Sports cardiology talk slideshare export

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SPORTS CARDIOLOGY
John Vyselaar, MD, FRCPC
Consultant Cardiologist:
• Vancouver Whitecaps FC
• BC Lions Football Club
• Va...

Disclosures
• Speaker honoraria: Bayer, Servier, Novartis, Boehrigher-Ingleheim,
Amgen, BMS/Pfizer, more…
• Advisory board...

Objectives
• Define sports
cardiology
• Review screening of
athletes for
cardiovascular illness
• Review common sports
car...

What is sports cardiology?
Aren’t athletes healthy?

Sports Cardiology
• A discipline within cardiology that deals with the interaction between the
heart and cardiovascular sy...

Sports Cardiology
• Who doesn’t like sports – at least somehow?
• Childhood memories
• Recreational sports – team building...

Sports Cardiology
• Two main goals
• Ensuring safety during exercise by screening for
conditions that predispose to sudden...

Screening Athletes to Prevent Sudden
Cardiac Death
What can we do?
Does it work?

Who is an athlete?
• Pros
• Joes
• Youth
• Collegiate
• Masters athlete
• Weekend warriors
• Team play or solo
• Hiking? D...

Occupational Athlete
• Physical skills / fitness are an important
component of their job / occupation
• Military
• Firefig...

Who do you screen?
• Everyone who is active?
• Beyond a set limit of activity?
• Certain ages? Certain activities?
• No ri...

What are you screening for?
• Athletes under age 35
• Variety of weird and unusual disorders
• Athletes over age 35
• Coro...

Navin Chandra et al. JACC 2013;61:1027-1040
American College of Cardiology Foundation

Harmon et al, Circulation. 2015 Jul 7; 132(1):
10–19.
Causes of Death in
NCAA Athletes 2003 –
2013

Harmon et al, Circulation. 2015 Jul 7; 132(1):
10–19.
Causes of Sudden
Cardiac Death in NCAA
Athletes 2003 – 2013

Sumeet S. Chugh, and Joseph B. Weiss JACC 2015;65:493-
502
American College of Cardiology Foundation

Sumeet S. Chugh, and Joseph B. Weiss JACC 2015;65:493-502 American College of Cardiology Foundation

Scope of the problem
• SCA during exercise is relatively rare but devastating when it occurs
• Patient
• Family
• Communit...

Rates of sudden cardiac arrest
• Studies consistently yield an incidence of SCD of:
• 1:50,000 per athlete year in college...

Screening for Causes of SCD?
• These are devastating events, but relatively uncommon
• Therefore, any screening tests have...

Adaptation to Exercise
• Confounds the screening assessment
• Many EKG (or imaging) findings that are abnormal in untraine...

What is Normal?
• Requires ongoing study, registries and data collection to determine
normal variants vs pathology
• Big t...

EKG Standards
• Have been refined multiple times, in an attempt to reduce false positives
• Currently we use the Internati...

International consensus standards for ECG interpretation in athletes.
Jonathan A Drezner et al. Br J Sports Med
doi:10.113...

ECG of a 29-year-old male asymptomatic soccer player showing sinus bradycardia (44 bpm),
early repolarisation in I, II, aV...

ECG from a patient with HCM demonstrating QRS voltage criteria for LVH in association with
deep TWI and ST segment depress...

ECG from a black athlete demonstrating voltage criteria for LVH, J-point elevation and convex
(‘domed’) ST segment elevati...

(A) ECG from an 18-year-old black basketball player demonstrating abnormal TWI extending into
V5.
Jonathan A Drezner et al...

Presence of Abnormalities on Resting EKG
Disease Frequency of Abnormalities
HCM High
ARVC Moderate
Dilated CM Moderate (LB...

Examples of Adaptations to Exercise
• Structural
• Increased left ventricular wall thickness (12-15 mm); overlaps with mil...

Coronary Artery Anomalies: a
Pictorial Review (PDF
Download Available). Available
from:
https://www.researchgate.net
/publ...

Coronary Artery Anomalies: a Pictorial Review (PDF Download Available). Available from:
https://www.researchgate.net/publi...

Does screening work?
• Hard to show a reduction in rare events

Domenico Corrado et al. JACC 2008;52:1981-1989
American College of Cardiology Foundation

Domenico Corrado et al. JACC 2008;52:1981-1989
American College of Cardiology Foundation

Carl J. Lavie, and Kimberly G. Harmon JACC 2016;68:712-714
American College of Cardiology Foundation

Screening in older athletes >35 years old
• No good data
• Basically, screening for coronary artery disease
• How to do th...

Screening – Conclusions
• Most protocols involve history and physical exam, +/- an EKG
• Some argue, just do the EKG – bet...

Investigating Symptoms During
Exercise

Symptoms
• The OTHER part of sports cardiology
• Anything from decreased performance, to palpitations or chest pain or
oth...

Answer
• FALSE
• Sporting activities vary tremendously in terms of aerobic intensity,
isometric activity, and continuous a...

Jere H. Mitchell et al. JACC 2005;45:1364-1367
American College of Cardiology Foundation

What to do?
• “Go to where the athlete is”
• Be creative
• Adjust stress protocols to reproduce activity
• Ramp – continuo...

Common Symptoms in Athletes
• “Getting winded too early”
• Broad differential: deconditioning, exercise-induced
asthma, an...

North Shore Sports
Cardiology
• Expanding further this fall
• Team of
• Myself
• Sam Doe
• Lana Galac
• Nancy Lord
• Jen P...

North Shore Sports
Cardiology
• Goal is to improve and augment existing sports cardiology interest and
make it more access...

North Shore Sports
Cardiology
• Other groups we work with
• American College of Cardiology, Sports and Exercise Section
• ...

Five Pillars
• Consultation services
• EKG screening programs
• High school, collegiate, masters
athletes
• Incorporating ...

SITE DEFIBRILLATOR? STAFF TRAINING WITH DEFIBRILLATOR STAFF TRAINING WITH CPR?
All North Vancouver Recreation Centres –
13...

North Shore Sports
Cardiology
• Part of our goal to be a centre of excellence at NSHC
• Cardiologists, nurse practitioner,...

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