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Sports Cardiology Essentials - Evaluation, Management and Case Studies
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Sports Cardiology Essentials - Evaluation, Management and Case Studies
von: Christine E. Lawless
Springer-Verlag, 2010
ISBN: 9780387927756
411 Seiten, Download: 10674 KB
 
Format:  PDF
geeignet für: Apple iPad, Android Tablet PC's Online-Lesen PC, MAC, Laptop

Typ: B (paralleler Zugriff)

 

 
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Inhaltsverzeichnis

  Chapter 1: Sudden Cardiac Death in Athletes: Scope of the Problem and Emergency Response 13  
     Incidence 13  
        Introduction 13  
        Causes 14  
        Specific Causes 15  
           Hypertrophic Cardiomyopathy 15  
           Commotio Cordis 17  
           Coronary Arterial Abnormalities 17  
           Myocarditis 17  
           Marfan’s Syndrome 18  
           Long QT Syndrome and Wolff–Parkinson–White Syndrome 19  
              Long QT Syndrome 19  
           Arrhythmogenic Right Ventricular Dysplasia 21  
        Immediate Treatment 22  
        AED Utilization: NCAA Collegiate Experience 24  
        Case 1 26  
     Summary 27  
     References 29  
  Chapter 2: Cardiovascular Screening of Athletes: Focused Exam, Electrocardiograms, and Limited Echocardiograms 33  
     Introduction 33  
     Rationale for Pre-participation Cardiovascular Screening with and Without ECG 33  
     Appropriate Workup of Athletes with Past History of Heart Disease, Symptoms, Positive Family History, or Abnormal Physical Exam 35  
        Chest Pain 36  
        Dyspnea 36  
        Syncope, Near-Syncope, and Dizziness 36  
        Family History 37  
           Case Study of Positive Family History 37  
     ECG-Based Screening 39  
     Barriers to Routine ECG-Based Screening in the USA 42  
        Large Numbers of Athletes and Size of Appropriate Physician Workforce to Conduct the Screenings 42  
        Cost of Conducting Such Screening in Such a Large Number of Eligible Athletes 44  
        Mortality Rate from SCD in Athletes is Already Quite Low 45  
        Lack of a Randomized Trial Demonstrating Clear Superiority of the ECG-Based Screening over a Standardized PPE Without ECG 45  
        Lack of Standardization for Interpretation of ECGs in Athletes 45  
        Lack of Normative Data in Certain Demographic and Ethnic Groups 46  
     How to Implement ECG-Based Screening Programs 46  
     How to Interpret ECGs in Athletes 48  
     The Role of Echocardiography in Screening of Athletes 49  
     What Issues Still Need to be Addressed Before Wide-Spread Screening Can be Implemented in the USA 50  
        Efficacy of ECG Screening 50  
     Summary 51  
     References 51  
  Chapter 3: Echocardiography and Advanced Cardiac Imaging in Athletes 54  
     Case 1: Electrocardiographic Evidence of Left Ventricular Hypertrophy 54  
        Summary 57  
     Case 2: Exertional Myocardial Ischemia in the Young Athlete 58  
        Summary 60  
     Case 3: Arrhythmia and Right Ventricular Dilation 60  
        Summary 65  
     References 66  
  Chapter 4: Exercise Training and Prescription 71  
     Aerobic Power 71  
     Anaerobic Power and Capacity 73  
     Muscle Strength and Endurance 73  
     Prescribing Exercise 74  
        Specificity of Training 74  
        Progressive Overload 75  
           Intensity 75  
        Frequency and Duration 76  
        Resistance Training 77  
     Types of Training Programs 78  
        Interval Training 78  
        Fartlek 78  
        Tempos 79  
     The Patient-Athlete 79  
     Hypertrophic Cardiomyopathy 82  
     Mitral Valve Prolapse and Myocarditis 82  
     Valvular Heart Disease 82  
     Congenital Heart Disease 83  
     Cardiac Transplantation 84  
     Elderly 84  
     Case Presentation 1 87  
        Medical History 87  
        Examination 87  
        Testing 87  
        Diagnosis 87  
        Hospital Course 87  
        Post Discharge Plan 88  
     Case Presentation 2 88  
        Medical History 88  
        Examination 89  
        Testing 89  
        Diagnosis 90  
        Plan 90  
     Summary 91  
     References 91  
  Chapter 5: Role of Genetic Testing for Sudden Death Predisposing Heart Conditions in Athletes1 93  
     Introduction 93  
     Hypertrophic Cardiomyopathy Case Vignette 94  
     Summary of Cardiomyopathy Genetic Testing 94  
        Hypertrophic Cardiomyopathy 94  
        Arrhythmogenic Right Ventricular Cardiomyopathy 98  
     Long QT Syndrome Case Vignette 99  
     Summary of Channelopathy Genetic Testing 100  
        Long QT Syndrome 100  
        Catecholaminergic Polymorphic Ventricular Tachycardia 101  
        Brugada Syndrome 102  
        Short QT Syndrome 103  
     Indications for Genetic Testing in the Athlete 103  
        The “Borderline” Patient 103  
        “Gold Standard” Diagnostic Marker for the Asymptomatic Athlete Who Is Part of a Family with a Sudden Death Predisposing Heart C 104  
     References 106  
  Chapter 6: Shortness of Breath 110  
     Introduction 110  
     Common Causes of Shortness of Breath During Exercise 111  
        Case 1 111  
        Exercise-Induced Bronchospasm 111  
        Case 2 115  
     Vocal Cord Dysfunction 117  
     Gastroesophageal Reflux Disease 118  
     Less Common Causes of Dyspnea During Exercise 118  
     Conclusion 119  
     References 119  
  Chapter 7: Chest Pain in the Athlete: Differential Diagnosis, Evaluation, and Treatment 122  
     Cardiac Chest Pain 125  
        History 125  
        Physical Examination 125  
        Aortic Dissection 126  
     Noncardiac Causes of Chest Pain 126  
        Musculoskeletal Etiologies of Chest Pain 126  
           Chest Wall Pain 126  
           Traumatic Rib Fracture 127  
           Rib Stress Fractures 128  
           Sternoclavicular Injury 129  
           “Stitch” 130  
           Costochondritis 130  
           Tietze’s Syndrome 131  
           Slipping Rib Syndrome 131  
           Precordial Catch Syndrome 131  
           Cervical Disk Disease/“Cervical Angina” 131  
        Pulmonary Chest Pain 132  
           Asthma/Exercise-Induced Bronchospasm 132  
           Pneumothorax 133  
           Pulmonary Contusion 134  
           Pneumomediastinum 135  
           Pulmonary Embolus 135  
           Pneumonia 137  
           Pleurisy 137  
           Hyperventilation 139  
        Gastrointestinal Chest Pain 139  
           Gastroesophageal Reflux Disease 139  
           Dysphagia 140  
        Psychiatric Etiologies of Chest Pain 140  
        Substance Abuse 141  
     Conclusion 141  
     Clinical Cases 142  
        Case 1 (Fig. 7.4) 142  
        Case 2 (Fig. 7.5) 142  
     References 143  
  Chapter 8: The Collapsed Athlete 147  
     Approach to the Down Athlete 149  
     Cardiac Causes 149  
     Hyperthermia/Exertional Heat Stroke 151  
        Background 151  
        Diagnosis 152  
        Treatment 153  
     Hypothermia 155  
        Background 156  
        Diagnosis 157  
        Treatment 157  
     Exercise-Associated Hyponatremia 158  
        Background 158  
        Diagnosis 159  
        Treatment 160  
     Hypoglycemia 160  
        Background 160  
        Diagnosis 161  
        Treatment 161  
     Exercise-Associated Collapse 162  
        Background 162  
        Diagnosis 162  
        Treatment 163  
     Seizures 163  
     Trauma 164  
     Case #1 164  
     Summary 165  
     References 165  
  Chapter 9: Syncope/?Presyncope in the Competitive Athlete 168  
     Introduction 168  
     Definitions 169  
        Syncope/Presyncope 169  
        Competitive Athlete 169  
        Exercise-Related Syncope 170  
     Epidemiology 170  
        Pathophysiology of Exercise-Related Syncope 171  
     Differential Diagnosis 172  
     Neurally Mediated Causes 172  
     Cardiac Causes 173  
     Evaluation 173  
        Physical Examination 175  
        Echocardiography 178  
        Further Diagnostic Testing 178  
        Ambulatory Monitoring 179  
        Continuous-Loop Event Monitoring 179  
        Tilt Table 179  
        Electrophysiologic Studies 180  
        Management of Syncope 180  
     Return to Play 182  
     Conclusion 182  
     References 183  
  Chapter 10: Electrophysiological Approach to Syncope and Near-Syncope in the Athlete 185  
     Case 185  
     Introduction 185  
     Significance of Syncope and Near-Syncope in the Athlete 186  
     Epidemiology 188  
     Mechanisms and Causes of Syncope and Near-Syncopein the Athlete 189  
     Evaluation of the Athlete with Syncope and Near-Syncope 191  
        History 192  
        Physical Examination 193  
        Diagnostic Testing 193  
           Noninvasive Testing 193  
              Electrocardiography 193  
              Electrocardiographic Monitoring (Holter Monitor, Event Monitor, Implantable Loop Recorder) 194  
              Echocardiogram 194  
              Tilt-Table Testing 195  
              Exercise Testing 196  
              Other Noninvasive Testing 196  
           Invasive Testing 197  
              Electrophysiology Testing 197  
              Cardiac Catheterization 198  
              Endomyocardial Biopsy 198  
     Management of Syncope in the Athlete 198  
        Treatment of Neurocardiogenic Syncope 199  
        Treatment of Arrhythmic Syncope 199  
        Implanted Devices in the Athlete 201  
     Athletic Restrictions 201  
     Illustrative Cases 202  
        Eighteen-Year-Old Female with Syncope 202  
        Nineteen-Year-Old Male Swimmer with Frequent Palpitationsand Near Syncope 203  
        Twenty-Year-Old Male with Syncope While Playing Basketball 204  
        Eighteen-Year-Old Male with Near Syncope and Palpitations During Basketball 204  
        Thirty-Seven-Year-Old Distance Runner with Episodesof Syncope at Rest After Exercise 206  
        Nine-Year-Old Female Who has Recurrent Collapse During Activity 207  
        Nineteen-Year-Old with Syncope During Football 207  
        Twenty-Year-Old Female with Syncope with Exertion 208  
        Forty-Year-Old Male Physician Who Has Syncope at RestWhile Examining Patients 209  
        Sixteen-Year-Old Female with Syncope 210  
        Thirty-Five-Year-Old Male with Near Syncope Playing Hockey 210  
     Conclusions 212  
     References 212  
  Chapter 11: Heart Murmurs 217  
     Introduction 217  
     Patient History 217  
     Physical Examination 219  
     Approach to Murmurs 223  
     Aids to Physical Examination 226  
     Training Tools 226  
     Diagnostic Evaluation 227  
     Management of Specific Valvular Conditions 228  
     Case 1 228  
        Patient History 228  
        Past Medical History 231  
        Physical Exam 233  
        Diagnostic Tests 234  
        Treatment 234  
        Outcome 234  
        Discussion 235  
     Case 2 236  
        Patient History 236  
        Past Medical History 236  
        Physical Examination 236  
        Diagnostic Tests 237  
        Treatment/Disposition 237  
     References 237  
  Chapter 12: Management of Hypertension in Athletes 239  
     Introduction 239  
     Classification of Blood Pressure 239  
     White Coat Hypertension 240  
     Secondary Hypertension in Athletes 240  
     Clinical Evaluation 241  
     Treatment of Hypertension in Athletes 243  
     Diuretics 244  
     Angiotensin-Converting Enzyme Inhibitors 247  
     Angiotensin Receptor Blockers 247  
     Beta-Adrenergic Blockers 247  
     Calcium Channel Blockers 248  
     Alpha Blockers 248  
     Alpha Agonists 248  
     Combination Therapy 249  
     Recommendations for Athletic Participation in Hypertensive Athletes 249  
     References 249  
  Chapter 13: Hypertrophic Cardiomyopathy 252  
     Case Vignette 252  
     Introduction 253  
     Definition and Etiology 254  
     Screening for Hypertrophic Cardiomyopathy 257  
        Screening for Families with Known HCM 257  
        General Pre-Participation Screening 257  
     Differentiating Hypertrophic Cardiomyopathy from Physiologic Hypertrophy 259  
     Clinical Features and Management of Hypertrophic Cardiomyopathy 260  
        Pathophysiology of HCM 260  
        Clinical Evaluation of Patients with HCM 261  
        Physical Examination in HCM 261  
        Electrocardiography 261  
        Echocardiography 262  
        Magnetic Resonance Imaging 263  
        Risk Stratification for Sudden Cardiac Death 263  
     Management of Patients with Hypertrophic Cardiomyopathy 266  
        Physical Exercise 266  
        Medical Therapy 268  
        Septal Reduction Therapy 268  
     Natural History of Hypertrophic Cardiomyopathy 269  
     References 269  
  Chapter 14: Commotio Cordis: Practical Aspects in Sports 272  
     Commotio Cordis-Clinical Characteristics 272  
     Experimental Models of Commotio Cordis 274  
     Commotio Cordis-Prevention 275  
     Commotio Cordis-Current Practical Management 277  
     Conclusion 278  
     References 278  
  Chapter 15: Coronary Artery Anomalies and Sports Activities 280  
     Introduction: Three Stories 280  
        Case 1: Sudden Cardiac Death in a Top High-School Athlete 280  
        Case 2: Sudden Crib Death in an Infant 281  
        Case 3: A Surprising Accidental Finding in an 83-Year-Old Woman 282  
        Comment 283  
     Coronary Artery Anomalies: A Brief Appraisal of a Complex Entity 284  
     Sports Activities and Coronary Anomalies 291  
     Screening, Diagnosis, and Counseling 293  
     Prevention and Treatment of Sudden Cardiac Death in Athletes 296  
     Conclusions 298  
     References 298  
  Chapter 16: Participation in Sports for the Athlete with the Marfan Syndrome 302  
     Introduction 302  
     The Evaluation 306  
        History 306  
        Examination 307  
        Diagnostic Testing 307  
     Treatment 308  
        Medical 308  
        Surgical 308  
     Recommendation for Athletic Participation 309  
        Types of Exercise 309  
     Case 1 311  
        Discussion 312  
     Case 2 312  
        Discussion 312  
     Conclusion 312  
     References 313  
  Chapter 17: Congenital Heart Disease: Exercise and Sports Participation 315  
     Introduction 315  
     Common Lesions in Adults with Congenital Heart Disease 316  
        Shunt Lesions 316  
           Atrial Septal Defect 316  
           Patent Foramen Ovale 317  
           Ventricular Septal Defect 317  
           Patent Ductus Arteriosus 317  
           Anomalous Venous Return 318  
           Eisenmenger’s Syndrome and Pulmonary Hypertension 318  
        Valvular Lesions 318  
           Bicuspid Aortic Valve 318  
           Aortic Stenosis 319  
           Aortic Insufficiency 319  
           Coarctation of the Aorta 320  
           Pulmonic Stenosis 320  
           Ebstein’s Anomaly 321  
           Complex Congenital Heart Lesions 321  
           Tetralogy of Fallot 321  
           Transposition of the Great Vessels 322  
           Single Ventricle Variants 322  
           Congenital Coronary Anomalies 323  
        Evaluation for Preparticipation Screening 323  
           History and Physical Examination 324  
           Electrocardiogram 325  
           Echocardiogram 325  
           Stress Testing 326  
           MRI/MRA and CT 326  
           Cardiac Catheterization 326  
     Recommendations 326  
     Cases 331  
        Case 1: Bicuspid Aortic Valve 331  
        Case 2 331  
     References 332  
  Chapter 18: Athlete with a Device: Implantable Cardioverter Defibrillators and Pacemakers 334  
     Postulated Risks of Sports 335  
        Triggering of Arrhythmia 335  
        Unknown Efficacy of the ICD During Sports 336  
        Nonarrhythmic Injury to the Athlete 337  
        Damage to the ICD System 337  
     Preliminary Safety and Efficacy Data: Survey Data 337  
        Current Recommendations by Physicians 337  
        Physician-Reported Sports Participation and Outcomes 338  
     Potential Safety-Related Precautions 342  
     Limitations to Survey Data 343  
     Ongoing Research 343  
     References 343  
  Chapter 19: Long QT Syndrome and Other Channelopathies 346  
     Introduction 346  
     Long QT Syndrome 347  
        Case Report #1 347  
        Case Report #2 348  
        Case Report #3 349  
        Case Report #4 352  
     Short QT Syndrome 354  
     Brugada Syndrome 355  
        Case Report #5 355  
     Catecholaminic Polymorphic Ventricular Tachycardia 359  
     Recommendations for Sport Participation in Patients with Channelopathies 360  
     References 366  
  Chapter 20: Cardiac Effects of Ergogenic Aides and Supplements 372  
     Introduction 372  
     Anabolic Androgenic Steroids 373  
        Atherogenic 374  
        Thrombogenic 375  
        Vasospasm 375  
        Direct Myocardial Effects 375  
        Are the Cardiac Effects of Anabolic Steroid Use Reversible? 375  
        Polysubstance Abuse 376  
        Dehydroepiandrosterone (DHEA) 376  
     Peptide Hormones and Analogues 377  
        Human Growth Hormone (hGH) 377  
        Mechanism of Action 378  
        Adverse Effects of GH Abuse 378  
        Specific Cardiovascular Concerns 378  
        Future Concerns 379  
        Erythropoietin (EPO) 379  
        Stimulants 379  
        Amphetamines 380  
        Cocaine 380  
        Ephedra and Ephedrine 380  
        Cardiovascular and Systemic Side Effects 381  
        Ephedra/Ephedrine as a Controlled or Restricted Drug in Sport 381  
     Caffeine/Gaurana 382  
        Caffeine as a Controlled or Restricted Drug in Sport 383  
        Effects of Caffeine Intake in Children 383  
        Guarana 383  
     Conclusion 384  
     References 384  
  Chapter 21: Return-to-Play Decisions in Athletes with Cardiac Conditions: Guidelines and Considerations 387  
     Introduction 387  
     Guidelines for Sports Participation for Athletes with Known Cardiac Conditions 387  
        Recommendations for Young Patients with Genetic Cardiovascular Diseases 388  
        Recommendations for Masters Athletes 391  
     Return-to-Play: General Considerations 391  
        Implanted Defibrillators 391  
        Ablations 392  
        Beta Blockers 392  
        Corrective Cardiac Surgery 392  
     The Grey-Zone Athlete 393  
        Grey-Zone Athlete: Case Study 393  
     Specific Considerations for Conditions That Predispose to SCD Episodes 394  
        Cardiomyopathies and Inflammatory Diseases 394  
        Congenital Heart Disease 395  
        Aortic Reconstruction: Case Study 395  
     Rhythm Disturbances 396  
        Supraventricular Rhythm Disturbances 396  
        AV Nodal Reentrant Tachycardia 396  
        Wolff–Parkinson–White Syndrome 396  
        Ventricular Rhythm Disturbances 397  
        Nonsustained or Sustained Ventricular Tachycardia 397  
        Ventricular Fibrillation 397  
     Common Valvular Diseases 398  
        Bicuspid Aortic Valve 398  
        Aortic Stenosis 398  
        Aortic Insufficiency 398  
        Mitral Valve Prolapse 398  
     Summary 399  
     References 399  
  b978-0-387-78701_4 402  


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