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Athletes heart

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athlets heart

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Athletes heart

  1. 1. K SRINIVAS ATHLETE’S HEART
  2. 2. HISTORY  Heneschen(1890) used physical examination to determine increased cardiac dimensions in elite nordic skiers.  Eugene darling in the same year in rowers of harvard university. 2/1/2015 2ATHLETE'S HEART
  3. 3.  Paul dudely white(1900) studied radial pulse rate among boston marathon competitors and was the first to report marked resting sinus bradycardia in long distance runners. 2/1/2015 3ATHLETE'S HEART
  4. 4.  Earlier it was thought to be beneficial adaptations to exercise.  But later it was postulated as a form of overuse pathology and prolonged participation in sport can lead to premature cardiovascular system collapse. 2/1/2015 4ATHLETE'S HEART
  5. 5.  Athlete’sheart syndrome , a term often applied to athletic patient who present with subjective symptoms or abnormal CVS findings. 2/1/2015 5ATHLETE'S HEART
  6. 6.  Aerobic /endurance exercises execises requiring primarily an increase in o2 transpot. 2/1/2015 6ATHLETE'S HEART
  7. 7.  Resting /strength exercises exercises primarily stressing the skeletal muscle. 2/1/2015 7ATHLETE'S HEART
  8. 8. PHYSIOLOGY  Physical activity acutely increases o2 demand which increases cardiac output (Q) and arteriovenous difference (A- V)O2.  1 lit of oxygen consumption (VO2) produces 5-6 lit increase in Q. 2/1/2015 8ATHLETE'S HEART
  9. 9.  The CV response to exercise has both external and internal work rate,  External work rate isVO2 required for exercise task and is direct determination of Q.  Internal work rate is MO2 required for exercise task and is direct determinant of HR 2/1/2015 9ATHLETE'S HEART
  10. 10. 2/1/2015ATHLETE'S HEART 10 Repetitive excercises to increase exercise capacity IncreasesVO2 Increased Q(HR and SV) Increased stroke volume
  11. 11.  The increase in SV means that performing the same exercise task which requires the sameVO2 can be performed at a slower HR and a lower MO2 or internal work rate. 2/1/2015ATHLETE'S HEART 11
  12. 12.  The physiologic mediators of these CV adaptations may be produced by increased resting vagal tone and reduced resting sympathetic tone resulting in resting sinus bradycardia 2/1/2015ATHLETE'S HEART 12
  13. 13. LEFT VENTRICLE  Studies revealed LV hypertrophy and dilation.  Pellica.et.al showed increased LV end diastolic diameter and small percentage had LV wall thickness more than 13mm. 2/1/2015ATHLETE'S HEART 13
  14. 14. MORGANROTH HYPOTHESIS  Morganroth.et.el studies demonstrated concentric LV hypertrophy in strength training and eccentic LV hypertrophy in aerobic training. 2/1/2015ATHLETE'S HEART 14
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  18. 18. Figure 3. Impact of different clinical variables on LV end-diastolic cavity dimensions in a large population of male and female elite athletes. Maron B J , and Pelliccia A Circulation. 2006;114:1633- 1644 Copyright © American Heart Association, Inc. All rights reserved.2/1/2015 18ATHLETE'S HEART
  19. 19.  On LV systolic function demonstrated preserved LV ejection fraction except for one study  On LV diastolic function improved LV diastolic function is essential mechanism in preserving stroke volume 2/1/2015ATHLETE'S HEART 19
  20. 20. RIGHT VENTRICLE  Cardiac remodelling is not confined to LV  Scharhag et al study demonstrated RV enlargement parallels LV enlargement supporting the concept of biventricular enlargement. 2/1/2015ATHLETE'S HEART 20
  21. 21. AORTA  Experiences a significant hemodynamic load during exercise.  Aerobic exercise- high volume aortic flow with modest systemic hypertension  Strength exercises-normal volume with profound systemic hypertension. 2/1/2015ATHLETE'S HEART 21
  22. 22.  Babee et al studies revealed increased aortic dimensions in strength exercise training.  Pellica et al studies revealed incresed aortic dimensions in aerobic training exercises. 2/1/2015ATHLETE'S HEART 22
  23. 23. LEFT ATRIUM  Studies confirmed high prevalnce of left atrial enlargement in athletes  SEX AND RACE 2/1/2015ATHLETE'S HEART 23
  24. 24. PATHOLOGY VS PHYSIOLOGICAL ADAPTATION 2/1/2015ATHLETE'S HEART 24
  25. 25. A, An electrocardiogram of a 46-year-old male triathlete who presented after long-standing palpitations and a recent episode of syncope. Baggish A L , and Wood M J Circulation. 2011;123:2723- 2735 Copyright © American Heart Association, Inc. All rights reserved.2/1/2015 25ATHLETE'S HEART
  26. 26. ARRHYTHMIAS Brady arrhythmias such as  Sinus bradycardia  Junctional bradycardia  AV block  The reduced AV conduction velocity may take accessory pathway such as WPW syndrome. 2/1/2015ATHLETE'S HEART 26
  27. 27.  Increased vagal tone may be responsible for early repolarisation and ST abnormalities. 2/1/2015ATHLETE'S HEART 27
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  29. 29. VALVE DISEASE IN ATHLETS AORTIC STENOSIS  Careful evaluation of symptoms and maximal exercise testing  Warm up dyspnea indicates clinically important AS 2/1/2015ATHLETE'S HEART 29
  30. 30. AORTIC REGURGITATION  Generally tolerate AR,because of increased HR during exercise, decreases diastole and regurgitant.  Rarely restrict the patients with AR unless there is ventricular deterioration. 2/1/2015ATHLETE'S HEART 30
  31. 31. AORTIC DISSECTION IN BAV  We do not restrict the patient unless the patient aortic root dimensions are more than 45 mm  Annual screening. 2/1/2015ATHLETE'S HEART 31
  32. 32. SYNCOPE  Majority of syncope in athlete’s is attributed to neurocardiogenic syncope.  Manifests in the immediate post exercise testing owing to sudden reduction in venous return, which facilitates transient cerebral hypoperfusion. 2/1/2015ATHLETE'S HEART 32
  33. 33.  Syncope during exercise, there is a possibility of malignant arrhythmias, valvular heart disease and myocardial ischemia. 2/1/2015ATHLETE'S HEART 33
  34. 34. DECREASED EXERCISE CAPACITY  Hyperthyroididm  Exercise induced asthma  Disease of the skeletal muscles  Anemia  AF  Viral illness 2/1/2015ATHLETE'S HEART 34
  35. 35. ELEVATED CARDIAC ENZYMES  Increase in cTnT occurs in athletes following prolonged exertion.  Endurance athletes were documented to have increased concentrations of CK-MB and satellite cells in their leg muscles. 2/1/2015ATHLETE'S HEART 35
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