The Female Athlete Malcolm Legget
MCQ Is complete LBBB or RBBB a training related ECG abnormality in women 1. Yes 2. No 3. Sometimes
Participation in Sport Female sports participation increasing. Paris Olympics 1900-22 of 997 athletes competed in just five sports: tennis, sailing, croquet, equestrian and golf. LA Olympics 1984 23% of all participants London Olympics 2012 44% of all participants
1900 Tennis, Golf 1904 Archery 1908 Tennis, Figure skating 1912 Swimming 1924 Fencing 1928 Athletics, Gymnastics 1936 Alpine Skiing 1948 Canoeing 1952 Equestrian sports 1960 Speed skating 1964 Volleyball, Luge 1976 Rowing, Basketball, Handball 1980 Field Hockey 1984 Shooting, Cycling 1988 Tennis, Table Tennis, Sailing 1992 Badminton, Judo, Biathlon 1996 Football, Softball 1998 Curling, Ice Hockey 2000 Weightlifting, Pentathlon, Taekwondo, Triathlon 2002 Bobsleigh 2004 Wrestling 2008 BMX 2012 Boxing 2014 Ski Jumping
Nadezhda Ostapchuk
Benefits of Exercise Coronary artery disease leading cause of death in women in developed countries Kills more women than cancer, accidents and diabetes combined Prevention of diabetes, hypertension, and hyperlipidaemia, obesity Improves endothelial function, reduces peripheral resistance, lowers LDL, increase HDL, increase insulin responsiveness, improves glucose tolerance
Nurses Health Study NEJM 2000
How Much Exercise? 30-60 minutes of moderate physical activity every day Women who exercised > 5 hours per week 40% reduction in RR of a cardiac event Benefits more related to duration than intensity of exercise Psychological and physiological benefits
Cardiovascular Response to Exercise in Women Lower stroke volume and smaller increase in SV from rest to exercise Smaller LV volume and mass Lower V0 2 max, but HR max no different Training effect similar in males and females Gradual age related decline, but not related to menopause
Cardiac Remodelling Mild left ventricular and left atrial dilatation Wall thickness > 12 mm very rare ( cf males) Increase in LV mass uncommon Age, body size, resting HR and type of sport effect LV size Other mechanisms- lower BP with exercise, lower androgenic hormones, genetic factors
Pellicia A et al. 2007
24 year old Keen runner More SOB with exercise last 6 months Intermittent palpitations, worse with exercise, associated with light headedness No relevant past or family history
16 year old Competitive rower Near syncope with rapid palpitations at the end of a race Looked very pale Reverted after 2 minutes Type A personality
Wolff-Parkinson-White syndrome
DJH
33 year old Training for half marathon Bad flu 6 weeks ago Now more SOB and very tired Palpitations during and after running Coughing at night
ECG LBBB
The Master Athlete Higher incidence of structural heart disease More atypical symptoms Risk of sudden death low
57 year old Bad family history premature coronary disease Smoker 25 pack year history Impaired glucose tolerance Overweight Wants to give up smoking and do more exercise
Ischaemia- inferior wall
68 year old Heart murmur noted 5 years ago Increasing palpitations with exercise associated with SOB last few months Occasional sharp chest pain, perhaps worse with exercise Always fit in past, wants to exercise more
Unifocal ventricular ectopics
Mitral Valve Prolapse
MCQ Is complete LBBB or RBBB a training related ECG abnormality in women 1. Yes 2. No 3. Sometimes
FloJo 1988 100m 10.49 seconds
Eating disorder, oligomennorrhea, decreased bone density
Take Home Messages Female participation in sport increasing and to be encouraged History and examination. More atypical symptoms in females ECG Resting and exercise stress echocardiography Different response to exercise than males
Take Home Messages Exercise testing in those at intermediate or greater risk or if any cardiac symptoms Avoid high intensity exercise in those with significant CAD, impaired ejection fraction, dysrhythmia, hypotension or uncontrolled hypertension Adverse events more common in those who exercise irregularly or at start of a programme Appropriate screening important