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Cardiac Pathology in Athletes

Cardiac Pathology in Athletes. Sudden Death. About 25 young patients die each year nationally in sudden-initially unexplained deaths on the field in all sports ~ usually heart related. Usually hypertropic cardiomyopathy or congenital abnormalities 10:1 ratio male to female

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Cardiac Pathology in Athletes

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  1. Cardiac Pathology in Athletes

  2. Sudden Death • About 25 young patients die each year nationally in sudden-initially unexplained deaths on the field in all sports ~ usually heart related. • Usually hypertropic cardiomyopathy or congenital abnormalities • 10:1 ratio male to female • Football & Basketball see the highest incidents.

  3. Definition • Sudden Death: • 90% collapse during or after activity • 62% High School Age

  4. Heart Anatomy Review

  5. Causes of Sudden Death • Hypertrophic Cardiomyopathy (HCM) • Aortic Stenosis • Congenital Coronary Artery Anomalies • Marfan Syndrome • Mitral Valve Prolapse

  6. Hypertrophic Cardiomyopathy • Definition • Can occur c or s obstruction • What happens then?

  7. Hypertrophic Cardiomyopathy cont. • Clinical Presentation: • History • Physical Exam • The first clinical presentation of this condition may be sudden cardiac death!

  8. Hypertrophic Cardiomyopathy cont. • Diagnostic tests: • Bethesda Guidelines – HCM • Patients with unequivocal diagnosis of HCM should not participate in most competitive sports with possible exception of low intensity sports (i.e. BOWLING)

  9. Coronary Artery Abnormalities • Presentation: • The 1st clinical presentation of this condition may sudden cardiac death! • Diagnostic Tests:

  10. Marfan Syndrome • 5% of death due to rupture of aortic valve • Abe Lincoln • Clinical physical signs: • Bethesda Guidelines – Marfan’s • Patients s a family hx of sudden death & s aortic root dilitation ca participate in low & moderate intensity sports

  11. Rare causes of Sudden Death • Long QT Syndrome: electrical abnormality • Bethesda Guideline: QT • Restrict from ALL competitive sports

  12. Mitral Valve Prolapse • Two flapped valve between LA and LV balloons back into the LA with each HB.

  13. YOU NEED A CARDIAC EVALUATION! When do you need to refer a patient

  14. Referrals/Common Cardiac S/S • Syncope • Chest pain • Decreased exercise tolerance • Tachycardia or palpitations c exercise • New or loud murmur • Hypertension • Finding of Marfan syndrome • Family Hx

  15. Referrals/Common Cardiac S/S • Dyspnea • Fatigue • Claudication • Skin Color, Temp and Aprearance • Generalized Edema

  16. Cardiac Examination • Inspection: • Palpation: • Blood Pressure: • Pulse: • Auscultations:

  17. Auscultations • A: (UR) • P: (UL) • T: (LL) • M: (Apex)

  18. Diagnostic Testing • EKG • CXR • ECHO • Stress ECHO • Transesophageal ECHO • Thallium Scan • Cardiac Catheter

  19. You need a cardiac Work-Up if: • Pathological Murmur during Diastole • If S1 or S2 not heard clearly • Murmur in UL or UR (pulmonary/aortic) • Any murmur > II • Scale: I= only cardiologist will hear II= Softest of Softest III= Soft IV= Stethoscope flat V= Stethoscope tilted VI= Stethoscope nearly touching

  20. Commotio Cordis • Blunt chest trauma resulting in severe cardiac contusion • Immediate LOC, hypotension, rhythm disturbance • Tx: Precordial chest thump • AED & Early CPR

  21. Summary • Sudden Death is a rare event • Work-up depends on (+) Hx, as PE is subtle or often normal • The first presentation of sudden death may be the event itself

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