Lawless Sports Cardiology Essentials

Evaluation, Management and Case Studies
1. Auflage 2010
ISBN: 978-0-387-92775-6
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 411 Seiten

This book presents an invaluable symptoms-based approach to sports cardiology for sports medicine physicians, primary care physicians, and cardiologists. Edited by an authority in the field, the text offers sought-after insight on the cardiac health of athletes. Case studies are featured throughout to further understanding and the integration of concepts into daily practice. With contributions by both sports medicine physicians and cardiologists, this timely book bridges the gap between disciplines and is an unparalleled resource for those looking to effectively manage the cardiac health of active patients.

Christine E. Lawless, MD, MBA, FACC. Section Director of Preventive and Sports Cardiology, Associate Professor of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, Ohio State University Medical Center, Columbus, OH

Autoren/Hrsg.

Lawless, Christine E.

Inhaltsverzeichnis

1;Chapter 1: Sudden Cardiac Death in Athletes: Scope of the Problem and Emergency Response;13
1.1;Incidence;13
1.1.1;Introduction;13
1.1.2;Causes;14
1.1.3;Specific Causes;15
1.1.3.1;Hypertrophic Cardiomyopathy;15
1.1.3.2;Commotio Cordis;17
1.1.3.3;Coronary Arterial Abnormalities;17
1.1.3.4;Myocarditis;17
1.1.3.5;Marfan’s Syndrome;18
1.1.3.6;Long QT Syndrome and Wolff–Parkinson–White Syndrome;19
1.1.3.6.1;Long QT Syndrome;19
1.1.3.7;Arrhythmogenic Right Ventricular Dysplasia;21
1.1.4;Immediate Treatment;22
1.1.5;AED Utilization: NCAA Collegiate Experience;24
1.1.6;Case 1;26
1.2;Summary;27
1.3;References;29
2;Chapter 2: Cardiovascular Screening of Athletes: Focused Exam, Electrocardiograms, and Limited Echocardiograms;33
2.1;Introduction;33
2.2;Rationale for Pre-participation Cardiovascular Screening with and Without ECG;33
2.3;Appropriate Workup of Athletes with Past History of Heart Disease, Symptoms, Positive Family History, or Abnormal Physical Exam;35
2.3.1;Chest Pain;36
2.3.2;Dyspnea;36
2.3.3;Syncope, Near-Syncope, and Dizziness;36
2.3.4;Family History;37
2.3.4.1;Case Study of Positive Family History;37
2.4;ECG-Based Screening;39
2.5;Barriers to Routine ECG-Based Screening in the USA;42
2.5.1;Large Numbers of Athletes and Size of Appropriate Physician Workforce to Conduct the Screenings;42
2.5.2;Cost of Conducting Such Screening in Such a Large Number of Eligible Athletes;44
2.5.3;Mortality Rate from SCD in Athletes is Already Quite Low;45
2.5.4;Lack of a Randomized Trial Demonstrating Clear Superiority of the ECG-Based Screening over a Standardized PPE Without ECG;45
2.5.5;Lack of Standardization for Interpretation of ECGs in Athletes;45
2.5.6;Lack of Normative Data in Certain Demographic and Ethnic Groups;46
2.6;How to Implement ECG-Based Screening Programs;46
2.7;How to Interpret ECGs in Athletes;48
2.8;The Role of Echocardiography in Screening of Athletes;49
2.9;What Issues Still Need to be Addressed Before Wide-Spread Screening Can be Implemented in the USA;50
2.9.1;Efficacy of ECG Screening;50
2.10;Summary;51
2.11;References;51
3;Chapter 3: Echocardiography and Advanced Cardiac Imaging in Athletes;54
3.1;Case 1: Electrocardiographic Evidence of Left Ventricular Hypertrophy;54
3.1.1;Summary;57
3.2;Case 2: Exertional Myocardial Ischemia in the Young Athlete;58
3.2.1;Summary;60
3.3;Case 3: Arrhythmia and Right Ventricular Dilation;60
3.3.1;Summary;65
3.4;References;66
4;Chapter 4: Exercise Training and Prescription;71
4.1;Aerobic Power;71
4.2;Anaerobic Power and Capacity;73
4.3;Muscle Strength and Endurance;73
4.4;Prescribing Exercise;74
4.4.1;Specificity of Training;74
4.4.2;Progressive Overload;75
4.4.2.1;Intensity;75
4.4.3;Frequency and Duration;76
4.4.4;Resistance Training;77
4.5;Types of Training Programs;78
4.5.1;Interval Training;78
4.5.2;Fartlek;78
4.5.3;Tempos;79
4.6;The Patient-Athlete;79
4.7;Hypertrophic Cardiomyopathy;82
4.8;Mitral Valve Prolapse and Myocarditis;82
4.9;Valvular Heart Disease;82
4.10;Congenital Heart Disease;83
4.11;Cardiac Transplantation;84
4.12;Elderly;84
4.13;Case Presentation 1;87
4.13.1;Medical History;87
4.13.2;Examination;87
4.13.3;Testing;87
4.13.4;Diagnosis;87
4.13.5;Hospital Course;87
4.13.6;Post Discharge Plan;88
4.14;Case Presentation 2;88
4.14.1;Medical History;88
4.14.2;Examination;89
4.14.3;Testing;89
4.14.4;Diagnosis;90
4.14.5;Plan;90
4.15;Summary;91
4.16;References;91
5;Chapter 5: Role of Genetic Testing for Sudden Death Predisposing Heart Conditions in Athletes1;93
5.1;Introduction;93
5.2;Hypertrophic Cardiomyopathy Case Vignette;94
5.3;Summary of Cardiomyopathy Genetic Testing;94
5.3.1;Hypertrophic Cardiomyopathy;94
5.3.2;Arrhythmogenic Right Ventricular Cardiomyopathy;98
5.4;Long QT Syndrome Case Vignette;99
5.5;Summary of Channelopathy Genetic Testing;100
5.5.1;Long QT Syndrome;100
5.5.2;Catecholaminergic Polymorphic Ventricular Tachycardia;101
5.5.3;Brugada Syndrome;102
5.5.4;Short QT Syndrome;103
5.6;Indications for Genetic Testing in the Athlete;103
5.6.1;The “Borderline” Patient;103
5.6.2;“Gold Standard” Diagnostic Marker for the Asymptomatic Athlete Who Is Part of a Family with a Sudden Death Predisposing Heart C;104
5.7;References;106
6;Chapter 6: Shortness of Breath;110
6.1;Introduction;110
6.2;Common Causes of Shortness of Breath During Exercise;111
6.2.1;Case 1;111
6.2.2;Exercise-Induced Bronchospasm;111
6.2.3;Case 2;115
6.3;Vocal Cord Dysfunction;117
6.4;Gastroesophageal Reflux Disease;118
6.5;Less Common Causes of Dyspnea During Exercise;118
6.6;Conclusion;119
6.7;References;119
7;Chapter 7: Chest Pain in the Athlete: Differential Diagnosis, Evaluation, and Treatment;122
7.1;Cardiac Chest Pain;125
7.1.1;History;125
7.1.2;Physical Examination;125
7.1.3;Aortic Dissection;126
7.2;Noncardiac Causes of Chest Pain;126
7.2.1;Musculoskeletal Etiologies of Chest Pain;126
7.2.1.1;Chest Wall Pain;126
7.2.1.2;Traumatic Rib Fracture;127
7.2.1.3;Rib Stress Fractures;128
7.2.1.4;Sternoclavicular Injury;129
7.2.1.5;“Stitch”;130
7.2.1.6;Costochondritis;130
7.2.1.7;Tietze’s Syndrome;131
7.2.1.8;Slipping Rib Syndrome;131
7.2.1.9;Precordial Catch Syndrome;131
7.2.1.10;Cervical Disk Disease/“Cervical Angina”;131
7.2.2;Pulmonary Chest Pain;132
7.2.2.1;Asthma/Exercise-Induced Bronchospasm;132
7.2.2.2;Pneumothorax;133
7.2.2.3;Pulmonary Contusion;134
7.2.2.4;Pneumomediastinum;135
7.2.2.5;Pulmonary Embolus;135
7.2.2.6;Pneumonia;137
7.2.2.7;Pleurisy;137
7.2.2.8;Hyperventilation;139
7.2.3;Gastrointestinal Chest Pain;139
7.2.3.1;Gastroesophageal Reflux Disease;139
7.2.3.2;Dysphagia;140
7.2.4;Psychiatric Etiologies of Chest Pain;140
7.2.5;Substance Abuse;141
7.3;Conclusion;141
7.4;Clinical Cases;142
7.4.1;Case 1 (Fig. 7.4);142
7.4.2;Case 2 (Fig. 7.5);142
7.5;References;143
8;Chapter 8: The Collapsed Athlete;147
8.1;Approach to the Down Athlete;149
8.2;Cardiac Causes;149
8.3;Hyperthermia/Exertional Heat Stroke;151
8.3.1;Background;151
8.3.2;Diagnosis;152
8.3.3;Treatment;153
8.4;Hypothermia;155
8.4.1;Background;156
8.4.2;Diagnosis;157
8.4.3;Treatment;157
8.5;Exercise-Associated Hyponatremia;158
8.5.1;Background;158
8.5.2;Diagnosis;159
8.5.3;Treatment;160
8.6;Hypoglycemia;160
8.6.1;Background;160
8.6.2;Diagnosis;161
8.6.3;Treatment;161
8.7;Exercise-Associated Collapse;162
8.7.1;Background;162
8.7.2;Diagnosis;162
8.7.3;Treatment;163
8.8;Seizures;163
8.9;Trauma;164
8.10;Case #1;164
8.11;Summary;165
8.12;References;165
9;Chapter 9: Syncope/?Presyncope in the Competitive Athlete;168
9.1;Introduction;168
9.2;Definitions;169
9.2.1;Syncope/Presyncope;169
9.2.2;Competitive Athlete;169
9.2.3;Exercise-Related Syncope;170
9.3;Epidemiology;170
9.3.1;Pathophysiology of Exercise-Related Syncope;171
9.4;Differential Diagnosis;172
9.5;Neurally Mediated Causes;172
9.6;Cardiac Causes;173
9.7;Evaluation;173
9.7.1;Physical Examination;175
9.7.2;Echocardiography;178
9.7.3;Further Diagnostic Testing;178
9.7.4;Ambulatory Monitoring;179
9.7.5;Continuous-Loop Event Monitoring;179
9.7.6;Tilt Table;179
9.7.7;Electrophysiologic Studies;180
9.7.8;Management of Syncope;180
9.8;Return to Play;182
9.9;Conclusion;182
9.10;References;183
10;Chapter 10: Electrophysiological Approach to Syncope and Near-Syncope in the Athlete;185
10.1;Case;185
10.2;Introduction;185
10.3;Significance of Syncope and Near-Syncope in the Athlete;186
10.4;Epidemiology;188
10.5;Mechanisms and Causes of Syncope and Near-Syncopein the Athlete;189
10.6;Evaluation of the Athlete with Syncope and Near-Syncope;191
10.6.1;History;192
10.6.2;Physical Examination;193
10.6.3;Diagnostic Testing;193
10.6.3.1;Noninvasive Testing;193
10.6.3.1.1;Electrocardiography;193
10.6.3.1.2;Electrocardiographic Monitoring (Holter Monitor, Event Monitor, Implantable Loop Recorder);194
10.6.3.1.3;Echocardiogram;194
10.6.3.1.4;Tilt-Table Testing;195
10.6.3.1.5;Exercise Testing;196
10.6.3.1.6;Other Noninvasive Testing;196
10.6.3.2;Invasive Testing;197
10.6.3.2.1;Electrophysiology Testing;197
10.6.3.2.2;Cardiac Catheterization;198
10.6.3.2.3;Endomyocardial Biopsy;198
10.7;Management of Syncope in the Athlete;198
10.7.1;Treatment of Neurocardiogenic Syncope;199
10.7.2;Treatment of Arrhythmic Syncope;199
10.7.3;Implanted Devices in the Athlete;201
10.8;Athletic Restrictions;201
10.9;Illustrative Cases;202
10.9.1;Eighteen-Year-Old Female with Syncope;202
10.9.2;Nineteen-Year-Old Male Swimmer with Frequent Palpitationsand Near Syncope;203
10.9.3;Twenty-Year-Old Male with Syncope While Playing Basketball;204
10.9.4;Eighteen-Year-Old Male with Near Syncope and Palpitations During Basketball;204
10.9.5;Thirty-Seven-Year-Old Distance Runner with Episodesof Syncope at Rest After Exercise;206
10.9.6;Nine-Year-Old Female Who has Recurrent Collapse During Activity;207
10.9.7;Nineteen-Year-Old with Syncope During Football;207
10.9.8;Twenty-Year-Old Female with Syncope with Exertion;208
10.9.9;Forty-Year-Old Male Physician Who Has Syncope at RestWhile Examining Patients;209
10.9.10;Sixteen-Year-Old Female with Syncope;210
10.9.11;Thirty-Five-Year-Old Male with Near Syncope Playing Hockey;210
10.10;Conclusions;212
10.11;References;212
11;Chapter 11: Heart Murmurs;217
11.1;Introduction;217
11.2;Patient History;217
11.3;Physical Examination;219
11.4;Approach to Murmurs;223
11.5;Aids to Physical Examination;226
11.6;Training Tools;226
11.7;Diagnostic Evaluation;227
11.8;Management of Specific Valvular Conditions;228
11.9;Case 1;228
11.9.1;Patient History;228
11.9.2;Past Medical History;231
11.9.3;Physical Exam;233
11.9.4;Diagnostic Tests;234
11.9.5;Treatment;234
11.9.6;Outcome;234
11.9.7;Discussion;235
11.10;Case 2;236
11.10.1;Patient History;236
11.10.2;Past Medical History;236
11.10.3;Physical Examination;236
11.10.4;Diagnostic Tests;237
11.10.5;Treatment/Disposition;237
11.11;References;237
12;Chapter 12: Management of Hypertension in Athletes;239
12.1;Introduction;239
12.2;Classification of Blood Pressure;239
12.3;White Coat Hypertension;240
12.4;Secondary Hypertension in Athletes;240
12.5;Clinical Evaluation;241
12.6;Treatment of Hypertension in Athletes;243
12.7;Diuretics;244
12.8;Angiotensin-Converting Enzyme Inhibitors;247
12.9;Angiotensin Receptor Blockers;247
12.10;Beta-Adrenergic Blockers;247
12.11;Calcium Channel Blockers;248
12.12;Alpha Blockers;248
12.13;Alpha Agonists;248
12.14;Combination Therapy;249
12.15;Recommendations for Athletic Participation in Hypertensive Athletes;249
12.16;References;249
13;Chapter 13: Hypertrophic Cardiomyopathy;252
13.1;Case Vignette;252
13.2;Introduction;253
13.3;Definition and Etiology;254
13.4;Screening for Hypertrophic Cardiomyopathy;257
13.4.1;Screening for Families with Known HCM;257
13.4.2;General Pre-Participation Screening;257
13.5;Differentiating Hypertrophic Cardiomyopathy from Physiologic Hypertrophy;259
13.6;Clinical Features and Management of Hypertrophic Cardiomyopathy;260
13.6.1;Pathophysiology of HCM;260
13.6.2;Clinical Evaluation of Patients with HCM;261
13.6.3;Physical Examination in HCM;261
13.6.4;Electrocardiography;261
13.6.5;Echocardiography;262
13.6.6;Magnetic Resonance Imaging;263
13.6.7;Risk Stratification for Sudden Cardiac Death;263
13.7;Management of Patients with Hypertrophic Cardiomyopathy;266
13.7.1;Physical Exercise;266
13.7.2;Medical Therapy;268
13.7.3;Septal Reduction Therapy;268
13.8;Natural History of Hypertrophic Cardiomyopathy;269
13.9;References;269
14;Chapter 14: Commotio Cordis: Practical Aspects in Sports;272
14.1;Commotio Cordis-Clinical Characteristics;272
14.2;Experimental Models of Commotio Cordis;274
14.3;Commotio Cordis-Prevention;275
14.4;Commotio Cordis-Current Practical Management;277
14.5;Conclusion;278
14.6;References;278
15;Chapter 15: Coronary Artery Anomalies and Sports Activities;280
15.1;Introduction: Three Stories;280
15.1.1;Case 1: Sudden Cardiac Death in a Top High-School Athlete;280
15.1.2;Case 2: Sudden Crib Death in an Infant;281
15.1.3;Case 3: A Surprising Accidental Finding in an 83-Year-Old Woman;282
15.1.4;Comment;283
15.2;Coronary Artery Anomalies: A Brief Appraisal of a Complex Entity;284
15.3;Sports Activities and Coronary Anomalies;291
15.4;Screening, Diagnosis, and Counseling;293
15.5;Prevention and Treatment of Sudden Cardiac Death in Athletes;296
15.6;Conclusions;298
15.7;References;298
16;Chapter 16: Participation in Sports for the Athlete with the Marfan Syndrome;302
16.1;Introduction;302
16.2;The Evaluation;306
16.2.1;History;306
16.2.2;Examination;307
16.2.3;Diagnostic Testing;307
16.3;Treatment;308
16.3.1;Medical;308
16.3.2;Surgical;308
16.4;Recommendation for Athletic Participation;309
16.4.1;Types of Exercise;309
16.5;Case 1;311
16.5.1;Discussion;312
16.6;Case 2;312
16.6.1;Discussion;312
16.7;Conclusion;312
16.8;References;313
17;Chapter 17: Congenital Heart Disease: Exercise and Sports Participation;315
17.1;Introduction;315
17.2;Common Lesions in Adults with Congenital Heart Disease;316
17.2.1;Shunt Lesions;316
17.2.1.1;Atrial Septal Defect;316
17.2.1.2;Patent Foramen Ovale;317
17.2.1.3;Ventricular Septal Defect;317
17.2.1.4;Patent Ductus Arteriosus;317
17.2.1.5;Anomalous Venous Return;318
17.2.1.6;Eisenmenger’s Syndrome and Pulmonary Hypertension;318
17.2.2;Valvular Lesions;318
17.2.2.1;Bicuspid Aortic Valve;318
17.2.2.2;Aortic Stenosis;319
17.2.2.3;Aortic Insufficiency;319
17.2.2.4;Coarctation of the Aorta;320
17.2.2.5;Pulmonic Stenosis;320
17.2.2.6;Ebstein’s Anomaly;321
17.2.2.7;Complex Congenital Heart Lesions;321
17.2.2.8;Tetralogy of Fallot;321
17.2.2.9;Transposition of the Great Vessels;322
17.2.2.10;Single Ventricle Variants;322
17.2.2.11;Congenital Coronary Anomalies;323
17.2.3;Evaluation for Preparticipation Screening;323
17.2.3.1;History and Physical Examination;324
17.2.3.2;Electrocardiogram;325
17.2.3.3;Echocardiogram;325
17.2.3.4;Stress Testing;326
17.2.3.5;MRI/MRA and CT;326
17.2.3.6;Cardiac Catheterization;326
17.3;Recommendations;326
17.4;Cases;331
17.4.1;Case 1: Bicuspid Aortic Valve;331
17.4.2;Case 2;331
17.5;References;332
18;Chapter 18: Athlete with a Device: Implantable Cardioverter Defibrillators and Pacemakers;334
18.1;Postulated Risks of Sports;335
18.1.1;Triggering of Arrhythmia;335
18.1.2;Unknown Efficacy of the ICD During Sports;336
18.1.3;Nonarrhythmic Injury to the Athlete;337
18.1.4;Damage to the ICD System;337
18.2;Preliminary Safety and Efficacy Data: Survey Data;337
18.2.1;Current Recommendations by Physicians;337
18.2.2;Physician-Reported Sports Participation and Outcomes;338
18.3;Potential Safety-Related Precautions;342
18.4;Limitations to Survey Data;343
18.5;Ongoing Research;343
18.6;References;343
19;Chapter 19: Long QT Syndrome and Other Channelopathies;346
19.1;Introduction;346
19.2;Long QT Syndrome;347
19.2.1;Case Report #1;347
19.2.2;Case Report #2;348
19.2.3;Case Report #3;349
19.2.4;Case Report #4;352
19.3;Short QT Syndrome;354
19.4;Brugada Syndrome;355
19.4.1;Case Report #5;355
19.5;Catecholaminic Polymorphic Ventricular Tachycardia;359
19.6;Recommendations for Sport Participation in Patients with Channelopathies;360
19.7;References;366
20;Chapter 20: Cardiac Effects of Ergogenic Aides and Supplements;372
20.1;Introduction;372
20.2;Anabolic Androgenic Steroids;373
20.2.1;Atherogenic;374
20.2.2;Thrombogenic;375
20.2.3;Vasospasm;375
20.2.4;Direct Myocardial Effects;375
20.2.5;Are the Cardiac Effects of Anabolic Steroid Use Reversible?;375
20.2.6;Polysubstance Abuse;376
20.2.7;Dehydroepiandrosterone (DHEA);376
20.3;Peptide Hormones and Analogues;377
20.3.1;Human Growth Hormone (hGH);377
20.3.2;Mechanism of Action;378
20.3.3;Adverse Effects of GH Abuse;378
20.3.4;Specific Cardiovascular Concerns;378
20.3.5;Future Concerns;379
20.3.6;Erythropoietin (EPO);379
20.3.7;Stimulants;379
20.3.8;Amphetamines;380
20.3.9;Cocaine;380
20.3.10;Ephedra and Ephedrine;380
20.3.11;Cardiovascular and Systemic Side Effects;381
20.3.12;Ephedra/Ephedrine as a Controlled or Restricted Drug in Sport;381
20.4;Caffeine/Gaurana;382
20.4.1;Caffeine as a Controlled or Restricted Drug in Sport;383
20.4.2;Effects of Caffeine Intake in Children;383
20.4.3;Guarana;383
20.5;Conclusion;384
20.6;References;384
21;Chapter 21: Return-to-Play Decisions in Athletes with Cardiac Conditions: Guidelines and Considerations;387
21.1;Introduction;387
21.2;Guidelines for Sports Participation for Athletes with Known Cardiac Conditions;387
21.2.1;Recommendations for Young Patients with Genetic Cardiovascular Diseases;388
21.2.2;Recommendations for Masters Athletes;391
21.3;Return-to-Play: General Considerations;391
21.3.1;Implanted Defibrillators;391
21.3.2;Ablations;392
21.3.3;Beta Blockers;392
21.3.4;Corrective Cardiac Surgery;392
21.4;The Grey-Zone Athlete;393
21.4.1;Grey-Zone Athlete: Case Study;393
21.5;Specific Considerations for Conditions That Predispose to SCD Episodes;394
21.5.1;Cardiomyopathies and Inflammatory Diseases;394
21.5.2;Congenital Heart Disease;395
21.5.3;Aortic Reconstruction: Case Study;395
21.6;Rhythm Disturbances;396
21.6.1;Supraventricular Rhythm Disturbances;396
21.6.2;AV Nodal Reentrant Tachycardia;396
21.6.3;Wolff–Parkinson–White Syndrome;396
21.6.4;Ventricular Rhythm Disturbances;397
21.6.5;Nonsustained or Sustained Ventricular Tachycardia;397
21.6.6;Ventricular Fibrillation;397
21.7;Common Valvular Diseases;398
21.7.1;Bicuspid Aortic Valve;398
21.7.2;Aortic Stenosis;398
21.7.3;Aortic Insufficiency;398
21.7.4;Mitral Valve Prolapse;398
21.8;Summary;399
21.9;References;399
22;b978-0-387-78701_4;402