{"title":"Coronary angiography","authors":"S. Möhlenkamp","doi":"10.1093/med/9780198779742.003.0019","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0019","url":null,"abstract":"Invasive coronary angiography is used in symptomatic athletes with clinical suspicion of coronary artery disease which presumably requires interventional therapy, i.e. mainly in acute coronary syndrome and myocardial infarction. Because of its invasive nature, it is not used in asymptomatic athletes. Advanced intra-coronary artery imaging, including intra-vascular ultrasound (IVUS), intra-coronary Doppler ultrasound (ICDUS) and assessment of fractional flow reserve (FFR), can help to improve understanding of epicardial and intra-myocardial microvascular causes of symptoms. Plaque rupture, plaque erosion, coronary vasospasm, and thrombotic coronary occlusion have been demonstrated subsequent to athletic activities, but it is uncertain to what extent exhaustive exercise triggered the symptoms that led to invasive angiography. Because of radiation exposure, use of contrast agent, and the costs of the test careful risk–benefit assessment is necessary, especially in asymptomatic athletes with risk factors and in young athletes.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"51 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":"115986548","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":"Impact of sporting discipline, gender, ethnicity, and genetics on the athlete’s heart","authors":"N. Sheikh","doi":"10.1093/med/9780198779742.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0003","url":null,"abstract":"Participation in regular exercise is associated with several electrical and structural cardiac adaptations collectively termed the ‘athlete’s heart’. The nature and extent of these changes are influenced by several demographic factors, including the sporting discipline, gender, and ethnicity of the athlete. Knowledge of these influences is crucial for the correct interpretation of data from pre-participation cardiac evaluation of athletes and prevention of erroneous diagnoses. The greatest adaptations are usually observed in male athletes, those competing in endurance exercise, and those of African/Afro-Caribbean (black) ethnicity. In particular, much attention has recently been given to cardiac remodelling in black athletes, a significant proportion of whom exhibit profound electrical and structural cardiac changes in response to exercise. Data on the influence of genetic factors on the athlete’s heart are now emerging, which may aid our understanding of the complex mechanisms underlying this process and ultimately help differentiation of normal physiology from cardiac pathology.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"34 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":"114834474","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":"Class 1 anti-arrhythmic drug provocation test","authors":"M. Antz","doi":"10.1093/MED/9780198779742.003.0013","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0013","url":null,"abstract":"The Brugada syndrome is associated with potentially lethal arrhythmias and sudden cardiac death. The diagnosis is made from the surface ECG. In suspicious but not typical ECGs, intravenous administration of class 1 anti-arrhythmic drugs (i.e. sodium channel blocking agents such as ajmaline, flecainide, or procainamide) can be performed for diagnostic reasons.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"8 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":"114891818","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":"Structural and functional adaptations in the athlete’s heart","authors":"A. Pelliccia, S. Caselli","doi":"10.1093/MED/9780198779742.003.0002","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0002","url":null,"abstract":"Cardiac changes in athletes have been described for more than a century, with initial observations derived by chest percussion and chest X-rays. Recent advances in cardiovascular imaging have allowed morphological and functional assessment of cardiac remodelling associated with systematic training, and consequently over the last decades a vast literature has been assembled focused on the constellation of alterations known as ‘athlete’s heart’. This chapter provides means for understanding the determinants, extent, and upper limits of cardiovascular adaptation in athletes. A detailed overview of all cardiac chambers is provided to help the physician to recognize the physiological limits of cardiovascular remodelling.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"22 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":"124843177","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}
S. Mueller, F. Baldassarri, J. Schönfeld, M. Halle
{"title":"Monitoring exercise programmes and improving cardiovascular performance","authors":"S. Mueller, F. Baldassarri, J. Schönfeld, M. Halle","doi":"10.1093/MED/9780198779742.003.0043","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0043","url":null,"abstract":"Cardiovascular exercise performance is associated with lower morbidity and mortality. In addition to maximal load, heart rate, and peak oxygen consumption, cardiopulmonary exercise testing and lactate analyses can provide relevant information on cardiovascular performance, diagnosis, exercise prescription, and monitoring of exercise programmes based on submaximal parameters. Using submaximal thresholds has the advantage that the prescription and effect of exercise training are directly linked to the underlying energy metabolism and therefore can reveal the specific needs of the individual. There are several methods ofr strength testing that are all based on maximum parameters and should be chosen according to the best-fit principle to the underlying strength training programme. In addition, new media such as wearables, innovative gadgets and telemonitoring have become increasingly popular in recent years and can be used to monitor the exercise training sessions, providing information for evaluation and adjustment of training if necessary.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"141 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":"123672138","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":"Ventricular tachyarrhythmias","authors":"E. Guasch, L. Mont","doi":"10.1093/med/9780198779742.003.0030","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0030","url":null,"abstract":"The identification of ventricular arrhythmias in athletes should always be carefully considered because of the increased risk of SCD. The main factor determining this risk is the presence of an underlying structural or primary arrhythmic heart disease. Consequently, the identification of ventricular arrhythmias in an athlete should prompt exploratory testing, most commonly involving 24-hour Holter ECG, echocardiography, and an exercise test. Other tests should be considered on an individual basis. In general, the more frequent and complex the ventricular arrhythmias, the higher are the risks of a heart disease, and a more thorough examination is required. While most arrhythmias in athletes without heart disease are idiopathic ventricular arrhythmias, considerable attention has been paid recently to an exercise-induced substrate for ventricular arrhythmias, similar to classic forms of arrhythmogenic ventricular cardiomyopathy. Overall, the identification of a cardiac condition will determine the prognosis, therapeutic approach, and eligibility for competitive sport.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"21 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":"123476138","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":"Cardiovascular screening of adult/senior competitive athletes","authors":"L. Vanhees, M. Börjesson","doi":"10.1093/med/9780198779742.003.0039","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0039","url":null,"abstract":"Regular physical activity at moderate to intense intensity provides substantial health benefits. Therefore individuals should be encouraged to increase their level of physical activity. However, acute bouts of moderate to vigorous exercise may induce cardiovascular (CV) complications, such as malignant arrhythmias and sudden cardiac death/arrest (SCD/SCA), in adults and seniors, mainly due to known or occult cardiovascular disease. The rationale for cardiovascular evaluation and screening is to minimize these dangerous cardiac complications and to ensure safe participation in competitive or leisure-time sports. In individuals engaged in moderate to intense leisure-time physical activities or sporting activities, cardiovascular evaluation should be based on theidentification and severity of the underlying cardiovascular disease. The extent of the evaluation should depend on the intended level of physical activity, the habitual level of exercise and the individual risk profile. Several recommendations for screening, evaluation, and eligibility, given by international societies in Europe and the USA, are discussed. For adult/senior competitive athletes, screening should consist of, at least, personal and familial history (including symptoms), clinical examination, resting ECG, and graded maximal exercise testing, with the last of these mainly in subjects with increased CV risk. Depending on the underlying disease or risk, additional examinations may be required.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"13 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":"132547523","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":"Echocardiogram: morphological and functional evaluation including new echocardiographic techniques","authors":"S. Caselli, F. D’Ascenzi","doi":"10.1093/med/9780198779742.003.0015","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0015","url":null,"abstract":"Echocardiography is the most important imaging technique for the characterization of athlete’s heart as it allows evaluation of morphological and functional cardiac adaptations induced by exercise. It is usually performed when abnormalities are found on clinical examination and/or on resting or stress echocardiograms, and is particularly helpful for differential diagnosis of pathological conditions at risk for sudden cardiac death such as hypertrophic, dilated, arrhythmogenic, or non-compaction cardiomyopathies. This chapter reviews useful methods for performing a standard echocardiographic examination in competitive athletes and for correct interpretation of findings by discussing determinants and upper limits of cardiac adaptations, reference values, and specific clues for the differential diagnosis of pathological conditions.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"22 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":"130224736","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":"Physiology of exercise","authors":"A. D’Silva, Sanjay Sharma","doi":"10.1093/MED/9780198779742.003.0001","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0001","url":null,"abstract":"When we exercise we are accessing the same potential as the physical activity that our ancestors depended on for survival. Humans are adapted for high performance locomotor function, and exercise physiology studies the integration of neurological, respiratory, circulatory, endocrine, and metabolic systems coordinating a response to energy and oxygen demand. From rest to exercise cardiac output increases up to five- to sevenfold and pulmonary ventilation increases over 16-fold in order to enhance oxygen transport for unlocking energy in respiring muscle cells. Furthermore, a symphony of changes in cellular respiration, vascular resistance, and adrenergic stimulation is required to support the necessary transformation of chemical energy to kinetic energy for prolonged muscle activity. This chapter describes these processes in detail and relates physiological changes during exercise to the findings of the normal cardiopulmonary exercise test.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"3 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":"117215309","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":"Less frequent causes of SCD (commotio cordis): non-cardiac causes (drug abuse, hyperpyrexia, rhabdomyolysis, sickle cell anaemia)—Part 1","authors":"E. Solberg, P. Adami","doi":"10.1093/med/9780198779742.003.0036","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0036","url":null,"abstract":"It is important to be aware of the clinical features of less frequent causes of SCD in Europe (e.g. commotio cordis and aortic rupture) and non-cardiac causes (e.g. drug abuse, hyperpyrexia, rhabdomyolysis, sickle cell trait, asthma, and extreme environmental conditions). Lay people and health personnel may not understand the mechanisms leading to sudden cardiac arrest and therefore not act properly. This chapter describes these conditions and their relation to sudden cardiac arrest, and provides advice for prevention and action in actual cases.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"8 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":"115607141","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}
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