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RISK FACTORS FOR SUDDEN DEATH

RISK FACTORS FOR SUDDEN DEATH. Exercise: How and When Does it Lead to Sudden Death? Prof. Massimo Santini. Exercise - Sport and Sudden Cardiac Death. Sport-related Sudden Cardiac Death.

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RISK FACTORS FOR SUDDEN DEATH

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  1. RISK FACTORS FOR SUDDEN DEATH Exercise: How and When Does it Lead to Sudden Death? Prof. Massimo Santini

  2. Exercise - Sport and Sudden Cardiac Death

  3. Sport-related Sudden Cardiac Death Sudden cardiac death during sport activity is an unexpexted death of cardiovascular etiology in which there is loss of consciousness within an hour of onset of symptoms. (80%) Trauma or thechnical accidents during sport activity are not inclusive of this definition.

  4. Sport-related SCDEpidemiology < 35 yrs 1:100.000 - 1:300.000 > 35 yrs 1:15.000 - 1:50.000 Risk in males >>> than in females 5 : 1

  5. Sudden Death During Different Types of Sport Maron BJ Circ 2009

  6. Bar chart showing the number of sudden deaths in athletes in relation to age in 118 deaths in sportsmen referred to a tertiary centre in the UK over a 12-year period.

  7. Hourly distribution of Sudden Cardiac Death N° of Athletes Time of Day Maron BJ JAMA 1996

  8. Couses of sudden cardiac death in 118 sports deaths referred to a tertiary cardiac centre in the UK over 12 years.

  9. Prof Henschen 1899 “ “The largest heart will win the race” But others were not so convinced!!!

  10. Sport-related SCD • 35 yrs • 1:15.000 - 1:50.000

  11. THE DOCTOR'S WORLD; JAMES FIXX: THE ENIGMA OF HEART DISEASEBest-selling book ''The Complete Book of Running'' Father died at 43 yrs. At 35 had Heart attact. Had been a smoker (40 die) heavy yung man(110 kg for years) All three coronary were damaged: Cx: 100% CDx: 80% DA: 50%. Ateriosc. Damage of aorta and Femoral.

  12. CV Abnormalities found at autopsy in athletes ≥35 yrs who died suddenly HCM MVP 80% Unexplained Coronary artery disease Aquired Valve Disease

  13. Flow response to Higher Myocardial Demand

  14. Placque rupture Enhanced cathecolamine- induced platelet aggregation Exercise induced coronary artery spasm Mechanism of Acute Coronary Events During Exercise

  15. Sport-related SCD < 35 yrs 1:100.000 - 1:300.000

  16. Causes of Sudden Cardiac DeathinYoung Athletes (<35 yrs)(n°158 athletes;1985-95) Maron BJ JAMA 1996

  17. (Corrado et al. NEJM 1998) Anomalous c.a. origin 12% ARVD 23% Premature CAD 18% Anomalous c.a. origin 19% ARVD 3% HCM 2% Atherosclerotic c.a. disease 2% HCM 36% (Maron et al. JAMA 1996)

  18. - 89%

  19. The Hank Gathers Case H.G. was a 23-year-old basketball star . His first symptom was a syncopal spell, which occurred during a game. He underwent to a cardiologic evaluation performed by a group of expert cardiologist and electrophysiologist. ECG Holter showed only VPB and an exercise test trhee-beat runs of VT. The coronaries were normal. At electrophysiologic study, polymorphic VT was induced with triple extrastimuli. A later Holter, acquired while he was playing very active, disclosed repetitive VT up to 21 beats in duration at 200 bpm.

  20. A divergence of opinion arose between the cardiologist and electrophysiologist as to wheter the patient should play basketball The electrophysiologist said that H.G. SHOULD NOT PLAY The family was hurt and angered at this recommendation

  21. Finally all agreed that a trial of high dosage propanolol (200mg/day) should be tried. Surprisingly, on basket Holters, this regimen suppressed the VT nearly completely.A series of Holter was done with different reduced dosage of the drug.Tha athlete cut back the dosage to 40 mg/day on his own and did not show up for his next basket ball Holter

  22. He died on march 4, 1990 during a game National television

  23. SCD in young athletes without structural cardiac abnormalities Canalopatie • Long QT syndrome • Short QT Syndrome • Catecholaminergic polymorphic ventricular tachycardia • Brugada Syndrome Patologia del Sistema di conduzione • WPW • Lown Gannon Levine Idiopatic ventricular fibrillation

  24. Exercise + + + Elect Instab Pathogenesis of Sudden Cardiac Death in Athletes Structure Function HCM ARVC CAA CAD Myocarditis ……. Transient ischemia Acidosis Hypoxemia Increased sympathetic drive B P V T V /F V

  25. Ventricular Fibrillation In 95% of cases

  26. Minimize the risk of athletic field deaths: the great challange of Sports Cardiology

  27. The secret of longevity: No Sport, just whisky and cigars

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