Pelliccia Sports Cardiology Casebook

1. Auflage 2009
ISBN: 978-1-84882-042-5
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 243 Seiten

Comparatively little is known about the risk of sudden death associated with exercise in young competitive athletes, and whether the benefits of sports activity outweigh the hazards of exercise-related fatal events is a clinical dilemma. This is only a small part of the story, however, as there are considerable effects of exercise whether it be at a competitive level or on a 'leisure' level on patients of all ages. This in itself is of massive importance to the cardiac patient population as exercise is a key component of effective recovery and recommended as central in the prevention of much cardiac disease.

Autoren/Hrsg.

Pelliccia, Antonio

Inhaltsverzeichnis

1;Sports Cardiology Casebook;2
2;Foreword;5
3;Contents;7
4;Contributors;10
5;Introduction;14
5.1;References;16
6;1 A 27-Year-Old Professional Cyclist with Palpitations on Effort;18
6.1; Family and Personal History;18
6.2; Physical Examination;18
6.2.1; 12-Lead ECG;18
6.3; Diagnostic Testing;19
6.4; Recommendations and Treatment;22
6.5; Clinical Course;22
6.6; Discussion;23
7;References;24
8;2 Impaired Performance in a Master Long-Distance Runner;26
8.1; History;26
8.1.1; Athletic History;26
8.2; Family History;26
8.3; Medication;26
8.4; Physical Examination;27
8.5; 12-Lead ECG;27
8.6; Maximal Exercise Test with Gas Analysis;27
8.7; Trans-Thoracic Echocardiography;28
8.8; Stress Echocardiography;30
8.9; Diagnosis and Recommendations;30
8.10; Discussion;30
9;References;31
10;3 A 26-Year-Old Cyclist with Syncope on Effort;32
10.1; Family and Personal History;32
10.2; Medical History;32
10.3; Physical Examination;32
10.4; 12-Lead ECG;32
10.5; Echocardiography;33
10.6; Exercise Electrocardiography;34
10.7; Clinical Course;34
10.8; Discussion;35
10.9; Recommendations for Sports Participation in Patients with ARVC;37
11;References;37
12;4 A 32-Year-Old Female Soccer Player with Unexplained Syncope;39
12.1; Previous Medical History;39
12.2; Physical Examination and Diagnostic Testing;39
12.3; Clinical Course;39
12.4; Family History;41
12.5; Type and Level of Sports Activity Performed;41
12.6; Physical Examination;41
12.7; 12-Lead ECG;41
12.8; Diagnostic Testing;42
12.8.1; ECG Holter-Monitoring (48h);42
12.8.2; Blood Pressure (BP)-Monitoring;43
12.8.3; Late Potentials (HV)-ECG;43
12.8.4; Exercise -- Testing;43
12.8.5; Echocardiography;44
12.8.6; Ajmalin -- Testing;44
12.8.7; Sleep Apnea Monitoring;45
12.8.8; Cardiac CT Scan;45
12.8.9; Cardiac Magnetic Resonance;45
12.8.10; Tilt Table Testing;45
12.8.11; Neurologist Consultation;46
12.8.12; Cerebral Doppler;47
12.8.13; Cerebral MRI;48
12.8.14; Ophthalmologist Examination;48
12.8.15; Laboratory Results;48
12.9; Final Diagnosis and Recommendations;48
12.10; Discussion;48
13;References;49
14;5 A 23-Year-Old Top-Level Soccer Player Suffering Syncope on Effort;50
14.1; Medical History;50
14.2; Physical Examination;50
14.3; 12-Lead ECG;50
14.4; Echocardiography;50
14.5; Exercise Electrocardiography;50
14.6; Holter Monitoring;51
14.7; Other Diagnostic Testing;52
14.8; Clinical Course;52
14.9; Other Diagnostic Testing;53
14.10; Treatment;53
14.11; Subsequent Clinical Course;53
14.12; Discussion;54
15;References;55
16;6 A 21-Year-Old Female Beach Volleyball Player with Palpitations and Pre-syncope on Effort;56
16.1; Medical History;56
16.2; Physical Examination;56
16.3; 12-Lead ECG;56
16.4; Diagnostic Testing;56
16.5; Clinical Course and Recommendations;57
16.6; Subsequent Follow-Up;58
16.7; Discussion;60
16.8; Summary of the Recommendations for Sports Participation in Athletes with AVNRT [ 3 , 5 ];60
17;References;61
18;7 A 49-Year-Old Male Marathon Runner with Exercise Induced Prolonged Palpitations;62
18.1; Family and Personal History;62
18.2; Medical History;62
18.3; 12-Lead ECG;62
18.4; Echocardiography;62
18.5; Exercise Electrocardiography;63
18.6; ECG Holter Monitoring;64
18.7; Diagnosis and Treatment;64
18.8; 2nd Cardiovascular Evaluation;65
18.8.1; Physical Examination;65
18.9; 12-Lead ECG;65
18.10; Other Testing;65
18.11; Treatment;65
18.12; Clinical Course;66
18.13; Discussion;67
18.14; Suggested Recommendations for Sports Participation in Adult and Senior Athletes with Atrial Fibrillation (AF);68
19;References;69
20;8 A Female Cyclist with Prolonged Palpitations on Effort;71
20.1; Medical History;71
20.2; Physical Examination;71
20.3; Electrocardiogram;71
20.4; Echocardiography;71
20.5; ECG Holter Monitoring;71
20.6; Electrophysiological Study;72
20.7; Second Clinical Evaluation;73
20.8; Diagnosis and Recommendation;73
20.9; Discussion;75
21;References;76
22;9 The Girl with Systolic Murmur on the Left Sternal Border;77
22.1; Family and Personal History;77
22.2; Physical Examination;77
22.3; 12-Lead ECG;77
22.4; Diagnostic Course;77
22.5; Cardiology Consultation;78
22.6; 12-Lead ECG;78
22.7; Echocardiography;78
22.8; Diagnosis;80
22.9; What is the Risk for Our Patient of Continuing her Sport?;80
22.10; Recommendations;80
22.11; Discussion;80
23;References;81
24;10 Elite Tennis Player with a Complete Atrio-Ventricular Block;82
24.1; Medical History;82
24.2; Physical Examination;82
24.3; 12-lead electrocardiogram;82
24.4; M-mode Echocardiogram;82
24.5; Electrophysiologic Study;83
24.6; Diagnosis and Recommendation;83
24.7; Clinical Course;84
24.8; 24-Hour ECG Monitoring;84
24.9; Exercise Testing;84
24.10; Clinical Outcome;84
24.11; Medical History;85
24.12; 12-Lead ECG;85
24.13; 24-Hour Holter ECG Monitoring;85
24.14; Doppler-Echocardiography;85
24.15; Discussion;86
25;References;88
26;11 A Young Canoeist with an Abnormal Electrocardiogram;89
26.1; Family and Personal History;89
26.2; Physical Examination;89
26.3; 12-Lead ECG;89
26.4; Echocardiography;89
26.5; Exercise Electrocardiography;90
26.6; ECG Holter Monitoring;90
26.7; Additional Diagnostic Testing;91
26.8; Clinical Course;92
26.9; Discussion;93
27;References;96
28;12 ECG Repolarization Abnormalities in an African Descent Athlete: Pathologic or Physiologic Finding?;97
28.1; Medical History;97
28.2; Physical Examination;97
28.3; 12-Lead ECG;97
28.4; Echocardiography;97
28.4.1; Cardiac Magnetic Resonance (CMR);99
28.5; Diagnosis and Recommendations;99
28.6; Discussion;100
29;References;102
30;13 A 16-Year-Old Female Runner with Prolonged QT Interval;104
30.1; Medical History;104
30.2; Physical Examination;104
30.3; 12-Lead ECG;104
30.4; Other Diagnostic Testing;104
30.5; Diagnosis and Recommendations;106
30.6; Discussion;107
30.7; Pitfalls in the Measurements of QT Interval in Athletes;107
30.8; Diagnosis of LQTS in Asymptomatic Athletes;108
30.9; Management;109
31;References;109
32;14 Athlete with Variable QTc Interval and Abnormal T Wave Pattern;111
32.1; Family and Personal History;111
32.2; Physical Examination;111
32.3; 12-Lead ECG;111
32.4; Echocardiography;111
32.5; Exercise Electrocardiography;112
32.6; ECG Holter Monitoring;113
32.7; Family Screening;114
32.8; Cardiac Magnetic Resonance;115
32.9; Diagnosis and Recommendations;115
32.10; Clinical Course;116
32.11; Genetic Analysis;117
32.12; Follow-Up;117
32.13; Discussion;117
33;References;119
34;15 Young Triathlete with Unusual ST-Segment Elevation in Precordial Leads;120
34.1; Family and Personal History;120
34.2; Physical Examination;120
34.3; 12-Lead ECG;120
34.4; Exercise Electrocardiography;121
34.5; Flecainide Testing;121
34.6; Echocardiography;122
34.7; Diagnosis;123
34.8; Discussion;123
34.9; Recommendations for Sports Participation in Brugada Patients;124
34.10; Early Repolarization Pattern in Athletes;125
35;References;126
36;16 A 17-Year-Old Competitive Soccer Player with Pre-excitation Pattern on 12-Lead ECG;127
36.1; Family and Personal History;127
36.2; Physical Examination;127
36.3; 12-Lead ECG;127
36.4; Diagnostic Course;127
36.5; Recommendations;128
36.6; Discussion;128
37;References;129
38;17 A Symptomatic Judoka with Wolff-Parkinson-White Pattern;131
38.1; Athletic History;131
38.2; Family History;131
38.3; Personal History;131
38.4; Physical Examination;131
38.5; 12-Lead ECG;131
38.6; Echocardiography;132
38.7; Electrophysiologic Study and Ablation Procedure;132
38.8; Clinical Course and Recommendations;133
38.9; Discussion;133
39;References;135
40;18 A 35-Year-Old Competitive Cyclist with Frequent Premature Ventricular Beats;136
40.1; Athletes History;136
40.2; Previous Diagnostic Testing;136
40.3; Medical History;136
40.4; Physical Examination;137
40.5; 12-Lead ECG;137
40.6; New Diagnostic Testing;137
40.7; Recommendations and Treatment;141
40.8; Clinical Course;141
40.9; Discussion;141
41;References;143
42;19 An Athlete with Ischemic Pattern on Exercise ECG;144
42.1; Family and Personal History;144
42.2; Physical Examination;144
42.3; 12-Lead ECG;144
42.4; Exercise Electrocardiography;144
42.5; Echocardiography;145
42.6; ECG Holter Monitoring;146
42.7; Other Tests;146
42.8; Ventriculo-Coronary Angiography;147
42.9; Cardiac Magnetic Resonance;147
42.10; Diagnosis and Recommendations;148
42.11; Discussion;148
43;References;149
44;20 A 17-Year-Old National Cyclist with Exercise-Induced Ventricular Tachycardia;150
44.1; Family and Personal History;150
44.2; Medical History;150
44.3; Physical Examination;150
44.4; 12-Lead ECG;151
44.5; Echocardiography;151
44.6; Blood Analysis;151
44.7; Exercise Test: Race Simulation;152
44.8; Holter ECG Monitoring During Bicycle Race;152
44.9; Recommendations;154
44.10; Additional Diagnostic Tests;154
44.11; Electrophysiologic Study;154
44.12; Subsequent Clinical Course;154
44.13; Continued Follow-Up;154
44.14; Final Recommendations;155
44.15; Discussion;155
45;References;156
46;21 A 53-Year-Old Recreational Jogger with Atrial Fibrillation;157
46.1; Family and Personal History;157
46.2; Physical Examination;157
46.3; 12-Lead ECG;157
46.4; Echocardiography;158
46.5; Diagnosis and Treatment;158
46.6; Clinical Course;158
46.7; Discussion;159
47;References;161
48;22 Paroxysmal Atrial Fibrillation in a Professional Cyclist;162
48.1; Family and Personal History;162
48.2; Athletic History;162
48.3; Physical Examination;162
48.4; 12-Lead ECG;162
48.5; Echocardiography;163
48.6; Maximal Exercise Testing with Gas Analysis;163
48.7; Follow-Up and Other Testing;164
48.8; Treatment and Recommendations;166
48.9; Subsequent Follow-Up;166
48.10; Discussion;166
49;References;167
50;23 A Female Soccer Player with Unusual Fatigability and Ventricular Arrhythmia;168
50.1; Medical History;168
50.2; Diagnostic Testing;168
50.3; Clinical Course;170
50.4; Recommendations and Treatment;170
50.5; Subsequent Clinical Course;170
50.6; Recommendations and Treatment;171
50.7; Discussion;171
51;References;172
52;24 A 38-Year-Old Marathon Runner with Tricuspid Valve Regurgitation;173
52.1; Personal Medical History;173
52.2; Family History;173
52.3; Type and Level of Sports Activity Performed;173
52.4; Physical Examination;173
52.5; Diagnostic Testing;174
52.5.1; 12-Lead ECG;174
52.5.2; Echocardiography;174
52.5.3; Treadmill - Exercise - Testing;175
52.5.4; Cardiac Magnetic Resonance (CMR);175
52.5.5; ECG Holter Monitoring;176
52.5.6; Laboratory Results;177
52.6; Diagnosis and Recommendations;177
52.7; Discussion;177
53;Reference;177
54;25 A Young Rower with an Unusual Left Ventricular Hypertrophy;178
54.1; Family and Personal History;178
54.2; Physical Examination;178
54.3; 12-Lead ECG;178
54.4; Echocardiography;178
54.5; Exercise Testing;179
54.6; Detraining;180
54.7; Clinical Course;181
54.8; Additional Diagnostic Testing;181
54.9; Diagnosis and Recommendations;182
54.10; Discussion;184
55;References;185
56;26 An Elite Athlete with Controversial Left Ventricular Hypertrophy;186
56.1; Medical History;186
56.2; Physical Examination;186
56.3; 12-Lead ECG;186
56.4; Echocardiography;186
56.5; Clinical Course;187
56.6; Diagnosis and Recommendations;190
56.7; Discussion;191
57;References;192
58;27 A Non-compaction Cardiomyopathy or Innocent LV Trabeculation?;194
58.1; Medical History;194
58.2; Family and Personal History;194
58.3; Physical Examination;194
58.4; 12-Lead ECG;194
58.5; Exercise Testing;195
58.6; 24-h ECG Holter Monitoring;195
58.7; Signal Averaging ECG;195
58.8; Echocardiography;196
58.9; Cardiac Magnetic Resonance (CMR);197
58.10; Diagnosis and Recommendations;197
58.11; Discussion;198
59;References;199
60;28 A 31-Year-Old Male, Recreational Soccer Player with 0Low Risk0 Hypertrophic Cardiomyopathy;202
60.1; Medical History;202
60.2; Physical Examination;202
60.3; 12-Lead ECG;202
60.4; Echocardiography;202
60.5; Exercise Testing;203
60.6; ECG Holter Monitoring;203
60.7; Diagnosis and Recommendations;203
60.8; Clinical Course;204
60.9; Autopsy Findings;204
60.10; Discussion;205
61;References;206
62;29 Competitive Cyclist Suffering from Myocardial Infarction, Willing to Resume Competitive Sport;207
62.1; Family and Personal History;207
62.2; Athletic History;207
62.3; Medical History;207
62.4; Reason for Cardiovascular Evaluation;209
62.5; Physical Examination;209
62.6; 12-Lead ECG;209
62.7; Evaluation and Risk Stratification;209
62.8; Diagnostic Testing;209
62.9; Recommendations;211
62.10; Discussion;211
63;References;212
64;30 A 32 Year-Old Male Soccer Player with Chest Trauma;213
64.1; Medical History;213
64.2; Physical Examination;213
64.3; 12-Lead ECG;213
64.4; Clinical Course;213
64.5; Cardiac Evaluation in the CCU;213
64.6; Additional Testing;215
64.7; Recommendations;215
64.8; Discussion;215
65;References;215
66;31 Asymptomatic Cyclist with Stenosis of Left Main Coronary Artery;217
66.1; Medical History;217
66.2; Physical Examination;217
66.3; 12-Lead ECG;217
66.4; Exercise Testing;217
66.5; Additional Testing;217
66.6; Diagnosis and Recommendations;218
66.7; Discussion;220
67;References;221
68;Appendices;222
69;Index;237