Cardiac screening high school athletes
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Discussion of effectiveness of cardiac screening in athletes in the prevention of sudden cardiac death and other cardiac problems in athletes. http://sportsmedicinepodcast.com
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Sudden Cardiac Death in Athletes
Sudden cardiac death in athletes can be caused by structural heart diseases, channelopathies, or drugs. While rare, it is devastating. Common causes include hypertrophic cardiomyopathy, anomalous coronary arteries, and long QT syndrome. Screening approaches differ between the US and Italy, with ECG screening detecting more cardiac disorders but also false positives. Guidelines on athletic participation depend on the severity and treatment of the underlying heart condition.
Sports cardiology talk slideshare export
Sports Cardiology Grand Rounds at Lions Gate Hospital. EKG screening and other services available through Dr. John Vyselaar, cardiologist, at the North Shore Heart Centre.
Cardiac Arrhythmias and Screening in Athletes
A symposium sponsored by the Brad Wilby Memorial Foundation educating doctors and coaches on the need for cardiac screening in athletes.
update on sudden cardiac death in athletes and young generation
This document discusses updates on sudden cardiac death in athletes and young people. It begins by outlining the benefits of exercise but notes there are also small risks, particularly for those with underlying heart conditions. For young athletes, the main causes of sudden cardiac death are structural heart diseases like hypertrophic cardiomyopathy, channelopathies (genetic arrhythmia conditions), and myocarditis. Screening aims to identify at-risk individuals to prevent lethal events. In adult athletes, coronary artery disease is the primary cause of death, and risk factors like genetics, inflammation and vascular factors can increase likelihood of issues.
Sudden cardiac death
This document provides information on sudden cardiac death (SCD), including its definition, epidemiology, risk factors, etiologies, and prevention. Some key points:
- SCD is defined as a natural death from cardiac causes within 1 hour of symptoms. It is a major cause of mortality, accounting for 10-15% of natural deaths.
- Risk factors include prior heart disease, low ejection fraction, family history, and cardiomyopathy. The risk is bimodal with peaks under 1 year old and over 65 years old.
- Causes include ventricular arrhythmias, asystole, and pulseless electrical activity. Prevention strategies include implantable defibrillators, antiarrhythmic drugs
Sudden cardiac death a systematic approach
The document discusses sudden cardiac death, providing definitions and discussing the magnitude of the problem, who is at risk, pathophysiology, and risk factors. It notes that sudden cardiac death claims over 7 million lives worldwide each year, with about 50% of coronary heart disease deaths being sudden. Risk increases with age, particularly between 45-75 years, and is higher in men. Left ventricular dysfunction, history of heart disease, family history, electrolyte imbalances, certain drugs, and autonomic nervous system abnormalities can also increase risk. Transient factors like ischemia can trigger events in those with pre-existing structural heart issues.
Sudden cardiac arrest/Death
Sudden cardiac arrest/death is the sudden cessation of cardiac activity that can lead to death if not treated rapidly. It is usually due to sustained ventricular tachycardia or fibrillation. Ischemic heart disease is the leading cause, accounting for around 70% of cases. Risk increases with age and underlying cardiac conditions. While screening the general population has not been shown to effectively identify high risk individuals, risk factor reduction through treatments like controlling hypertension, cholesterol, and diabetes as well as lifestyle changes can help with primary prevention. For secondary prevention, an implantable cardioverter-defibrillator is the preferred treatment for survivors of sudden cardiac arrest to terminate recurrent ventricular arrhythmias.
Sudden Cardiac Death and Arrythmias
This document discusses sudden cardiac death and arrhythmias in athletes. It provides information on:
1) The most common causes of exercise-related sudden death depend on age, with hypertrophic cardiomyopathy being the most common in young athletes under 35 years old.
2) While the risk of sudden death from exercise is low in healthy adults, it increases with certain cardiac conditions like coronary artery disease, structural heart diseases, and inherited arrhythmia syndromes.
3) Evaluation of athletes with arrhythmias or syncope requires careful examination, testing like ECGs, echocardiograms, and exercise testing to determine the cause and risk level to guide management decisions around activity restriction.
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Sudden Cardiac Death in Athletes
Sudden cardiac death in athletes can be caused by structural heart diseases, channelopathies, or drugs. While rare, it is devastating. Common causes include hypertrophic cardiomyopathy, anomalous coronary arteries, and long QT syndrome. Screening approaches differ between the US and Italy, with ECG screening detecting more cardiac disorders but also false positives. Guidelines on athletic participation depend on the severity and treatment of the underlying heart condition.
Sports cardiology talk slideshare export
Sports Cardiology Grand Rounds at Lions Gate Hospital. EKG screening and other services available through Dr. John Vyselaar, cardiologist, at the North Shore Heart Centre.
Cardiac Arrhythmias and Screening in Athletes
A symposium sponsored by the Brad Wilby Memorial Foundation educating doctors and coaches on the need for cardiac screening in athletes.
update on sudden cardiac death in athletes and young generation
This document discusses updates on sudden cardiac death in athletes and young people. It begins by outlining the benefits of exercise but notes there are also small risks, particularly for those with underlying heart conditions. For young athletes, the main causes of sudden cardiac death are structural heart diseases like hypertrophic cardiomyopathy, channelopathies (genetic arrhythmia conditions), and myocarditis. Screening aims to identify at-risk individuals to prevent lethal events. In adult athletes, coronary artery disease is the primary cause of death, and risk factors like genetics, inflammation and vascular factors can increase likelihood of issues.
Sudden cardiac death
This document provides information on sudden cardiac death (SCD), including its definition, epidemiology, risk factors, etiologies, and prevention. Some key points:
- SCD is defined as a natural death from cardiac causes within 1 hour of symptoms. It is a major cause of mortality, accounting for 10-15% of natural deaths.
- Risk factors include prior heart disease, low ejection fraction, family history, and cardiomyopathy. The risk is bimodal with peaks under 1 year old and over 65 years old.
- Causes include ventricular arrhythmias, asystole, and pulseless electrical activity. Prevention strategies include implantable defibrillators, antiarrhythmic drugs
Sudden cardiac death a systematic approach
The document discusses sudden cardiac death, providing definitions and discussing the magnitude of the problem, who is at risk, pathophysiology, and risk factors. It notes that sudden cardiac death claims over 7 million lives worldwide each year, with about 50% of coronary heart disease deaths being sudden. Risk increases with age, particularly between 45-75 years, and is higher in men. Left ventricular dysfunction, history of heart disease, family history, electrolyte imbalances, certain drugs, and autonomic nervous system abnormalities can also increase risk. Transient factors like ischemia can trigger events in those with pre-existing structural heart issues.
Sudden cardiac arrest/Death
Sudden cardiac arrest/death is the sudden cessation of cardiac activity that can lead to death if not treated rapidly. It is usually due to sustained ventricular tachycardia or fibrillation. Ischemic heart disease is the leading cause, accounting for around 70% of cases. Risk increases with age and underlying cardiac conditions. While screening the general population has not been shown to effectively identify high risk individuals, risk factor reduction through treatments like controlling hypertension, cholesterol, and diabetes as well as lifestyle changes can help with primary prevention. For secondary prevention, an implantable cardioverter-defibrillator is the preferred treatment for survivors of sudden cardiac arrest to terminate recurrent ventricular arrhythmias.
Sudden Cardiac Death and Arrythmias
This document discusses sudden cardiac death and arrhythmias in athletes. It provides information on:
1) The most common causes of exercise-related sudden death depend on age, with hypertrophic cardiomyopathy being the most common in young athletes under 35 years old.
2) While the risk of sudden death from exercise is low in healthy adults, it increases with certain cardiac conditions like coronary artery disease, structural heart diseases, and inherited arrhythmia syndromes.
3) Evaluation of athletes with arrhythmias or syncope requires careful examination, testing like ECGs, echocardiograms, and exercise testing to determine the cause and risk level to guide management decisions around activity restriction.
Sudden cardiac death
This document discusses sudden death and its causes. It begins by defining sudden death as any death occurring within 24 hours of symptom onset, which can be unpredictable or expected. The most common causes of sudden death are clinically silent degenerative diseases and failure to seek timely medical care. Autopsies aim to identify anatomical abnormalities, microscopic findings, toxicology results and other lab studies. Potential cardiac causes discussed include coronary artery disease, cardiomyopathies, valvular diseases and conduction abnormalities. Non-cardiac causes such as hemorrhage, neurological issues and miscellaneous conditions are also reviewed. The document concludes by emphasizing that sudden death can occur unexpectedly in individuals with cardiovascular disease.
ECG markers in Sudden Cardiac Death
This document summarizes several electrocardiogram markers that can indicate risks for sudden cardiac death. It describes Wolf-Parkinson-White syndrome seen as a short PR interval and delta wave. Brugada syndrome appears as ST elevation in right precordial leads. Long QT syndrome risks torsade de pointes and is seen as a prolonged QTc interval over 440 ms. Catecholaminergic polymorphic ventricular tachycardia can be precipitated by stress and is treated with beta blockers. Hypertrophic cardiomyopathy presents with a systolic murmur and is assessed on electrocardiogram.
Sudden cardiac death
This document discusses sudden cardiac death (SCD), providing information on:
- SCD is an unexpected death from cardiac causes within one hour of symptoms. It often occurs in people with known or unknown heart disease.
- Autopsies show most SCD victims had prior heart attacks or coronary artery disease. About 92% of SCD victims do not survive.
- Risk factors for SCD include age, male sex, family history of heart disease, smoking, diabetes, and high blood pressure. EKG abnormalities like prolonged QT also increase risk.
- Causes of SCD include coronary artery disease, cardiomyopathies, genetic conditions, and electrical issues in the heart. The most common mechanism is
Sudden cardiac death
Sudden cardiac arrest accounts for many deaths each year in developed countries. It is defined as abrupt loss of consciousness due to cardiac causes within one hour of symptom onset. The majority of cases are due to coronary heart disease and result in arrhythmias like ventricular fibrillation. Risk factors include prior ventricular arrhythmias, low ejection fraction, heart failure, and family history. Early defibrillation improves survival rates dramatically if delivered within 3 minutes of collapse. Post-myocardial infarction and congestive heart failure patients with left ventricular dysfunction have high rates of sudden cardiac death, which accounts for about half of total mortality in these groups.
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This document provides an overview of strokes, including:
- Strokes are caused by a blockage or rupture of an artery to the brain, cutting off oxygen flow.
- Symptoms include weakness, paralysis, difficulty speaking or swallowing.
- Diagnosis involves medical imaging, blood tests, and physical exams to determine the type and location of blockage or rupture.
- Treatment depends on the type of stroke but may include clot-busting drugs, surgery, medication, and lifestyle changes to prevent future strokes.
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The document discusses sudden cardiac death (SCD) in various populations. It notes that SCD accounts for 12-15% of natural deaths and almost 90% have cardiac causes. The peak ages for SCD are within the first year of life and between 45-75 years. The most common causes of SCD in children are congenital heart defects while in those over 35 it is coronary heart disease. Rare causes like hypertrophic cardiomyopathy also contribute to SCD in young adults. Exercise-related SCD is often due to congenital anomalies or premature heart disease in young and older athletes respectively.
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This document discusses strokes, including what they are, their causes, symptoms, types, risk factors, prevalence, and management. It defines a stroke as the sudden death of brain cells due to interrupted blood flow to the brain, and outlines the two main types - ischemic caused by blockages, and hemorrhagic caused by bleeding. Risk factors discussed include hypertension, smoking, atrial fibrillation, and others. The document also provides statistics on stroke prevalence worldwide and in India. It describes India's National Programme for Prevention and Control of Stroke, which focuses on screening, treatment, capacity building, and promoting healthy lifestyles.
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The document discusses stroke epidemiology and syndromes. Some key points:
- Stroke is a leading cause of death and disability worldwide.
- Risk factors for stroke include age, gender, hypertension, diabetes, smoking, atrial fibrillation, and heart disease.
- Ischemic strokes are caused by blood clots, while hemorrhagic strokes involve bleeding in the brain.
- Common stroke syndromes depend on the affected brain region and may cause weakness, sensory loss, speech issues, or visual problems. Middle cerebral artery strokes often cause contralateral weakness, while basilar artery strokes can cause "locked-in" syndrome.
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Hypertrophic cardiomyopathy (HCM) is a disease where the heart muscle becomes abnormally thickened, making it harder for the heart to pump blood. It is usually inherited and symptoms can include chest pain, shortness of breath, fainting, and palpitations. The condition makes individuals prone to arrhythmias and heart failure. While medications and procedures like implantable defibrillators can help treatment, individuals with a family history of sudden cardiac death are at highest risk of complications from HCM.
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The feedback was regarding a magazine cover and film poster design. The designs needed some adjustments to better communicate the intended messages. Specifically, the magazine cover photo did not clearly convey the article's topic and the film poster text was too small and busy. Suggestions were provided to select a more relevant photo and simplify the poster design.
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The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
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This document discusses sudden death and its causes. It begins by defining sudden death as any death occurring within 24 hours of symptom onset, which can be unpredictable or expected. The most common causes of sudden death are clinically silent degenerative diseases and failure to seek timely medical care. Autopsies aim to identify anatomical abnormalities, microscopic findings, toxicology results and other lab studies. Potential cardiac causes discussed include coronary artery disease, cardiomyopathies, valvular diseases and conduction abnormalities. Non-cardiac causes such as hemorrhage, neurological issues and miscellaneous conditions are also reviewed. The document concludes by emphasizing that sudden death can occur unexpectedly in individuals with cardiovascular disease.
ECG markers in Sudden Cardiac Death
This document summarizes several electrocardiogram markers that can indicate risks for sudden cardiac death. It describes Wolf-Parkinson-White syndrome seen as a short PR interval and delta wave. Brugada syndrome appears as ST elevation in right precordial leads. Long QT syndrome risks torsade de pointes and is seen as a prolonged QTc interval over 440 ms. Catecholaminergic polymorphic ventricular tachycardia can be precipitated by stress and is treated with beta blockers. Hypertrophic cardiomyopathy presents with a systolic murmur and is assessed on electrocardiogram.
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This document discusses sudden cardiac death (SCD), providing information on:
- SCD is an unexpected death from cardiac causes within one hour of symptoms. It often occurs in people with known or unknown heart disease.
- Autopsies show most SCD victims had prior heart attacks or coronary artery disease. About 92% of SCD victims do not survive.
- Risk factors for SCD include age, male sex, family history of heart disease, smoking, diabetes, and high blood pressure. EKG abnormalities like prolonged QT also increase risk.
- Causes of SCD include coronary artery disease, cardiomyopathies, genetic conditions, and electrical issues in the heart. The most common mechanism is
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Sudden cardiac arrest accounts for many deaths each year in developed countries. It is defined as abrupt loss of consciousness due to cardiac causes within one hour of symptom onset. The majority of cases are due to coronary heart disease and result in arrhythmias like ventricular fibrillation. Risk factors include prior ventricular arrhythmias, low ejection fraction, heart failure, and family history. Early defibrillation improves survival rates dramatically if delivered within 3 minutes of collapse. Post-myocardial infarction and congestive heart failure patients with left ventricular dysfunction have high rates of sudden cardiac death, which accounts for about half of total mortality in these groups.
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This document provides an overview of strokes, including:
- Strokes are caused by a blockage or rupture of an artery to the brain, cutting off oxygen flow.
- Symptoms include weakness, paralysis, difficulty speaking or swallowing.
- Diagnosis involves medical imaging, blood tests, and physical exams to determine the type and location of blockage or rupture.
- Treatment depends on the type of stroke but may include clot-busting drugs, surgery, medication, and lifestyle changes to prevent future strokes.
What is a SCAD (spontaneous coronary artery dissection)?
PPT presentation I created to educate people about how SCAD survivors use social media to support each other and organize. Katherine Leon had input on this as well, and the two of us presented a slightly different version of this in the WomenHeart "Champions Educating Champions" webinar series back in November of 2011.
Esenmenger syndrome
Eisenmenger syndrome is a form of pulmonary hypertension caused by long-standing left-to-right shunting at the atrial or ventricular level, leading to reversed or bidirectional shunting. It most commonly presents in the second to third decade of life and is associated with uncorrected congenital heart defects. Management focuses on avoiding risks that could destabilize the patient's balanced physiology, such as pregnancy, surgery, travel to high altitudes, and medications like vasodilators. While life expectancy has improved with advanced medical care, mortality remains high due to complications like heart failure, stroke, hemorrhage and sudden death.
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The document discusses sudden cardiac death (SCD) in various populations. It notes that SCD accounts for 12-15% of natural deaths and almost 90% have cardiac causes. The peak ages for SCD are within the first year of life and between 45-75 years. The most common causes of SCD in children are congenital heart defects while in those over 35 it is coronary heart disease. Rare causes like hypertrophic cardiomyopathy also contribute to SCD in young adults. Exercise-related SCD is often due to congenital anomalies or premature heart disease in young and older athletes respectively.
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The document discusses congestive heart failure (CHF), including its definition, epidemiology, pathophysiology, diagnosis, classification, and treatment approaches. It notes that CHF affects over 5 million Americans and costs over $10 billion annually. The main causes are coronary artery disease and hypertension. Treatment focuses on reducing preload and afterload through ACE inhibitors, beta-blockers, and aldosterone antagonists. Other therapies include diuretics, digoxin, resynchronization devices, and ventricular assist devices.
Stroke
This document discusses strokes, including what they are, their causes, symptoms, types, risk factors, prevalence, and management. It defines a stroke as the sudden death of brain cells due to interrupted blood flow to the brain, and outlines the two main types - ischemic caused by blockages, and hemorrhagic caused by bleeding. Risk factors discussed include hypertension, smoking, atrial fibrillation, and others. The document also provides statistics on stroke prevalence worldwide and in India. It describes India's National Programme for Prevention and Control of Stroke, which focuses on screening, treatment, capacity building, and promoting healthy lifestyles.
1.stroke epidemiology and stroke syndromes dr trilochan shrivastava
The document discusses stroke epidemiology and syndromes. Some key points:
- Stroke is a leading cause of death and disability worldwide.
- Risk factors for stroke include age, gender, hypertension, diabetes, smoking, atrial fibrillation, and heart disease.
- Ischemic strokes are caused by blood clots, while hemorrhagic strokes involve bleeding in the brain.
- Common stroke syndromes depend on the affected brain region and may cause weakness, sensory loss, speech issues, or visual problems. Middle cerebral artery strokes often cause contralateral weakness, while basilar artery strokes can cause "locked-in" syndrome.
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Hypertrophic cardiomyopathy (HCM) is a disease where the heart muscle becomes abnormally thickened, making it harder for the heart to pump blood. It is usually inherited and symptoms can include chest pain, shortness of breath, fainting, and palpitations. The condition makes individuals prone to arrhythmias and heart failure. While medications and procedures like implantable defibrillators can help treatment, individuals with a family history of sudden cardiac death are at highest risk of complications from HCM.
Prevention and Treatment of the Heart diseases
The document discusses advances in the prevention and treatment of heart disease in India. It notes that heart disease occurs 10 years earlier in Indians compared to Westerners, and the incidence is three times higher in urban areas. While lifestyle changes, stress, and other risk factors have increased heart disease rates, advances in prevention through lifestyle modification and regular checkups as well as new treatment options like angioplasty, stents and bypass surgery are helping reduce mortality from heart attacks.
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Dr. Sumita Sharma presents an outline on stroke that includes an introduction, the burden of stroke globally and in India, types and risk factors, pathophysiology, signs and symptoms, prevention, ongoing trials, and programs related to stroke. Stroke is the 2nd leading cause of death and 3rd leading cause of disability globally. In India, it is estimated to have a prevalence of 1.54 per 1000 population. Stroke can be ischemic due to blockage or hemorrhagic due to bleeding in the brain. Risk factors include hypertension, atrial fibrillation, diabetes, high cholesterol, smoking, alcohol, obesity, and coronary artery disease. Prevention involves controlling risk factors through lifestyle changes and medication.
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This document summarizes the prognosis and rehabilitation principles for ischemic and hemorrhagic strokes. It covers classifications of strokes, early and late prognosis for different types, risk factors affecting prognosis, evidence from studies on mortality and functional recovery, and rehabilitation guidelines. The key points are that hemorrhagic strokes generally have poorer early prognosis but better late prognosis compared to ischemic strokes, which have lower initial mortality but slower long-term functional recovery.
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This document discusses palpitations in young adults. It begins by introducing the speakers and describing the services provided at AHVC, including general cardiology, interventional procedures, and electrophysiology. It then discusses common causes of palpitations like supraventricular tachycardia, outlines four case studies of patients presenting with palpitations, and debunks myths about palpitations always being benign or due to anxiety. The document emphasizes that arrhythmias in young patients should be properly evaluated.
Stroke
This document discusses stroke, including its definition, classification, clinical presentation, investigation, management, and prevention. Stroke is caused by a blockage or rupture of blood vessels in the brain. It is a leading cause of death and disability. Clinical features depend on the affected brain region but may include weakness, speech problems, visual issues, and more. Investigation involves imaging of the head and neck vessels. Acute management focuses on thrombolysis if appropriate, aspirin, and treating fever, blood sugar, and swallowing issues. Secondary prevention centers on controlling risk factors like hypertension, diabetes, and atrial fibrillation through medications, lifestyle changes, and procedures like carotid intervention.
9. coronary heart disease
Coronary heart disease (CHD) is the most common cause of death worldwide. It is caused by a buildup of fatty deposits called atheroma in the coronary arteries which supply the heart with blood. Symptoms include angina or chest pain that occurs with exertion or stress. Diagnosis is based on symptoms and tests like exercise tolerance tests, myocardial perfusion scans, or coronary angiography. Treatment involves lifestyle changes, medications like aspirin, nitrates, beta-blockers or calcium channel blockers to relieve symptoms, and procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) to improve blood flow.
CVD
Cerebrovascular disease (CVD) refers to a group of brain dysfunctions related to diseases of the blood vessels supplying the brain. The most important cause is hypertension, which damages blood vessel linings. Risk factors include high blood pressure, high cholesterol, obesity, diabetes, smoking, high alcohol intake, atrial fibrillation, and hypercoagulability. CVD includes cerebral infarction (ischemic stroke), intracerebral hemorrhage, subarachnoid hemorrhage, and transient ischemic attack (TIA). Diagnosis involves patient history and imaging tests. Treatment focuses on thrombolytic therapy, blood pressure control, preventing brain edema, anticoagulation, surgery, and rehabilitation.
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What is a SCAD (spontaneous coronary artery dissection)?
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Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
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- 1. Cardiac Screening in High School Athletes SportsMedicinePodcast.com
- 2. DISCLOSURES No relevant financial relationships Meets California AB1195 requirements for Cultural And Linguistic Compentency
- 3. Agenda Why talk about cardiac screening in high school athletes? How common is sudden cardiac death? What can (and should) we change ? How effective is our current cardiac screening? How do we screen currently?
- 4. Why talk about cardiac screening?
- 5. Why talk about cardiac screening?
- 6. Why talk about cardiac screening?
- 7. 39 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.June 12, 2013 Why talk about cardiac screening?
- 8. Why talk about cardiac screening?
- 9. How common is SCD?
- 10. How common is SCD? – Organized High School/College Athletes • Males - 1:133,333 per year or 7.5 per million • Females -1:769,230 per year or 1.3 deaths per million
- 11. How common is SCD? – Military Boot Camp • 13 deaths per 100,000 recruit-year thats about 120 deaths over 25 years
- 12. How common is SCD? – Marathon Runners • 1:50,000 Race Finishers (Mean Age 37yo) Marion 1986 • 1:184,000 cardiac event/ runners (Baggish 2012) – Triathlons • 1:75,000 deaths/ triathletes
- 13. How common is SCD? Total Deaths per year from SCD in athletes? about 300
- 14. How common is SCD? Ryan Shay Hank Gathers Fabrice Muamba
- 15. How common is SCD? Rich Peverley Dallas Stars
- 16. Causes of SCD?
- 17. Causes of SCD? HCM – 36% Coronary Anomalies 17% Increased Cardiac Mass (possible HCM) 10% Ruptured Aorta/Dissect 5% Tunneled LAD 5% Aortic Stenosis 5% Myocarditis 3% Dilated CM 3% Idiopathic Myocdardial scarring 3% Arrhythmogenic RV dysplasia 3%
- 19. 2007 - AHA and Six Sports Medicine Organizations Current Recommendations - U.S. 12 Point Cardiac Screening added to PPE Personal Medical History Family History Physical Exam
- 20. 2007 - AHA and Six Sports Medicine Organizations Current Recommendations - U.S. Personal Medical History - Exertional chest pain or discomfort - Unexplained syncope/near-syncope - Excessive exertional fatigue/dyspnea - Prior diagnosis of heart murmur - Elevated blood pressure
- 21. 2007 - AHA and Six Sports Medicine Organizations Current Recommendations - U.S. Family History - Premature sudden death (< age 50) - Disability from heart disease (< age 50) - History of HCM, LQTS, Marfan Syndrome
- 22. 2007 - AHA and Six Sports Medicine Organizations Current Recommendations - U.S. Physical Exam - Heart murmur - Femoral pulses (aortic coartation) - Marfan-like appearance - Brachial artery blood pressure
- 23. Effectiveness
- 24. Overall AHA Compliance Score 0-4 5-8 9-11 12 PEDIATRICS 0.8% 11.2% 83.0% 5.3% FAMILY MEDICINE 0.5% 13.3% 80% 5% TOTAL 0.7% 12.2% 81.4% 5.7% Source: Madsen NL, et al, Br J Sports Med 2013; 47:172-177
- 25. 41 AHA vs EKG Positive Results Needed W/U H&P EKG Total Wilson - UK 2720 athletes 2.5% 1.5% 4% Bessem Netherlands 428 athletes 8% 8% 13% Hevia Spain 1220 athletes 1.2% 6.1% 7.4% Baggish US 510 athletes 6% 16% 20% Total 4878 athletes 4.4% 7.9% 11.1% Source: Asif IM, Drezner JA, Prg in Cardio Disease, 54 (2012) 445-450
- 26. Why not an EKG on every athlete?
- 27. To EKG or Not? • Europe requires a resting EKG • Italy (Venuto) • 1982 - SCD 4.2/ 100,000 athletes • 2004 - SCD 0.9/ 100,000 athletes • Most common cause in Italy? • Arrhythmogenic RV dysplasia.
- 28. Whats a normal EKG? – EKG Findings in Athletes considered WNL • Sinus Bradycardia – as low as 30-40 bpm • Various A/V blocks occur in up to 33% of athletes – First Degree (PR>0.2) – Most Common – Second Degree (Mobitz-1 or Wenkeback) • Increased R or S wave voltage without Left axis deviation, QRS prolongation, or LAE • Incomplete RBBB • U-waves with up-sloping ST segments and normal T waves
- 29. Causes of SCD • Hypertrophic Cardiomyopathy********************** – Sporatic or inherited (autosomal-dominant) – Can predispose to malignant ventricular arrhythmias leading to syncope or sudden death – S/S: • Dyspnea (initially exertional in onset), Angina, Exertional syncope, exertional presyncope, fatigue, palpitations – Exam: • Systolic murmur that increases with valsalva – Testing: • CXR: cardiomegaly • EKG: LVH • Echo: confirmation of HCM – Tx: • B-Blockers • ICD • Septal artery ethanol ablation
- 30. Causes of SCD • Coronary Artery Anomalies – In one review of 78 cases of CAA who died of sudden death, 62% of those were asymptomatic – S/S: Only ~ 1/3 of pts have any symptoms of exertional syncope (<25yo) or exertional cp (25-50yo) – Exam: usually normal – Testing: • EKG: usually normal or Q-waves showing infarction – Tx: Immediate exclusion from ALL participation in competitive sports, may need surgical intervention +/- usual tx for MI.
- 31. Causes of SCD
- 32. Causes of SCD • Traumatic cause of sudden death via arrhythmia (usually v-fib) • Caused by blunt force trauma to chest occurring during the vulnerable repolarization period ( usually on the T-wave and can be the QRS period also) • Some evidence support cardiac injury, but the etiology and electrophysiology have yet to be completely defined Commotio Cordis
- 33. Causes of SCD Commotio Cordis • Most commonly seen in adolescent baseball players but also unprotected karate kicks to chest, ice hockey, etc. • Chest protectors and softer core baseballs decrease, but do not eliminate the risk
- 34. Causes of SCD
- 36. How common is SCD? Total Deaths per year from SCD in athletes? about 300
- 38. 36th Bethesda Conference Eligibility recommendations for Competitive Athletes With Cardiovascular Abnormalities
- 40. Future changes?
- 41. Questions?