China
| | - Gang Ma
- College of Chemical Engineering, Nanjing Forestry University Nanjing 210037 People's Republic of China
| | - Lequn Zhou
- Anhui Epoxy Resin and Additives Engineering Technology Research Center Huangshan 245000 People's Republic of China
| | - Fei Deng
- Sinopec Yizheng Chemical Fiber Co., Ltd Yizheng 211900 People's Republic of China
| | - Fang Wang
- Sinopec Yizheng Chemical Fiber Co., Ltd Yizheng 211900 People's Republic of China
| | - Xinbao Zhu
- College of Chemical Engineering, Nanjing Forestry University Nanjing 210037 People's Republic of China .,Anhui Epoxy Resin and Additives Engineering Technology Research Center Huangshan 245000 People's Republic of China
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10
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Abstract
Hereditary diseases under the age of 35 are the most common underlying heart disease, leading to sudden cardiac death (SCD) in competitive sports, while in older people, atherosclerotic coronary artery disease (CAD) is the main cause. The following preventive measures are recommended: (a) The pre-participation cardiovascular screening, (b) the genetic testing, (c) the use of implantable cardioverter-defibrillator (ICD), (d) the prohibition of doping in sports, (e) the prevention of 'exercise-induced' cardiac complications, (f) the reduction of high-risk factors for CAD, and (g) the use of cardiopulmonary resuscitation. The cost-effectiveness of the electrocardiograms in the pre-participation screening programs remains questionable. Genetic testing is recommended in borderline cases and positive family history. Athletes with ICD can, under certain conditions, participate in competitive sports. Excessive endurance exercise appears to harm the endothelium, promotes inflammatory processes and leads to fibrosis in the myocardium, and calcium deposition in the coronary vessels. Cardiac arrest may be reversed if cardiopulmonary resuscitation is performed and a defibrillator is immediately used. Thus, equipping all fields with automatic external defibrillators are recommended.
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Affiliation(s)
- Asterios Deligiannis
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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11
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Dickey GJ, Bian K, Khan HR, Mao H. Developing commotio cordis injury metrics for baseball safety: unravelling the connection between chest force and rib deformation to left ventricle strain and pressure. Comput Methods Biomech Biomed Engin 2021; 25:247-256. [PMID: 34320889 DOI: 10.1080/10255842.2021.1948022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Commotio cordis is a sudden death mechanism that occurs when the heart is impacted during the repolarization phase of the cardiac cycle. This study aimed to investigate commotio cordis injury metrics by correlating chest force and rib deformation to left ventricle strain and pressure. We simulated 128 chest impacts using a simulation matrix which included two initial velocities, 16 impact locations spread across the transverse and sagittal plane, and four baseball stiffness levels. Results showed that an initial velocity of 17.88 m/s and an impact location over the left ventricle was the most damaging setting across all possible settings, causing the most considerable left ventricle strain and pressure increases. The impact force metric did not correlate with left ventricle strain and pressure, while rib deformations located over the left ventricle were strongly correlated to left ventricle strain and pressure. These results lead us to the recommendation of exploring new injury metrics such as the rib deformations we have highlighted for future commotio cordis safety regulations.
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Affiliation(s)
- Grant J Dickey
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, ON, Canada
| | - Kewei Bian
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, ON, Canada
| | - Habib R Khan
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Western Ontario, London, ON, Canada
| | - Haojie Mao
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, ON, Canada.,Department of Biomedical Engineering, University of Western Ontario, London, ON, Canada
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12
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Erickson CC, Salerno JC, Berger S, Campbell R, Cannon B, Christiansen J, Moffatt K, Pflaumer A, Snyder CS, Srinivasan C, Valdes SO, Vetter VL, Zimmerman F. Sudden Death in the Young: Information for the Primary Care Provider. Pediatrics 2021; 148:peds.2021-052044. [PMID: 34155130 DOI: 10.1542/peds.2021-052044] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
There are multiple conditions that can make children prone to having a sudden cardiac arrest (SCA) or sudden cardiac death (SCD). Efforts have been made by multiple organizations to screen children for cardiac conditions, but the emphasis has been on screening before athletic competition. This article is an update of the previous American Academy of Pediatrics policy statement of 2012 that addresses prevention of SCA and SCD. This update includes a comprehensive review of conditions that should prompt more attention and cardiology evaluation. The role of the primary care provider is of paramount importance in the evaluation of children, particularly as they enter middle school or junior high. There is discussion about whether screening should find any cardiac condition or just those that are associated with SCA and SCD. This update reviews the 4 main screening questions that are recommended, not just for athletes, but for all children. There is also discussion about how to handle post-SCA and SCD situations as well as discussion about genetic testing. It is the goal of this policy statement update to provide the primary care provider more assistance in how to screen for life-threatening conditions, regardless of athletic status.
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Affiliation(s)
- Christopher C Erickson
- Children's Specialty Physicians, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska .,Creighton University Medical Center, Creighton University, Omaha, Nebraska
| | - Jack C Salerno
- Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, Washington
| | - Stuart Berger
- Lurie Children's Hospital and Northwestern University, Chicago, Illinois
| | - Robert Campbell
- Children's Healthcare of Atlanta Sibley Heart Center and School of Medicine, Emory University, Atlanta, Georgia
| | | | - James Christiansen
- Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, Washington
| | - Kody Moffatt
- Children's Specialty Physicians, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska
| | - Andreas Pflaumer
- The Royal Children's Hospital and University of Melbourne, Melbourne, Australia
| | - Christopher S Snyder
- Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio
| | - Chandra Srinivasan
- McGovern Medical School, The University of Texas and The University of Texas Health Science Center, Houston, Texas
| | - Santiago O Valdes
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Victoria L Vetter
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
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El Masri I, Kayali SM, Blount C, Kirolos I, Khouzam JP, Kabra R. Is Exercise Helpful or Harmful in Dealing With Specific Arrhythmia. Curr Probl Cardiol 2020; 46:100740. [PMID: 33213943 DOI: 10.1016/j.cpcardiol.2020.100740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
Abstract
Exercise is universally known to benefit health by lowering risk for cardiovascular disease and mortality. However, in patients with pre-existing cardiac conditions, including channelopathies, cardiomyopathies and coronary artery disease, exercise can cause sudden cardiac death (SCD). In this review, we explore exercise related risks and current recommendations for specific conditions. The risk of myocardial infarction (MI) during strenuous exercise in asymptomatic individuals with coronary artery disease is decreased with habitual exercise, especially if they have a normal ejection fraction and no ischemia. Furthermore, cardiac rehabilitation has been shown to be beneficial in heart failure. On the other hand, surgery is recommended for certain anomalous coronaries prior to engaging in vigorous activity. In addition, both exercise-induced disease progression and SCD in arrhythmogenic cardiomyopathy restrict ability to engage in competitive sports, as is the case in hypertrophic cardiomyopathy. Other diseases, like myocarditis only cause temporary risk for SCD. Previously considered benign, common conditions like early repolarization do increase SCD risk. Finally, certain gear including thicker chest protectors for athletes engaging in sports with hard, small spherical objects decrease risk of commotio cordis. While significant advances have been achieved in diagnosing and treating previously unrecognized conditions that predispose to sudden cardiac death, more research is needed to further tailor recommendations to allow beneficial exercise in those with rarer conditions that are under-represented in large systemic studies.
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14
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Davey BT, Quintana C, Upadhyay S. An Unusual Case of Commotio Cordis Resulting in Ventricular Flutter. J Emerg Trauma Shock 2018; 11:225-227. [PMID: 30429633 PMCID: PMC6182959 DOI: 10.4103/jets.jets_78_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 16-year-old male developed palpitations immediately following chest impact with a soccer ball. The patient was noted to have ventricular flutter in a delayed presentation that was successfully treated. While ventricular fibrillation is the predominant arrhythmia following commotio cordis, ventricular flutter may occur as well. Ventricular flutter may be better tolerated in a young athletic individual with structurally normal heart and may lead to a delayed presentation.
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Affiliation(s)
- Brooke T Davey
- Division of Pediatrics Cardiology and Cardiac Surgery, Connecticut Children's Medical Center, University of Connecticut, Connecticut, USA
| | - Carolina Quintana
- Division of Pediatrics Cardiology and Cardiac Surgery, Connecticut Children's Medical Center, University of Connecticut, Connecticut, USA
| | - Shailendra Upadhyay
- Division of Pediatrics Cardiology and Cardiac Surgery, Connecticut Children's Medical Center, University of Connecticut, Connecticut, USA
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