SABIHA GATI AND SANJAY SHARMA
|
|
- Penelope Hensley
- 5 years ago
- Views:
Transcription
1 9 The athlete s heart SABIHA GATI AND SANJAY SHARMA Pasieka/Science Photo Library In this article, the authors highlight the spectrum, magnitude and determinants of the athlete s heart and provide a practical guide for differentiating physiological left ventricular hypertrophy from hypertrophic cardiomyopathy. Regular physical exercise is associated with a five-fold increase in cardiac output to facilitate oxygen delivery to exercising muscles. Cardiac output is a product of both stroke volume and heart rate. The ability of the heart to generate a large stroke volume is determined by a benign reversible cardiac remodelling process comprising ventricular hypertrophy, increase in cardiac chamber size and enhanced diastolic ventricular filling. Athletes also exhibit a slower resting heart rate from the functional effects of a large stroke volume with an appropriate increase in the electrical activity to generate a large and sustained increase in cardiac output during exercise. An increased cardiac chamber size and a slow heart rate are commonly acknowledged features of the athlete s heart (Figure 1). Occasionally the manifestations of athlete s heart overlap with phenotypic expressions of morphologically mild cardiomyopathies. The distinction between athlete s heart and cardiomyopathy is crucial when one considers that the cardiomyopathies are the main causes of sudden cardiac death (SCD) in young athletes. THE ATHLETE S ELECTROCARDIOGRAM The electrocardiogram in athletes exhibits features reflecting a high resting vagal tone and increased cardiac size (Figure 2). Sinus bradycardia, sinus arrhythmia, first- and second-degree heart block and voltage criteria for left ventricular hypertrophy (LVH) are common. Repolarisation anomalies Sabiha Gati, BSc(Hons), MRCP, Cardiology Research Fellow; Sanjay Sharma, BSc(Hons), MD, FRCP, FESC, Professor of Clinical Cardiology, St George s University of London
2 Gati Athleteʼs Heart_Layout 1 11/07/ :28 Page 2 CARDIOVASCULAR MEDICINE 10 a Electrical Bradycardia Repolarisation anomalies Voltage criteria for chamber enlargement Structural Increased chamber wall thickness and cavity size Functional Enhanced diastolic filling Augmentation of stroke volume Figure 1. Structural, functional and electrical changes in the athlete s heart b comprising of j-point, ST-segment elevation and high-amplitude T-waves are also common, particularly in athletes of African/Afro-Caribbean (black) origin (Box 1).1 In contrast, ST-segment depression is rare and suggestive of cardiac pathology. T-wave inversion in leads V1 V4 is acceptable in all athletes aged <15 years and all black athletes (Box 2).1 The persistence of T-wave inversion beyond V1 in Caucasians after 16 years of age is rare and should raise suspicion of underlying arrhythmogenic right ventricular cardiomyopathy, a recognised cause of SCD in young athletes. T-wave inversion in leads III and avf in isolation is of little significance. T-wave inversion in the lateral leads always warrants further investigation to exclude hypertrophic cardiomyopathy (HCM), which is the commonest cause of SCD in young athletes worldwide. Holter monitoring demonstrates sinus pauses and Mobitz type I second-degree block in up to 25 per cent of highly trained endurance athletes. Ventricular extrasystoles are common but rarely exceed 2000 over a 24-hour period. THE ATHLETE S ECHOCARDIOGRAM Echocardiographic meta-analyses in male athletes reveal a per Figure 2. (a) Example of a black athlete s ECG showing sinus bradycardia, voltage criteria for left ventricular hypertrophy (LVH), ST-segment elevation in leads V1 V5 and deep T-wave inversion in V1 V4. (b) Example of a Caucasian athlete s ECG showing sinus bradycardia, LVH and high-amplitude T-waves cent increase in left ventricular wall thickness and a 10 per cent increase in left ventricular cavity size compared with sedentary controls of similar age. In absolute terms most Caucasian (98 per cent) athletes exhibit a left ventricular wall thickness within normal limits ( 12mm). In contrast, up to 50 per cent of male athletes, particularly those competing in endurance sports, reveal a dilated left ventricular cavity (>55mm). Cardiac dimensions are influenced by several demographic factors (Figure 3); in general adult males participating in endurance/high dynamic intensity sporting disciplines exhibit the greatest structural changes. Black athletes more commonly demonstrate increases in left ventricular wall thickness compared with other ethnicities; up to 13 per cent of black athletes reveal a left ventricular wall thickness >12mm compared with just 2 per cent of Caucasian athletes.2 TRENDS IN UROLOGY & MEN S HEALTH JULY/AUGUST 2012
3 11 BOX 1. Classification of the athlete s electrocardiogram 10 COMMON ECG PATTERNS IN ATHLETES l Sinus bradycardia l First-degree atrioventricular block l J-point ST-segment elevation l Isolated QRS voltage criteria for left ventricular hypertrophy ECG PATTERNS SUGGESTIVE OF CARDIAC DISEASE IN ATHLETES l T-wave inversion l ST-segment depression l Pathological Q-waves l Left atrial enlargement l Left axis deviation l Ventricular pre-excitation l Complete left or right bundle branch block l Brugada-like early repolarisation UPPER LIMITS OF CARDIAC DIMENSIONS IN ATHLETES Studies in large groups of Olympian athletes in Italy and the UK have revealed an upper limit of left ventricular wall thickness in male athletes of 16mm. 3,4 Caucasian females do not reveal left ventricular wall thickness >12mm. In contrast, up to 3 per cent of black female athletes show a wall thickness >12mm but never exceeding 13mm. 5 Athletes exhibit a broad distribution of left ventricular cavity dimensions depending on age, size and type of sport. Almost 25 per cent of all males and 1 per cent of females reveal a left ventricular cavity size >60mm. The upper limit of left ventricular cavity size in males and females is 70mm and 66mm respectively. There are fewer data relating to right ventricular adaptation in athletes given the inherent limitations of imaging the chamber with echocardiography. Unlike the left ventricle, which has an ellipsoid shape, the right ventricle has a crescentlike shape; therefore dimensions vary according to the portion of the right ventricle that is measured. Emerging data from cardiac magnetic resonance imaging (MRI) have demonstrated balanced chamber enlargement. Upper limits for cardiac MRI-derived right ventricular end-diastolic cavity size are 58mm in male and 52mm in female elite athletes. 6 Our own experience of echocardiographic assessment of the right ventricle in male football players reveals that over 40 per cent exhibit right ventricular dimensions exceeding predicted upper limits. CARDIAC FUNCTION There are usually no differences in resting left ventricular systolic function between athletes and non-athletic individuals. Endurance athletes occasionally demonstrate lower fractional shortening at rest, which normalises with brief exercise. Invasive studies in athletes during exercise have demonstrated enhanced diastolic filling and augmentation of stroke volume even at periods of rapid heart rate. 7 Most athletes demonstrate a high peak oxygen consumption ranging from 55ml/kg per minute to over 70ml/kg per minute. SUDDEN DEATH IN YOUNG ATHLETES The benefits of exercise on the cardiovascular system are well established and exercising individuals live for an average of six years longer than sedentary persons. Rarely, a young athlete may die during or shortly after exercise. The incidence of SCD in young athletes aged years old is estimated between 1 in to 1 in Hypertrophic cardiomyopathy is the commonest cause of SCD worldwide, 8 followed by coronary artery anomalies. Among Italian athletes, the greatest number of fatalities was caused by arrhythmogenic right ventricular cardiomyopathy. 8 Acquired conditions implicated in the death of young athletes include acute myocarditis, commotio cordis and illicit drug use. Atherosclerotic coronary artery disease is the commonest cause of SCD in older athletes. BOX 2. Impact of age, ethnicity and sport on the athlete s ECG ADOLESCENT ATHLETES* l Juvenile ECG pattern l Notched T-waves l Large QRS complexes ENDURANCE ATHLETES* l Marked sinus bradycardia l Large QRS complexes l Left ventricular hypertrophy l Large left/right ventricle cavities BLACK ATHLETES* l Marked repolarisation changes l Inverted T-wave V1 V4 l Left ventricular hypertrophy *Females have a lower prevalence of repolarisation changes and large cardiac dimensions. PRE-PARTICIPATION SCREENING OF ATHLETES A mandatory state-sponsored preparticipation screening (PPS) programme in Italy has proved effective in identifying athletes with cardiomyopathies and electrical disorders of the heart. Such individuals are disqualified from sport to minimise the risk of SCD. The screening model is unable to detect anomalous coronary arteries or premature coronary artery disease. A 25-year follow-up study in Italy has revealed a significant (90 per cent) reduction in SCD since the implementation of screening from 36/ person-years to 0.4/ person-years. 9 However, PPS remains a controversial issue in most Western countries because of issues relating to cost-effectiveness, false-positive and negative results, the financial and logistical implications of developing an adequate infrastructure and manpower to implement a similar system. In the UK, several sporting organisations, including the Lawn Tennis Association,
4 12 Male sex Adult athletes Football Association, Premier Rugby League and the English Institute of Sport, advocate PPS. The charitable organisation Cardiac Risk in the Young has facilitated the screening of more than athletes since 1997 and report a 0.3 per cent identification rate for potentially sinister disorder at the expense of a false-positive rate of 3 per cent. Hypertrophic cardiomyopathy Large body surface area Left ventricular hypertrophy Figure 3. Key determinants of left ventricular hypertrophy in athletes LVH 13 16mm THE DIAGNOSTIC CHALLENGE: ATHLETE S HEART OR HYPERTROPHIC CARDIOMYOPATHY? Physical training is occasionally associated with electrical and structural cardiac changes that overlap with cardiac disease. One of the most important diagnostic dilemmas encountered is the differentiation of physiological LVH from morphological mild HCM when confronted Athlete s heart Endurance sports Black ethnicity Cardiovascular symptoms First-degree relatives with hypertrophic cardiomyopathy Female/Caucasian/low body surface area/young age ST-depression/deep T-wave inversion Isolated Sokolow-Lyon LVH Left ventricular end-diastolic diameter >54mm Left ventricle >50mm Left ventricular outflow tract obstruction or bizarre patterns of LVH Diastolic dysfunction Normalisation of ECG/echo on detraining Peak oxygen consumption >50ml/kg per minute Identifiable gene mutation Figure 4. Clinical criteria for differentiating athlete s heart from hypertrophic cardiomyopathy in athletes with left ventricular hypertrophy (LVH) 13 16mm 11 with an athlete with a left ventricular wall thickness of 13 16mm. In most instances the differentiation between the two entities is possible using clinical history, athlete demographics, ECG, echocardiography and cardiopulmonary exercise testing (Figure 4). The presence of cardiac symptoms and/or a family history of HCM in an athlete with LVH suggests HCM. The athlete s demographic profile provides a clue to the differentiation between the two entities; for example, LVH is most unusual in any adolescent or female Caucasian athlete and would be highly suggestive of HCM. A small cavity, dynamic left ventricular outflow obstruction and abnormal indices of diastolic function on echocardiography favour HCM. Cardiac MRI has the advantage of identifying myocardial fibrosis, which would be consistent with pathological LVH. The ECG can prove extremely helpful in making the differentiation between athlete s heart and HCM. Whereas both conditions are associated with voltage criterion for LVH, individuals with HCM also exhibit additional abnormalities including ST-segment depression, T-wave inversion, pathological Q-waves and left bundle branch block. A high peak oxygen consumption >50ml/kg per minute or >120 per cent predicted for age during cardiopulmonary exercise testing is a feature of athlete s heart. Individuals with HCM have impaired myocardial relaxation and consequently fail to augment a stroke volume, which is associated with a low peak oxygen consumption. Detraining an athlete is not an easy task as it risks fitness and team selection, but the resolution of LVH after a six-week period of cessation of exercise is suggestive of athlete s heart. Recent advances in methods for analysis of genetic mutations may permit the use of genotyping for resolving the diagnostic dilemma in cases where doubt persists in spite of comprehensive clinical TRENDS IN UROLOGY & MEN S HEALTH JULY/AUGUST 2012
5 13 KEY POINTS Systematic training is associated with electrical and structural modifications within the heart that are manifest on the ECG and cardiac imaging studies Sinus bradycardia and a modest increase in chamber size are common Age, sex, body surface area, ethnicity and sporting discipline are important determinants of the magnitude of physiological cardiac adaptation to exercise ECG and echocardiographic changes seen in athlete s heart may occasionally overlap with morphologically mild hypertrophic cardiomyopathy The differentiation between physiological left ventricular hypertrophy and hypertrophic cardiomyopathy is possible in most cases but can prove challenging in some Sudden cardiac death in athletes is rare and usually a result of inherited or congenital abnormalities of the heart Screening with health questionnaire, physical examination and 12-lead ECG is effective at identifying most disorders implicated in sudden cardiac death in young athletes evaluation. Unfortunately such tests can prove timely and a negative gene test does not necessarily exclude HCM with certainty. CONCLUSION The athlete s heart is characterised by increased cardiac dimensions that occasionally overlap with cardiomyopathies. A systematic clinical approach enables differentiation of athlete s heart from HCM in most cases. Declaration of interests: none declared. REFERENCES 1. Papadakis M, Carre F, Kervio G, et al. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J 2011;32: Basavarajaiah S, Boraita A, Whyte G, et al. Ethnic differences in left ventricular remodeling in highly-trained athletes: relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Coll Cardiol 2008; 51: Basavarajaiah S, Wilson M, Whyte G, et al. Prevalence of hypertrophic cardiomyopathy in highly trained athletes: relevance to preparticipation screening. J Am Coll Cardiol 2008;51: Sharma S, Maron BJ, Whyte G, et al. Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete s heart and hypertrophic cardiomyopathy. J Am Coll Cardiol 2002;40: Rawlins J, Carre F, Kervio G, et al. Ethnic differences in physiological cardiac adaptation to intense physical exercise in highly trained female athletes. Circulation 2010;121: Prakken NH, Velthuis BK, Teske AJ, et al. Cardiac MRI reference values for athletes and nonathletes corrected for body surface area, training hours/week and sex. Eur J Cardiovasc Prev Rehabil 2010;17: Fagard RH. Impact of different sports and training on cardiac structure and function. Cardiol Clin 1997;15: Basavarajaiah S, Shah A, Sharma S. Sudden cardiac death in young athletes. Heart 2007;93: Corrado D, Basso C, Pavei A, et al. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006;296: Corrado D, Pelliccia A, Heidbuchel H, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 2010;31: Zaidi A, Sharma S. The athlete s heart. Br J Hosp Med (Lond) 2011;72:
Professor Sanjay Sharma St George s University of London
How to Evaluate an Athlete of Afro- Caribbean Origin. Professor Sanjay Sharma St George s University of London Background: Causes of SCD in Sport Young competitive athlete Personal and family history Physical
More informationCurrent ECG interpretation guidelines in the screening of athletes
REVIEW ARTICLE 7 How to differentiate physiological adaptation to intensive physical exercise from pathologies Current ECG interpretation guidelines in the screening of athletes Gemma Parry-Williams, Sanjay
More informationDr Navin Chandra Clinical Research Fellow in Cardiology St George s University of London
Dr Navin Chandra Clinical Research Fellow in Cardiology St George s University of London Cardiac Adaptation in Athletes Athletic training for prolonged periods may result in physiological adaptations of
More informationInterpretation and Consequences of Repolarisation Changes in Athletes
Interpretation and Consequences of Repolarisation Changes in Athletes Professor Sanjay Sharma E-mail sasharma@sgul.ac.uk @SSharmacardio Disclosures: None Athlete s ECG Vagotonia Sinus bradycardia Sinus
More informationat least 4 8 hours per week
ECG IN ATHLETS An athlete is defined as an individual who engages in regular exercise or training for sport or general fitness, typically with a premium on performance, and often engaged in individual
More informationA new consensus document on electrocardiographic interpretation in athletes: does it help to prevent sudden cardiac death in athletes?
Neth Heart J (2018) 26:127 132 https://doi.org/10.1007/s12471-018-1076-6 POINT OF VIEW A new consensus document on electrocardiographic interpretation in athletes: does it help to prevent sudden cardiac
More informationEVALUATION OF ELECTROCARDIOGRAPHIC FINDINGS IN ATHLETES
EVALUATION OF ELECTROCARDIOGRAPHIC FINDINGS IN ATHLETES UNIT OF INHERITED CV DISEASES HEART CENTER OF THE YOUNG AND ATHLETES A DPT OF CARDIOLOGY UNIVERSITY OF ATHENS EVALUATION OF ELECTROCARDIOGRAPHIC
More informationEndurance Exercise and Cardiovascular Health
Endurance Exercise and Cardiovascular Health Professor Sanjay Sharma St George s University of London St George s Hospital NHS Trust sasharma@sgul.ac.uk @SSharmacardio Conflicts/Disclosures: None Objectives
More informationLa valutazione dell atleta: è una strategia salva-vita e costo-efficace?
La valutazione dell atleta: è una strategia salva-vita e costo-efficace? Primo trattato di Medicina Wilson and Jungner s criteria In the 1960s the World Health Organization adopted the Wilson and Jungner
More informationIntroduction. Abbreviations and Definitions
Abbreviations and Definitions HCM DCM LVH ARVC LAD LV LA RV RA IVSd LVPWd LVDd EDV SV EF LA Size LVNC LBBB RBBB RWT Hypertrophic Cardiomyopathy Dilated Cardiomyopathy Left Ventricular Hypertrophy Arrhythmogenic
More informationSports Cardiology Highlights from EuroPRevent 2012 Dublin
Sports Cardiology Highlights from EuroPRevent 2012 Dublin Hein Heidbuchel Cardiology Arrhythmology, University of Leuven, Belgium Past Chair, A Registered Branch of the ESC Sports Cardiology Highlights
More informationNormal ECG And ECHO Findings in Athletes
Normal ECG And ECHO Findings in Athletes Dr.Yahya Kiwan Consultant Interventional Cardiologist Head Of Departement Of Cardiology Canadian Specialist Hospital Sinus Bradycardia The normal heartbeat is initiated
More informationThe frontier between normal and abnormal electrocardiogram in athletes
The frontier between normal and abnormal electrocardiogram in athletes ESC Congress 2011 Paris F. Carré University Rennes 1-Pontchaillou Hospital Inserm U642, Rennes - F-35000 Cardiovascular preparticipation
More informationSudden Cardiac Death in Sports: Causes and Current Screening Recommendations
Sports Cardiology Sudden Cardiac Death in Sports: Causes and Current Screening Recommendations Domenico Corrado, MD, PhD Inherited Arrhytmogenic Cardiomyopathy Unit Department of Cardiac, Thoracic and
More informationHow to Read an Athlete s ECG. Sanjay Sharma BSc (Hons), MD, FRCP, FESC
How to Read an Athlete s ECG Sanjay Sharma BSc (Hons), MD, FRCP, FESC Athlete s EKG Vagotonia Sinus bradycardia Sinus arrhythmia First degree AVB ST-elevation Tall T waves Increased chamber size Left ventricular
More informationHistorical Notes: Clinical Exercise Testing in the Athlete. An Efficient Heart. Structural Changes, Cont. Coronary Arteries
Clinical Exercise Testing in the Athlete The athlete s heart Sudden cardiac death in athletes Screening athletes for cardiovascular disease Historical Notes: Giovanni Lancisi (father of cardiology), 17
More informationI have nothing to disclose. Research support from: Cardiac Risk in The Young
I have nothing to disclose. Research support from: Cardiac Risk in The Young Pre-participation screening of Young Athletes: Current Perspective Professor Sanjay Sharma Disclosures: None SCD in Young Athletes
More informationFrançois Carré Hôpital Pontchaillou -INSERM UMR1099-Université Rennes 1
Normal electrocardiogram variants in Athletes François Carré Hôpital Pontchaillou -INSERM UMR1099-Université Rennes 1 Disclosures No disclosure of interest concerning this lecture The cardiovascular sport
More informationECG Underwriting Puzzler Dr. Regina Rosace AVP & Medical Director
December 2018 ECG Underwriting Puzzler Dr. Regina Rosace AVP & Medical Director To obtain best results Select Slide Show from the ribbon at the top of your PowerPoint screen Select From Beginning on the
More informationCardiac hypertrophy and how it may break an athlete s heart e the Cypriot case
Eur J Echocardiography (2005) 6, 301e307 Cardiac hypertrophy and how it may break an athlete s heart e the Cypriot case C.E. Chee a,1, C.P. Anastassiades a,1, A.G. Antonopoulos b, A.A. Petsas b, L.C. Anastassiades
More informationThe Heart of a Cyclist Insights from Sports Cardiology. Michel Accad, MD February 21, 2018 UCSF Mini Medical School
The Heart of a Cyclist Insights from Sports Cardiology Michel Accad, MD February 21, 2018 UCSF Mini Medical School Lecture outline: WARNING: Not a lecture about how to boost your performance! Preliminary
More informationKey wards: PR Interval, QT interval, bradycardia.
bü z ÇtÄ TÜà väx : A Pilot Study Eman Abdo Elaziz Ahmed 1 and Amal Mahmoud Saied 2 Abstract Background: Sudden deaths of young competitive athletes are tragic events that continue to have a considerable
More informationEKG screening in athletics
Use of PPE EKG screening in athletics Stefan Montgomery MD, ATC 4/27/18 The overall role of the preparticipation physical evaluation (PPE) is to evaluate the health of the athlete to optimize safe sports
More informationCLINICAL RESEARCH ON CARDIOVASCULAR ALTERATION ON 86 S PROFESSIONAL ATHLETES IN IRAN
CLINICAL RESEARCH ON CARDIOVASCULAR ALTERATION ON 86 S PROFESSIONAL ATHLETES IN IRAN Lotfali Pourkazemi 1 * and Roghieh Razeghi Jadid 2 1 Sports Medicine Federation of Iran 2 Department of Herbal Sciences,
More informationThe Athlete s Heart. Critical Role of Echo. Neil J. Weissman, MD MedStar Health Research Institute & Professor of Medicine Georgetown University
The Athlete s Heart Critical Role of Echo Neil J. Weissman, MD MedStar Health Research Institute & Professor of Medicine Georgetown University Washington, D.C. Disclosures Grant support (to institution)
More informationSudden Death in Athletes: What is the role of ECG Screening?
Sudden Death in Athletes: What is the role of ECG Screening? Byron K. Lee MD Professor of Medicine Director of EP Laboratory leeb@medicine.ucsf.edu Division of Cardiology Cardiac Electrophysiology Arrhythmias,
More informationIndex. cardiacep.theclinics.com. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A AEDs. See Automated external defibrillators (AEDs) AF. See Atrial fibrillation (AF) Age as factor in SD in marathon runners, 45 Antiarrhythmic
More informationEVALUATION OF THE ATHLETE. Karen Stout, MD Professor, Medicine and Pediatrics University of Washington
EVALUATION OF THE 12 ATHLETE Karen Stout, MD Professor, Medicine and Pediatrics University of Washington NO DISCLOSURES OUTLINE Why evaluate athletes? What s the problem? What evaluation should be done?
More informationEcho Evaluation of the Heart of an Athlete
Echo Evaluation of the Heart of an Athlete 18 th SA Heart Congress, 2017 Johannesburg, South Africa November 9-12, 2017 Naser Ammash. MD Professor of Medicine Practice Chair, Cardiovascular Department
More informationThe interpretation of ECG in the young and in athletes.
PRACTICAL ECG COURSE The interpretation of ECG in the young and in athletes. Synopsis and aims: the practical ECG course is focused on ECG interpretation in young individuals (14-35 years) and in athletes.
More informationDEPARTMENT NAME PRE-PARTICIPATION SCREENING THE SPORTS PHYSICAL
PRE-PARTICIPATION SCREENING THE SPORTS PHYSICAL Michele Krenek, MSN, RN, FNP-C TCHAPP Conference, Houston, TX April 4, 2019 PRE-PARTICIPATION SPORTS SCREENING According to the AHA the definition of the
More informationAthletes with cardiac disease; dead and buried or chance for resurrection?
Athletes with cardiac disease; dead and buried or chance for resurrection? EuroPRevent 2011 Geneva F. Carré University Rennes 1-Pontchaillou Hospital Inserm U642, Rennes - F-35000 Risk of physical activity
More informationSUDDEN CARDIAC DEATH IN ATHLETES
SUDDEN CARDIAC DEATH IN ATHLETES Alix Dufresne, MD, FACP, FACC, FESC Cardiology Division Chief, Interfaith Medical Center Director Cardiology Clinic, Kingsbrook Jewish Center PURPOSE AND OBJECTIVES PURPOSE
More information27-year-old professionnal rugby player: asymptomatic
27-year-old professionnal rugby player: asymptomatic Benefits and limits of cardiac MRI in the young athlete with a suspected heart disease. Philippe PAULE Service de Cardiologie, HIA Clermont Tonnerre,
More informationUniversity of Groningen. The young athlete's heart Bessem, Bram
University of Groningen The young athlete's heart Bessem, Bram IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document
More informationAthlete s Heart vs. Cardiomyopathy
Athlete s Heart vs. Cardiomyopathy Linda D. Gillam, MD, MPH, FASE Chair, Department of Cardiovascular Medicine Medical Director, Cardiovascular Service Line Former Team Cardiologist to the New York Jets
More informationThe Athlete s Heart. Role of Echo. Neil J. Weissman, MD MedStar Health Research Institute & Professor of Medicine Georgetown University
The Athlete s Heart Role of Echo Neil J. Weissman, MD MedStar Health Research Institute & Professor of Medicine Georgetown University Washington, D.C. Disclosures Grant support (to institution) for Core
More informationCardiovascular Impacts of long-term endurance exercise: Implications of athlete s heart
Cardiovascular Impacts of long-term endurance exercise: Implications of athlete s heart Dr. Gary Mak 麥耀光心臟科專科醫生 IPP of HK Associa4on of Sports Medicine and Sports Science Director of Pro-Cardio Heart Disease
More information6/19/2018. Background Athlete s heart. Ultimate question. Applying the International Criteria for ECG
Applying the International Criteria for ECG Interpretation in Athletes to a preparticipation screening program DAVE SIEBERT, MD, CAQSM ASSISTANT PROFESSOR DEPARTMENT OF FAMILY MEDICINE UNIVERSITY OF WASHINGTON
More informationAthlete s Heart vs. Cardiomyopathy
Athlete s Heart vs. Cardiomyopathy Linda D. Gillam, MD, MPH, FASE Chair, Department of Cardiovascular Medicine Medical Director, Cardiovascular Service Line Former Team Cardiologist to the New York Jets
More informationRisk Factors for Sudden cardiac Death
Risk Factors for Sudden cardiac Death A. Arenal Arrhythmias in competitive sports Disclosure Conflict of interest Advisory board: Medtronic, Boston Scientific Research grants: Medtronic, Boston Scientific,
More informationAbnormal ECG patterns and significance in a group of mountaineers
Original Article Abnormal ECG patterns and significance in a group of mountaineers Wg Cdr V Vasdev*, Wg Cdr DS Chadha +, Gp Capt P Kharbanda #, Lt Col SK Datta**, Air Cmde RK Ganjoo AVSM VSM ++ ABSTRACT
More informationCARDIAC BENEFICIAL EFFECTS AND ADAPTATIONS IN ATHLETES
ARISTOTLE UNIVERSITY OF THESSALONIKI, GREECE SPORTS MEDICINE LABORATORY DIRECTOR: PROF. A. DELIGIANNIS CARDIAC BENEFICIAL EFFECTS AND ADAPTATIONS IN ATHLETES ASTERIOS DELIGIANNIS CARDIOLOGIST PROFESSOR
More informationJonathan Kim MD, FACC
Jonathan Kim MD, FACC Assistant Professor, Division of Cardiology, Emory University Adjunct Assistant Professor, School of Applied Physiology, Georgia Tech Team Cardiologist, Sports Medicine, Emory University
More informationThe interpretation of ECG in the young and in athletes.
PRACTICAL ECG COURSE The interpretation of ECG in the young and in athletes. Synopsis and aims: the practical ECG course is focused on ECG interpretation in young individuals (14-35 years) and in athletes.
More informationI n 490 BC, Pheidippides, the renowned Athenean
710 REVIEW Risk of competitive sport in young athletes with heart disease S Firoozi, S Sharma, W J McKenna... The majority of sudden deaths in young athletes occur in the context of underlying inherited
More informationThe Athletic Heart Takes Shape: Overview of Cardiac Remodeling Rory B. Weiner, MD
The Athletic Heart Takes Shape: Overview of Cardiac Remodeling Rory B. Weiner, MD Cardiovascular Performance Program, MGH Assistant Professor of Medicine, Harvard Medical School Outline Athlete s Heart
More informationPre-participation screening is warranted: Pro
Controversies on marathon and beyond Pre-participation screening is warranted: Pro DOMENICO CORRADO, MD, PhD Department of Cardiac, Thoracic and Vascular Sciences University of Padova, Italy domenico.corrado@unipd.it
More informationElectrocardiograms of Collegiate Football Athletes
Electrocardiograms of Collegiate Football Athletes Stephen F. Crouse, PhD, FACSM, Thomas Meade, MD, Brent E. Hansen, MS, John S. Green, PhD, Steven E. Martin, MS Department of Health Kinesiology, Texas
More informationHow NOT to miss Hypertrophic Cardiomyopathy? Adaya Weissler-Snir, MD University Health Network, University of Toronto
How NOT to miss Hypertrophic Cardiomyopathy? Adaya Weissler-Snir, MD University Health Network, University of Toronto Introduction Hypertrophic cardiomyopathy is the most common genetic cardiomyopathy,
More informationStudy methodology for screening candidates to athletes risk
1. Periodical Evaluations: each 2 years. Study methodology for screening candidates to athletes risk 2. Personal history: Personal history of murmur in childhood; dizziness, syncope, palpitations, intolerance
More informationNancy Goldman Cutler, MD Beaumont Children s Hospital Royal Oak, Mi
Nancy Goldman Cutler, MD Beaumont Children s Hospital Royal Oak, Mi Identify increased LV wall thickness (WT) Understand increased WT in athletes Understand hypertrophic cardiomyopathy (HCM) Enhance understanding
More informationHow the New International recommendation for Electrocardiographic interpretation in Athletes would change our practice
v Medical Group Journal of Cardiovascular Medicine and Cardiology ISSN: 2455-2976 DOI CC By Roberto Ferrara 1, Andrea Serdoz 1, Mariangela Peruzzi 2, Elena Cavarretta 2,3 * 1 Department of Physiology and
More informationCardiac hypertrophy : differentiating disease from athlete
Cardiac hypertrophy : differentiating disease from athlete Ario Soeryo Kuncoro, MD, Cardiologist Echocardiography Division, National Cardiovascular Centre Harapan Kita-Jakarta Departement of Cardiology
More informationThe 12-lead ECG shows a broad range of abnormal
Clinical Investigation and Reports Clinical Significance of Abnormal Electrocardiographic Patterns in Trained Athletes Antonio Pelliccia, MD; Barry J. Maron, MD; Franco Culasso, PhD; Fernando M. Di Paolo,
More informationThe Athlete s Heart in Adolescent Africans
Journal of the American College of Cardiology Vol. 59, No. 11, 2012 2012 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2011.12.008
More informationHypertrophic Cardiomyopathy or «Athlete s Heart»
Hypertrophic Cardiomyopathy or «Athlete s Heart» S. GUERARD, J-R. CAIGNAULT, V. GRIFFET Desgenettes Military Hospital LYON Déclaration de Relations Professionnelles Disclosure Statement of Financial Interest
More informationPlaying it safe: exercise and cardiovascular health
Playing it safe: exercise and cardiovascular health Dhutia H, Sharma S. Playing it safe: exercise and cardiovascular health. Practitioner 2015; 259 (1786):15-20 Dr Harshil Dhutia BSc MRCP Cardiology Fellow
More informationThe cardiovascular benefits of regular physical exercise have been well documented
CHAPTER ONE 1.1. Introduction The cardiovascular benefits of regular physical exercise have been well documented (Paffenbarger et al. 1997), with overwhelming evidence from epidemiological and intervention
More informationNormal electrocardiographic findings: recognising physiological adaptations in athletes
Scan to access more free content For numbered affiliations see end of article. Correspondence to Jonathan A Drezner, Department of Family Medicine, University of Washington, 1959 NE Pacific Street, Box
More informationPrevalence of Modified ARVC Task Force Criteria in Elite Male Athletes
ESC Congress Paris 2011 Prevalence of Modified ARVC Task Force Criteria in Elite Male Athletes A Zaidi, N Sheikh, S Gati, S Ghani, R Howes, S Sharma St George s, University of London, United Kingdom Conflict
More informationRight ventricular adaptation in endurance athletes. António Freitas. No conflict of interest
The role of echocardiography in sports cardiology Right ventricular adaptation in endurance athletes. António Freitas Cardiology Department - Fernando Fonseca Hospital Lisbon Sports Medicine Centre - Lisbon
More informationNovel echocardiographic modalities: 3D echo, speckle tracking and strain rate imaging. Potential roles in sports cardiology. Stefano Caselli, MD, PhD
Novel echocardiographic modalities: 3D echo, speckle tracking and strain rate imaging. Potential roles in sports cardiology. Stefano Caselli, MD, PhD Ospedale San Pietro Fatebenefratelli Rome, Italy Differential
More informationTHE EFFECT OF ETHNICITY AND BODY SIZE ON THE ATHLETE S HEART AND THEIR IMPACT ON CARDIOVASCULAR PRE-PARTICIPATION SCREENING NATHAN RIDING
THE EFFECT OF ETHNICITY AND BODY SIZE ON THE ATHLETE S HEART AND THEIR IMPACT ON CARDIOVASCULAR PRE-PARTICIPATION SCREENING NATHAN RIDING A thesis submitted in partial fulfillment of the requirements of
More informationAbnormal electrocardiographic findings in athletes: recognising changes suggestive of cardiomyopathy
Scan to access more free content For numbered affiliations see end of article Correspondence to Jonathan A Drezner, Department of Family Medicine, University of Washington, 1959 NE Pacific Street, Box
More informationECG Interpretation Made Easy
ECG Interpretation Made Easy Dr. A Tageldien Abdellah, MSc MD EBSC Lecturer of Cardiology- Hull University Hull York Medical School 2007-2008 ECG Interpretation Made Easy Synopsis Benefits Objectives Process
More informationECG ABNORMALITIES D R. T AM A R A AL Q U D AH
ECG ABNORMALITIES D R. T AM A R A AL Q U D AH When we interpret an ECG we compare it instantaneously with the normal ECG and normal variants stored in our memory; these memories are stored visually in
More informationElectrocardiographic changes in 1000 highly trained junior elite athletes
Br J Sports Med 1999;33:319 324 319 St George s Hospital Medical School, Cranmer Terrace, London SW17 ORE, United Kingdom S Sharma P Elliott R Kaushal N Mahon W J McKenna University of Wolverhampton, Division
More informationR egular intensive physical exercise is associated with an
495 CARDIOVASCULAR MEDICINE Physiological upper limits of ventricular cavity size in highly trained adolescent athletes J Makan, S Sharma, S Firoozi, G Whyte, P G Jackson, W J McKenna... See end of article
More informationFootball has claimed the lives of several high profile athletes in the past decade SPORTS MEDICINE. Written by Sanjay Sharma and Mathew Wilson, Qatar
SPORTS MEDICINE SUDDEN DEATH IN FOOTBALL Written by Sanjay Sharma and Mathew Wilson, Qatar BACKGROUND Participation in regular exercise has appreciable cardiovascular benefits and there is evidence that
More informationDiploma in Electrocardiography
The Society for Cardiological Science and Technology Diploma in Electrocardiography The Society makes this award to candidates who can demonstrate the ability to accurately record a resting 12-lead electrocardiogram
More informationEndurance sports and sudden cardiac death
Symposium: Endurance training and ventricular arrhythmias Endurance sports and sudden cardiac death DOMENICO CORRADO, MD, PhD Department of Cardiac, Thoracic and Vascular Sciences University of Padova,
More informationComparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes
Comparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes Nathan R. Riding PhD 1,2, Nabeel Sheikh MBBS, MRCP 3, Carmen Adamuz MD, PhD 4, Victoria Watt
More informationHypertrophic Cardiomyopathy
Hypertrophic Cardiomyopathy Injuries in sports are going to happen. There is nothing we can do to change them. We can simply work to prevent as many of them as we can while reducing the life- long effects
More informationEvaluation of Left Ventricular Hypertrophy in U.S. Air Force Aviators
Evaluation of Left Ventricular Hypertrophy in U.S. Air Force Aviators Daniel LaMar, MD, MPH Maj, USAF, MC, FS USAF School of Aerospace Medicine WPAFB, OH RAM 2013 Distribution A: Approved for public release;
More informationSudden cardiac death: Primary and secondary prevention
Sudden cardiac death: Primary and secondary prevention By Kai Chi Chan Penultimate Year Medical Student St George s University of London at UNic Sheba Medical Centre Definition Sudden cardiac arrest (SCA)
More information2/26/2015.
Gerry Keenan MMS PA-C Associate Professor -Physician Assistant Studies Arizona School of Health Sciences A T Still University Event Medical Director-USA/Karate- Arizona Clinical Director-MEDfest/Healthy
More informationPAEDIATRIC ACUTE CARE GUIDELINE. ECG Interpretation
Princess Margaret Hospital for Children PAEDIATRIC ACUTE CARE GUIDELINE ECG Interpretation Scope (Staff): Scope (Area): All Emergency Department Clinicians Emergency Department This document should be
More informationThe sudden cardiac death (SCD)
Daniel Lithwick, MHA, Christopher B. Fordyce, MD, Barbara N. Morrison, BHK, Hamed Nazzari, MD, PhD, Gena Krikler, Saul H. Isserow, MBBCh, Brett Heilbron, MB ChB, Jack Taunton, MD Pre-participation screening
More informationCase 1. Case 2. Case 3
Case 1 The correct answer is D. Occasionally, the Brugada syndrome can present similar morphologies to A and also change depending on the lead position but in the Brugada pattern the r is wider and ST
More informationReuse of this item is permitted through licensing under the Creative Commons:
H. Dhutia, A. Malhotra, V. Gabus, A. Merghani, G. Finocchiaro, L. Millar, R. Narain, M. Papdakis, H. Naci, M. Tome, S. Sharma Cost implications of using different ECG criteria for screening young athletes
More informationUnusual Serial Electrocardiographic Changes which Progressed to Arrhythmogenic Right Ventricular Cardiomyopathy
CASE REPORT Unusual Serial Electrocardiographic Changes which Progressed to Arrhythmogenic Right Ventricular Cardiomyopathy Shu Yoshihara 1,2, Masaki Matsunaga 2, Taku Yaegashi 3, Shioto Suzuki 4, Masaaki
More informationThe Screening Debate. Robert M. Campbell, MD Children s Healthcare of Atlanta Emory University School of Medicine
The Screening Debate Robert M. Campbell, MD Children s Healthcare of Atlanta Emory University School of Medicine No Disclosures Screening screen ing ˈskrēniNG/ noun noun: screening; plural noun: screenings
More informationExercise guidelines in athletes with isolated repolarisation abnormalities and structurally normal heart.
Exercise guidelines in athletes with isolated repolarisation abnormalities and structurally normal heart. Hanne Rasmusen Consultant cardiologist, PhD Dept. of Cardiology Bispebjerg University Hospital
More informationScreening of Children and Adolescents at Risk of Sudden Cardiac Arrest: What Is the Utility of Non-Invasive Imaging?
Screening of Children and Adolescents at Risk of Sudden Cardiac Arrest: What Is the Utility of Non-Invasive Imaging? Beth F. Printz, M.D., Ph.D. Medical Director, Non-Invasive Imaging Rady Children s Hospital,
More informationCardiac Conditions in Sport & Exercise. Cardiac Conditions in Sport. USA - Sudden Cardiac Death (SCD) Dr Anita Green. Sudden Cardiac Death
Cardiac Conditions in Sport & Exercise Dr Anita Green Cardiac Conditions in Sport Sudden Cardiac Death USA - Sudden Cardiac Death (SCD)
More informationPaediatric ECG Interpretation
Paediatric ECG Interpretation Dr Sanj Fernando (thanks to http://lifeinthefastlane.com/ecg-library/paediatric-ecginterpretation/) 3 yo boy complaining of abdominal pain and chest pain Child ECG vs Adult
More informationDr. Schroeder has no financial relationships to disclose
Valerie A Schroeder MD MS Assistant Professor University of Kansas Medical Center READING THE WAVES- THE HEART S ELECTRICAL MESSAGE FINANCIAL DISCLOSURE Dr. Schroeder has no financial relationships to
More informationPrevalence of Different Electrocardiographic Patterns in Iranian Athletes
ORIGINAL REPORT Prevalence of Different Electrocardiographic Patterns in Iranian Athletes Behzad Farahani 1, Mehrshad Poursaeid Esfahani 2, Mohammad Amin Abbasi 3, Farhad Moradi 1, and Ata Abbasi 4 1 Department
More informationManaging Hypertrophic Cardiomyopathy with Imaging. Gisela C. Mueller University of Michigan Department of Radiology
Managing Hypertrophic Cardiomyopathy with Imaging Gisela C. Mueller University of Michigan Department of Radiology Disclosures Gadolinium contrast material for cardiac MRI Acronyms Afib CAD Atrial fibrillation
More informationInternational Criteria for Electrocardiographic Interpretation in Athletes
International Criteria for Electrocardiographic Interpretation in Athletes Jonathan A. Drezner, MD* 1, Sanjay Sharma, MD* 2, Aaron Baggish, MD 3, Michael Papadakis, MD 2, Mathew G. Wilson, PhD 4, Jordan
More informationINTERNATIONAL RUGBY BOARD Putting players first
The information in this Cardiac Screening Guideline is presented as guidance for Unions, Medical Practitioners and Rugby athletes. The Cardiac Screening recommendations will not be mandated for Unions
More informationRonald J. Kanter, MD Director, Electrophysiology Miami Children s Hospital Professor Emeritus, Duke University Miami, Florida
S306- Pediatric Electrocardiography: A Potpourri Ronald J. Kanter, MD Director, Electrophysiology Miami Children s Hospital Professor Emeritus, Duke University Miami, Florida Disclosure of Relevant Relationship
More informationApril 22, 2017 Abraham Rothman, MD
April 22, 2017 Abraham Rothman, MD University of Nevada School of Medicine } Definitions } Adults } Children } Heart beats } Children and adolescents who want to participate in intensive exercise. } Just
More informationNew scientific advances in Sports Cardiology-
New scientific advances in Sports Cardiology- Highlights from EuroPRevent Prague 2010 ESC meeting, Stockholm 100831 Mats Börjesson, MD, Assoc prof, Univ lecturer Sahlgrenska University Hospital/Östra,
More informationPECTUS EXCAVATUM WITH SPONTANEOUS TYPE 1 ECG BRUGADA PATTERN OR BRUGADA LIKE PHENOTYPE: ANOTHER BRUGADA ECG PHENOCOPY
PECTUS EXCAVATUM WITH SPONTANEOUS TYPE 1 ECG BRUGADA PATTERN OR BRUGADA LIKE PHENOTYPE: ANOTHER BRUGADA ECG PHENOCOPY ANDRÉS RICARDO PÉREZ RIERA MD Chief of the Sector of Electro-Vectocardiography of the
More informationThe Electrocardiogram part II. Dr. Adelina Vlad, MD PhD
The Electrocardiogram part II Dr. Adelina Vlad, MD PhD Basic Interpretation of the ECG 1) Evaluate calibration 2) Calculate rate 3) Determine rhythm 4) Determine QRS axis 5) Measure intervals 6) Analyze
More informationFANS ARVC (Arrhythmogenic Right Ventricular Cardiomyopathy) Investigation Protocol
Clinical Features FANS ARVC (Arrhythmogenic Right Ventricular Cardiomyopathy) Investigation Protocol History: Progressive disease, characterised by the following clinical stages: o Early concealed phase
More information