The ESC Textbook of Sports Cardiology最新文献

{"title":"The electrocardiogram in the athlete","authors":"Zorzi Alessandro, D. Corrado","doi":"10.1093/med/9780198779742.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0007","url":null,"abstract":"Interpretation of the athlete’s 12-lead electrocardiogram (ECG) should be based on specific criteria because changes that would be considered abnormal in the untrained population may develop in trained athletes as a physiological and benign consequence of the heart’s adaptation to exercise. ECG abnormalities in athletes are classified into two groups—‘common and training-related’ (Group 1) and ‘uncommon and training-unrelated’ (Group 2)—based on their prevalence, relation to exercise training, association with an increased risk of cardiovascular disease, and need for further investigations. The present chapter reviews the abnormalities that may be found in an athlete ECG and proposes criteria for interpretation of such changes as normal variants or abnormal findings that need further assessment to exclude an underlying cardiac disease.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115293637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition and ergogenic aids prescription for competitive athletes","authors":"R. Maughan, S. Shirreffs","doi":"10.1093/med/9780198779742.003.0048","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0048","url":null,"abstract":"Appropriate nutrition support can help sustain an athlete in consistent intensive training without succumbing to chronic fatigue, illness, and injury, and can also help to promote the adaptations in muscle and other tissues that occur in response to the training stimulus. Special strategies before and during competition can be employed to achieve short-term objectives. Energy intake, relative to energy expenditure, will influence body mass and can be modified to influence proportions of lean and fat mass. Carbohydrate and protein recommendations for athletes are extensively researched from a performance and body composition perspective and vary according to many factors, including the size of the athlete, the training load, and their training and competition aims. The available evidence favours a high carbohydrate diet for most athletes in training and prior to competition. Protein recommendations are typically about 2–2.5 times higher than for sedentary individuals: the need to distribute protein intake over the day may be as important as the total intake. Water and electrolyte losses can be significantly increased as a result of sweating, especially in prolonged exercise in hot and humid environments during exercise. Performance will be negatively affected if losses are high and are not replaced. Nutritional supplement use is widespread in the athletic population, although not all supplements are supported by evidence of efficacy or safety.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121013379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"World Anti-Doping Agency (WADA) and International Olympic Committee (IOC) list of prohibited substances and methods and their cardiovascular effects","authors":"J. Niebauer, C. Sundberg","doi":"10.1093/MED/9780198779742.003.0047","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0047","url":null,"abstract":"The abuse of doping substances is prevalent in sports and in society at large. Doping substances are also present in a substantial fraction of nutritional supplements. They can cause severe side effects. This chapter is focused on cardiovascular side effects. Androgenic anabolic steroids can induce left ventricular hypertrophy, heart fibrosis, and systolic and diastolic dysfunction, and has been associated with dyslipidaemia, endothelial dysfunction, and coronary artery disease. Beta-2 agonists can induce chronotropic and inotropic effects, QT prolongation, palpitations, arrhythmias and sudden cardiac death. Erythropoietin can induce hypertension and embolism. Use of banned substances and methods in sports, i.e. doping, is prohibited, unethical, and dangerous. Research efforts in sports sciences and sports medicine are needed to prevent and treat doping abuse and to help athletes be successful without the need for doping.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127389884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"History and physical examination","authors":"M. Schiavon, A. Zorzi, D. Corrado","doi":"10.1093/MED/9780198779742.003.0006","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0006","url":null,"abstract":"Personal and family history are invaluable components in pre-participation screening of athletes. Both the American Heart Association and the European Society of Cardiology recommend administering a questionnaire about family and personal history and performing a physical examination focused on the common signs of heart disease in the young. However, it should be kept in mind that the screening history questions that are currently recommended are based on expert opinion and enquire about common symptoms that are not specific to cardiac diseases. Moreover, many athletes show innocent cardiac murmurs which may trigger further unnecessary cardiovascular examination. Hence, the education and experience of screening physicians are critical for improving the effectiveness of history-taking and physical examination in pre-participation evaluation.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"265 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123105510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Channelopathy in athletes","authors":"N. Panhuyzen-Goedkoop, A. Wilde","doi":"10.1093/med/9780198779742.003.0029","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0029","url":null,"abstract":"Channelopathies are primary inherited electrical disorders (prevalence 2–4%). Long QT syndrome (LQTS), short QT syndrome (SQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and Brugada syndrome (BrS) predispose to life-threatening ventricular arrhythmia (VT/VF). Several triggers can provoke VT/VF, such as exercise (LQTS,CPVT), vagotonia (BrS), hyperthermia (LQTS and BrS), immersion in cold water (LQTS), or electrolyte/volume depletion.\u0000 It is a challenge for the screening physician to recognize the signature ECG changes of channelopathy at rest (LQTS, SQTS, BrS) or during exercise (CPVT) to identify the disease and assess the risk of VT/VF. Eligibility decision-making should involve cardiological expertise in channelopathy and determination of phenotypic and genotypic expression, and is not solely based on the assumption that channelopathies induce VT/VF.\u0000 This chapter discusses the clinical presentation, management, and risk assessment in athletes of the four major channelopathies (LQTS, SQTS, CPVT, and BrS).","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"159 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120942062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating athlete’s heart from left ventricular non-compaction cardiomyopathy","authors":"A. D’Silva, Sanjay Sharma","doi":"10.1093/MED/9780198779742.003.0024","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0024","url":null,"abstract":"Left ventricular non-compaction cardiomyopathy is a recently recognized heart muscle disorder, which remains incompletely understood. It was originally considered to be a congenital disorder resulting from disruption of the normal developmental process of myocardial compaction, but the evidence supporting this notion is lacking. Some experts have suggested that the entity is not a distinct cardiomyopathy but a morphological trait shared by many phenotypically distinct cardiomyopathies. Others have shown that left ventricular non-compaction may be acquired by cardiac remodelling. Gold standard diagnostic criteria are currently lacking and proposed imaging-based criteria have created an epidemic of over-diagnosis in low risk populations. Athletes suffer significant false-positive rates, and current evidence suggests that this entity may be related to cardiovascular adaptation to increased preload. This chapter describes the contemporary knowledge and current controversies regarding left ventricular non-compaction cardiomyopathy and how this can be differentiated from athlete’s heart.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115194415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Common ECG patterns in the athlete’s heart","authors":"R. Stein, V. Froelicher","doi":"10.1093/med/9780198779742.003.0008","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0008","url":null,"abstract":"Chronic exercise can lead to phenotypic changes in athletes that are directly related to the type, duration, intensity, and years of sport training. The clinical expression can be influenced by the individual’s genetic, gender, humoral, and metabolic factors. Alterations founded in the athlete’s electrocardiogram (ECG) have been considered to be an electrical expression of these adaptations and usually reflect benign remodelling of the heart (athlete’s heart) and autonomic adaptations. In this chapter, we discuss the most prevalent normal features found on the 12-lead ECG of athletes.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123131306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The athlete with congenital heart disease","authors":"Guido E Pieles, G. Stuart","doi":"10.1093/med/9780198779742.003.0028","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0028","url":null,"abstract":"An increasing number of patients with congenital heart disease (CHD) are participating in regular sport at levels ranging from gentle recreational activities to elite professional sport. In general, children and adults with CHD should be encouraged to engage in regular physical activity, but long-term complications, such as heart failure, arrhythmias, and the need for re-operation, can occur. The sports cardiologist must be alert to the presence of underlying CHD, as physiology, haemodynamics, and functional status can change with time even after correction or palliation and intervention may be necessary before the onset of major symptoms. Although consensus management guidelines for adults with CHD are available, there is very little lesion-specific advice on sports and exercise. The wide range of diagnoses and pathophysiology make regular and individualized assessment essential. Assessment tools include ECG, echocardiogram, and CMR, but regular comprehensive functional exercise assessment is recommended. Care of the athlete with CHD should be coordinated in close collaboration with congenital heart specialists.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126271918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Criteria and considerations relative to safe participation in sport for athletes with cardiac abnormalities","authors":"A. Pelliccia, H. Heidbuchel, D. Corrado, Sanjay Sharma, M. Börjesson","doi":"10.1093/MED/9780198779742.003.0041","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0041","url":null,"abstract":"This chapter describes the criteria for advising safe participation in competitive sport in individuals with underlying (or even silent) cardiovascular (CV) diseases. The rationale for advising sport participation in patients with CV diseases is based on the broad clinical perception, substantiated by scientific evidence, that such individuals are exposed to an increased risk of sudden cardiac death/cardiac arrest (SCD/CA), or progression of the underlying disease, in association with intensive exercise training and sport participation. However, modification of the type/intensity of sport, or abstinence from competition in selected cases, may reduce the risk. Competitive athletes, especially professionals, with clinically silent CV abnormalities are usually driven by the will to accept possible future risks, but achieve the immediate benefits associated with a lucrative athletic career including (but not limited to) the economic, societal, and visibility correlates. In this context, the role of the physician is to identify the pathological cardiac condition and approriately advise the athlete regarding the benefits and risk associated with participation in sport. This chapter suggests the approach that the physician can adopt, based on the best scientific knowledge of the CV disease and keeping in mind the primary aim of safeguarding the athlete’s health. The present recommendations are the framework for a protocol of evaluation and management of athletes with CV disease, based on the available scientific evidence and expert opinion. Currently, in the absence of robust evidence, these recommendations cannot be considered as legally binding. Therefore, individual physicians may also practise outside the remit of these recommendations, based on their scientific and professional experience in sports cardiology. Implementation of these recommendations may achieve a relevant medical approach to safeguarding the health of athletes, and provide a uniform method of managing elite and professional athletes as they compete globally.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123802704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-participation screening of young competitive athletes","authors":"D. Corrado, A. Zorzi","doi":"10.1093/MED/9780198779742.003.0038","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0038","url":null,"abstract":"Sudden cardiac arrest is most often the first clinical manifestation of an underlying cardiovascular disease and usually occurs in previously asymptomatic athletes. The risk–benefit ratio of physical exercise differs between young competitive athletes and middle-aged/senior individuals engaged in leisure-time sports activity. Competitive sports are associated with an increased risk of sudden cardiovascular death in susceptible adolescents and young adults with underlying cardiovascular disorders. In middle-aged/older individuals, physical activity can be regarded as a ‘two-edged sword’: vigorous exertion increases the incidence of acute coronary events in those who do not exercise regularly, whereas habitual physical activity reduces the overall risk of myocardial infarction and sudden cardiac death. Although cardiovascular pre-participation evaluation offers the potential to identify athletes with life-threatening cardiovascular abnormalities before the onset of symptoms and may reduce their risk of sudden death, there is a significant debate among cardiologists about its efficacy, the impact of false-positive results, and the cost-effectiveness of routine screening. This chapter presents an appraisal of the available data and criticisms concerning screening programmes aimed at preventing sudden death of either young competitive athletes or older individuals engaged in leisure-time sports activity.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130707061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}