{"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}
{"title":"The athlete’s heart in children and adolescents","authors":"G. Stuart, Guido E Pieles","doi":"10.1093/med/9780198779742.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0004","url":null,"abstract":"Athlete’s heart occurs in childhood but is less well understood than in adults. In children, exercise-related cardiac remodelling occurs but with more heterogeneity than in adults. It can be difficult to distinguish age-related cardiac maturation, exercise-related adaptation, and the early manifestation of cardiac disease such as cardiomyopathy. The initial assessment of a child with possible athlete’s heart includes a detailed history (medical, family, and exercise), comprehensive physical examination, ECG, and echocardiography. Congenital and structural heart disease should be excluded and the pubertal stage should be considered when interpreting findings. Investigations should be interpreted according to somatic size (using centiles) and pubertal stage rather than chronological age. Ethnic variations in physiology should be identified. If in doubt, child athletes with possible ethnically related changes should be followed up until maturity. T-wave inversion in anteroseptal leads is usually normal before puberty but abnormal after puberty. Lateral T-wave inversion is usually abnormal at any age. Voltage criteria for left ventricular hypertrophy are common in healthy child athletes. The presence of pathological Q waves, T-wave inversion, and ST-segment depression requires exclusion of cardiomyopathy. Most child athletes’ heart chamber size is within the normal reference ranges for age/gender, but hypertrophic cardiomyopathy should be considered in adolescent athletes with wall thickness >12mm (girls >11mm).","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":"129057498","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-excitation and conduction abnormalities","authors":"P. Delise","doi":"10.1093/med/9780198779742.003.0032","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0032","url":null,"abstract":"Ventricular pre-excitation (Wolff–Parkinson–White pattern) and conduction abnormalities may be discovered during cardiovascular pre-participation screening in athletes. Their prevalence varies between 0.1% (Wolff–Parkinson–White, left bundle branch block) and 1% (right bundle branch block).\u0000 Patients with pre-excitation and paroxysmal palpitations need to be treated before considering their eligibility to participate in sport. An electrophysiological study is required in asymptomatic athletes with the Wolff–Parkinson–White pattern. Subjects are considered ineligible for participation in sport if the RR intervals between pre-excited complexes during induced atrial fibrillation are <250ms.\u0000 Subjects with conduction abnormalities may or may not be affected by heart disease. In the absence of heart disease, athletes with first- or second-degree atrioventricular (AV) block which normalizes during effort are eligible to participate in sport. According to current Italian and US guidelines, athletes with right bundle branch block, left anterior hemiblock, left posterior hemiblock, and left bundle branch block can participate in all sports in the absence of heart disease (including genetic Lenègre disease) and no episodes of AV block.","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":"125298456","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":"Bicuspid aortic valve disease and competitive sports: key considerations and challenges","authors":"B. Wessler, N. Pandian","doi":"10.1093/med/9780198779742.003.0027","DOIUrl":"https://doi.org/10.1093/med/9780198779742.003.0027","url":null,"abstract":"Bicuspid aortic valve (BAV) is a common congenital disorder. It could simply be a minor anatomic abnormality or be associated with progressive aortic stenosis, aortic regurgitation, and aortic dilation. If an athlete is recognized to have a BAV, questions arise with regard to whether they can pursue their selected sports, particularly elite athletic activity, and what type of follow-up examinations are necessary and how often should be done. Valvular disorders such as the degree of aortic stenosis and aortic regurgitation, aortic size, and coexisting disorders are also influencing factors. The absence of robust controlled studies, which are difficult to perform, make decision-making difficult, although recommendations by expert panels provide some guidance. The general consensus is that athletes with BAV with normal valvular function and no aortic dilation can participate in all athletic activities. Those with mild aortic dilation should undergo annual screening, some more frequently than others. Those with moderate or severe valvular stenosis or regurgitation should be managed based on the haemodynamic impact of the valve lesion. Athletes with coexisting lesions or syndromes should be evaluated comprehensively. The overall recommendation to an individual athlete should incorporate many factors and employ a multidisciplinary approach.","PeriodicalId":143273,"journal":{"name":"The ESC Textbook of Sports Cardiology","volume":"29 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":"126089595","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 (aortic rupture): non-cardiac causes (asthma, extreme environmental conditions (heat, cold, altitude))—Part 2","authors":"E. Solberg, P. Adami","doi":"10.1093/MED/9780198779742.003.0037","DOIUrl":"https://doi.org/10.1093/MED/9780198779742.003.0037","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 is the second part of this topic and continues to describes these conditions their relation to SCA, and provides advice for prevention and action in actual cases.","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":"133170422","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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