{"title":"The risk, aetiology, clinical features, management, and prevention of exercise-related sudden cardiac death and acute cardiac events in adult athletes","authors":"P. Thompson","doi":"10.1093/med/9780198779742.003.0035","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0035","url":null,"abstract":"Regular physical activity reduces atherosclerotic coronary artery disease (CAD) events including acute myocardial infarction (AMI) and sudden cardiac death (SCD). Conversely, vigorous exercise acutely and transiently increases the risk of both these CAD events in adult athletes with known or occult CAD. CAD is the cause of most exercise-related SCDs in adult athletes. Exercise-related AMIs are typically caused by atherosclerotic plaque rupture and acute thrombosis, whereas exercise-related SCD can be caused by both plaque rupture and exercise-induce ischaemia. The management of athletes with CAD requires aggressive risk factor reduction plus an assessment of risk for an acute cardiac event based on exercise testing, ventricular function measurement, and an assessment of electrical stability. Whether or not an athlete should return to competition after a CAD event is a joint decision made by the athlete and the clinician based on the risks and benefits of athletic participation for that athlete.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"26 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":"131904414","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":"Physical activity and leisure-time exercise prescription for sedentary/untrained individuals","authors":"M. Piepoli, M. Dellborg, M. Börjesson","doi":"10.1093/med/9780198779742.003.0042","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0042","url":null,"abstract":"Modern life is associated with limited physical demands. Societal change has made travel, work, and free time physically less demanding. Sedentary/untrained individuals are an increasing group in modern society, and they are also considered to be at higher risk of cardiovascular complications. Thus this group should benefit from an increased level of physical activity (PA) as both primaryand secondary prevention. Advice on lifestyle should include guidance on smoking, eating, and physical activity, each complementary and additive to the other. The prescription of exercise to sedentary individuals is recommended to all, but should include an individual risk–benefit analysis to achieve the maximum potential health benefits at the lowest possible risk. However, there are also some absolute contraindications for PA in sedentary individuals. The final prescription should be followed up, and it should include assessment of the PA level and/or fitness, and must be adjusted when indicated.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"130 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":"130533855","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":"Incidence of sudden cardiac death in athletes","authors":"J. Drezner, K. Harmon","doi":"10.1093/med/9780198779742.003.0033","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0033","url":null,"abstract":"Sudden cardiac death (SCD) is the leading cause of fatalities in competitive athletes during sports and exercise. These tragic events often receive intense public attention and stimulate debate regarding the most appropriate prevention strategies. A precise understanding of SCD incidence is needed to guide effective screening programmes and proper emergency preparations at athletic events. However, published estimates of SCD incidence vary widely, and are strongly influenced by the methodology used for case identification (numerator) and calculations of the population at risk (denominator). Studies searching only media reports or catastrophic insurance claims tend to underestimate SCD risk. Few studies with mandatory reporting of SCD are available, leaving significant knowledge gaps in our understanding of SCD in competitive athletes. In general, SCD is more common in males, black athletes, and male basketball players. This chapter reviews the incidence of SCD in athletes and examines differences based on gender, race, sport, and geographic region.","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":"130805173","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 children and adolescent athletes (<14 years)","authors":"M. Chessa, W. Budts, Javier Fernández Sarabia","doi":"10.1093/med/9780198779742.003.0040","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0040","url":null,"abstract":"Sport is not in itself the cause of enhanced mortality. During physical activity physiological changes, such as increased catecholamine levels, acidosis, and dehydration, can trigger cardiac arrest in those young athletes who are affected by underlying cardiovascular disorders. Because sports can prompt adverse events from underlying cardiac disease, pre-participation screening has been advised as strategy in the prevention of sudden cardiac death (SCD) in competitive athletes. SCD is rare in young healthy athletes, but remains a tragic and counter-intuitive event, subject to persistently high public visibility, triggering of emotion, and media attention, with potential legal liability considerations. Pre-participation screening in children and adolescent athletes can be done by an experienced specialist (paediatrician, family doctor, cardiologist, or sports medicine specialist); it includes family and personal history, physical examination (including blood pressure), and resting 12-lead ECG. All these issues are discussed in this chapter.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"53 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":"115149164","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":"Overlap ECG patterns in the athlete’s heart and cardiomyopathies","authors":"H. Dhutia, M. Papadakis","doi":"10.1093/MED/9780198779742.003.0009","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0009","url":null,"abstract":"Physiological adaptation to exercise manifests on the surface ECG with phenotypes that occasionally overlap with those present in patients with cardiomyopathy, one of the leading causes of exercise-related cardiac death in young athletes. In the era of pre-participation screening, differentiation of physiology from pathology is crucial given the potential consequences of an erroneous diagnosis or false reassurance. This chapter provides a comprehensive overview of the ECG anomalies that may cause diagnostic dilemmas in clinical practice, delineates the size of the ‘ECG grey zones’, and provides practical algorithms for ascertaining which ECG phenotypes require further evaluation.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"20 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":"115116137","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":"Electrophysiological study","authors":"M. Antz","doi":"10.1093/med/9780198779742.003.0014","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0014","url":null,"abstract":"An electrophysiological (EP) study is performed for diagnostic reasons, for risk assessment, and for therapy of arrhythmias. It can be useful in athletes with palpitations or documented arrhythmias of unclear origin, in non-sustained ventricular tachycardia, structural heart disease, or electrical abnormalities such as the Brugada syndrome, and for treatment of ectopic beats, supraventricular or ventricular tachycardia, and atrial fibrillation.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"6 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":"124503967","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":"Cardiac safety at fitness centres","authors":"E. Solberg, Jakob Johansson, A. Biffi","doi":"10.1093/MED/9780198779742.003.0046","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0046","url":null,"abstract":"Fitness centres are a major location for exercise. There is a lack of data on adverse cardiac events and the structure of cardiovascular safety at such centres. No European recommendation is available. However, sudden cardiac arrest at such centres has a documented higher survival rate. Potentials for prevention of cardiac events thus exist, although the standard of emergency equipment on site, regular training in basic life support for staff members, and emergency plans could be improved.","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":"129759266","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":"Cardiac safety at sports events: the medical action plan","authors":"L. Serratosa, E. Kramer, M. Börjesson","doi":"10.1093/MED/9780198779742.003.0045","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0045","url":null,"abstract":"The cardiac-specific medical services plan, in and around a sports stadium or arena, should be carefully undertaken and individualized, in order to ensure safe, effective, and coordinated management of any sudden cardiac arrest (SCA).\u0000 This is ensured practically by tailoring the designated number and skills of on-duty health-care personnel and by having adequate and appropriate medical equipment, effective communication systems, and the emergency medical service transportation logistics required to initiate cardiopulmonary resuscitation (CPR) and defibrillation within the first 3–5 minutes after SCA, regardless of the size or type of sport environment. The planning should be written down in a medical action plan (MAP) which should be communicated to all relevant and appropriate officials, health-care personnel, and, where relevant, participants and spectators. Relevant contact information regarding activation of the necessary emergency medical services, listing the sport environment health-care personnel, and continuous education and skills training are vital parts of the MAP.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"6 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":"126234772","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 causes of sudden death in athletes","authors":"C. Basso, S. Rizzo, G. Thiene","doi":"10.1093/MED/9780198779742.003.0034","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0034","url":null,"abstract":"Sudden cardiac death (SCD) is usually the result of an interaction between transient acute events (’triggers’) and either structural or non-structural cardiovascular substrates. The structural culprit resides in any of the cardiovascular components, i.e. aorta, coronary arteries, myocardium, valves, conduction system, or ion channels. Epidemiological studies have demonstrated that the occurrence of SCD in athletes is nearly three times than that in non-athletes, so that sport activity adds a significant risk if the athletes are affected by concealed cardiac diseases. Triggers of SCD in young competitive athletes include exercise-related sympathetic stimulation, abrupt haemodynamic changes, and myocardial ischaemia. In this chapter, we will review the various structural diseases, either congenital or acquired, which pose a risk of SCD in athletes. Disparities among published studies emphasizes the need for uniform reporting (source of data, retrospective versus prospective, autopsy versus no autopsy, etc). Identifying causes of SCD in the athletic population is important for guiding preventive measures.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"18 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":"123981785","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":"Mitral valve prolapse in relation to sport","authors":"C. Schmied, Sanjay Sharma","doi":"10.1093/med/9780198779742.003.0026","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0026","url":null,"abstract":"Depending on the definition of the disease and diagnostic criteria mitral valve prolapse (MVP) is one of the commonest structural abnormalities of the heart. The condition is characterized by myxoid degeneration of the mitral valve and appears to be more common in females. Trans-thoracic echocardiography is the primary diagnostic tool for diagnosing MVP and provides information about the structure and function of the valve, but also allows comprehensive evaluation of the subvalvular complex. Additional trans-oesophageal echocardiography and 3D echocardiography provide excellent further assessment of the mitral valve complex. The vast majority of patients have a relatively benign natural history. However, a small proportion may develop severe mitral regurgitation due to degenerative disease or chordal rupture, infective endocarditis, embolic cerebrovascular accident, supraventricular and ventricular arrhythmias, and sudden cardiac death. Athletic training has the potential for expediting the degenerative process and a propensity for arrhythmias or even sudden death.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"2 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":"131334586","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}