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IOC Manual of Sports Cardiology
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IOC Manual of Sports Cardiology
von: Mathew Wilson, Jonathan Drezner, Sanjay Sharma
Wiley-Blackwell, 2016
ISBN: 9781119046882
530 Seiten, Download: 52062 KB
 
Format:  PDF
geeignet für: Apple iPad, Android Tablet PC's Online-Lesen PC, MAC, Laptop

Typ: A (einfacher Zugriff)

 

 
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Inhaltsverzeichnis

  Title Page 3  
  Copyright Page 4  
  Contents 5  
  Contributors 12  
  Foreword 15  
  Preface 16  
  Part 1 The Cardiovascular System 19  
     Chapter 1 Anatomy and Physiology of the Heart 21  
        Introduction 21  
        Gross Cardiac Anatomy 21  
        Electrical Conduction in the Heart 24  
        Structure of the Cardiomyocyte 26  
        Cardiac Function 27  
        Intrinsic and Extrinsic Regulation of Cardiac Function 28  
        Conclusion 30  
     Chapter 2 The Vascular System 31  
        Introduction 31  
        The Circulatory Systems 31  
        The Systemic Circulation 31  
        The Lymphatic System 33  
        Control of Blood Flow 33  
        Neural Regulation 34  
        Local Regulating Mechanisms 35  
        Nitric Oxide 35  
        Mechanisms that Mediate Vasodilator Function 36  
        Haemodynamics 37  
        Conclusion 38  
     Chapter 3 Energy Production Pathways During Exercise 39  
        Introduction 39  
        Primary Sources of Energy in the Human Body 39  
        Interacting Energy Systems During Exercise 41  
        Measurement of Energy Sources 45  
        Training Effect 47  
        Conclusion 48  
        References 48  
     Chapter 4 Cardiovascular Responses to Exercise 50  
        Introduction 50  
        Cardiovascular Responses to Aerobic Exercise 50  
        Cardiovascular Responses to Static Exercise 58  
        Conclusion 59  
        References 60  
     Chapter 5 The Athlete’s Heart: Impact of Age, Sex, Ethnicity and Sporting Discipline 61  
        Introduction 61  
        Electrical Remodelling in the Athlete’s Heart 61  
        Structural Remodelling in the Athlete’s Heart 61  
        The Influence of Age on the Athlete’s Heart 62  
        The Influence of Sex on the Athlete’s Heart 64  
        The Influence of Ethnicity on the Athlete’s Heart 64  
        Influence of Sporting Discipline on the Athlete’s Heart 68  
        Conclusion 68  
        References 69  
     Chapter 6 Physical Activity in the Prevention and Management of Atherosclerotic Disease 71  
        Introduction 71  
        Definitions Encompassing Physical Activity 71  
        Preventing CVD: The Continuum of Human Activity from Sedentary Behaviour to Moderate- to Vigorous-Intensity Physical Activity 71  
        Physical Activity within Rehabilitation and Secondary Prevention 73  
        Early Commencement of Exercise Rehabilitation 74  
        Reducing Risk of Exertion-Related Events 75  
        Post-surgery and Early Rehabilitation 76  
        Post-Angioplasty and Post-Myocardial Infarction 77  
        Conclusion 77  
        References 78  
  Part 2 Preventing Sudden Cardiac Death in Athletes 81  
     Chapter 7 Incidence and Aetiology of Sudden Cardiac Death in Athletes 83  
        Introduction 83  
        Developing a Numerator and Denominator 83  
        The Incidence of SCD 85  
        Are Athletes at Greater Risk of SCD than Non-athletes? 89  
        Relative Frequency of SCD 89  
        Aetiology of SCD 89  
        Conclusion 90  
        References 90  
     Chapter 8 Cardiovascular Screening for the Prevention of Sudden Cardiac Death in Athletes 92  
        Introduction 92  
        The Risk of Sudden Death in Athletes 92  
        Rationale for Screening Competitive Athletes 93  
        The Screening Programmes Implemented in Italy 93  
        Rationale for Including a 12-Lead ECG in the PPE 94  
        Efficacy of Screening to Identify Cardiac Disease Risk 94  
        Impact of the Screening Programme on Cardiac Mortality 95  
        Costs of Systematic Screening across Italy 96  
        Limitations of Screening Programmes 97  
        Conclusion 98  
        References 98  
     Chapter 9 Comparison of Pre-participation Evaluations for Assessing Cardiovascular Risk in Athletes 100  
        Introduction 100  
        American Heart Association (AHA) 100  
        Pre-participation Physical Evaluation Monograph 4th Edition (4th Monograph) 101  
        European Society of Cardiology (ESC) 102  
        International Olympic Committee (IOC) 103  
        Fédération Internationale de Football Association (FIFA) 103  
        Comparison of the Five Protocols 103  
        Considerations 109  
        Conclusion 111  
        Acknowledgements 111  
        References 111  
     Chapter 10 Normal Electrocardiographic Findings in Athletes 113  
        Introduction 113  
        Normal ECG Findings in Athletes 113  
        Sinus Bradycardia 113  
        Sinus Arrhythmia 113  
        Junctional Escape Rhythm 114  
        Ectopic Atrial Rhythm 114  
        First-Degree Atrioventricular Block 114  
        Second-Degree Atrioventricular Block (Mobitz Type I/Wenckebach Phenomenon) 114  
        Incomplete Right Bundle Branch Block 115  
        Early Repolarisation 116  
        QRS Voltage Criteria for Left Ventricular Hypertrophy 118  
        Repolarisation Findings in Relation to Age and Ethnicity 118  
        Criteria for Interpretation of the Athletes’ ECGs 118  
        Conclusion 120  
        References 120  
     Chapter 11 Abnormal Electrocardiographic Findings in Athletes: Recognising Changes Suggestive of Cardiomyopathy 122  
        Introduction 122  
        T-Wave Inversion 124  
        ST-Segment Depression 126  
        Pathological Q-Waves 126  
        Voltage Criterion for Left Ventricular Hypertrophy 126  
        Voltage Criterion for Right Ventricular Hypertrophy 127  
        Intraventricular Conduction Abnormalities and QRS Fragmentation 127  
        Voltage Criteria for QRS-Axis Deviation and Atrial Enlargement 128  
        Premature Ventricular Contraction 130  
        Other ECG Phenotypes Associated with Cardiomyopathy 130  
        Conclusion 131  
        References 131  
     Chapter 12 Abnormal Electrocardiographic Findings in Athletes: Recognising Changes Suggestive of Primary Electrical Disease 132  
        Introduction 132  
        Long QT Interval 132  
        Short QT Interval 135  
        Brugada Pattern 135  
        Wolff–Parkinson–White Pattern 137  
        Supraventricular Tachycardias 140  
        Premature Ventricular Contractions and Ventricular Arrhythmias 140  
        Sinus Bradycardia 141  
        Heart Block 142  
        Sudden Death Syndromes with a Normal ECG 144  
        Conclusion 144  
        References 144  
     Chapter 13 Effective Echocardiographic Assessment of the Athlete: Basic Examination to Advanced Imaging Techniques 146  
        Introduction 146  
        Stage 1: Pre-echocardiographic Information 146  
        Stage 2: Standard Echocardiographic Examination 148  
        Stage 3: Novel Echocardiographic Indices 155  
        Stage 4: The Role of Exercise 161  
        Conclusion 162  
        References 162  
     Chapter 14 Early Repolarisation in Athletes 165  
        Introduction 165  
        Early Repolarisation Syndrome 165  
        Defining ER 165  
        ER in the General Population 166  
        Prevalence of ER in Athletes 167  
        Prognosis of ER in Athletes 168  
        Conclusion 169  
        References 169  
     Chapter 15 Clinical (Laboratory) Exercise Testing 171  
        Introduction 171  
        Basic Principles 171  
        Methods 172  
        ECG Recording 175  
        ECG Interpretation 178  
        Conclusion 179  
        References 180  
     Chapter 16 The Role of Cardiovascular Magnetic Resonance in the Assessment of Athletes 181  
        Introduction 181  
        The Athletes Heart 183  
        Who Should Have a CMR? 183  
        Hypertrophic Cardiomyopathy 183  
        Other Causes of LVH 185  
        Myocarditis 188  
        Cardiac Sarcoid 188  
        Coronary Artery Disease 190  
        Future Directions 190  
        Conclusion 191  
        Acknowledgements 191  
        References 191  
     Chapter 17 Genetic Testing for Cardiovascular Conditions Predisposing to Sudden Death 193  
        Introduction 193  
        Genetics of Inherited CVD 193  
        Genetic Testing for Inherited CVD 196  
        Genetic Testing in Sudden Death Risk Assessment 198  
        Genetic Testing in the Athlete 200  
        Conclusion 203  
        References 204  
  Part 3 Cardiac Conditions Predisposing to Sudden Cardiac Death 205  
  Section 1 Introduction 207  
     Chapter 18 Causes of Sudden Cardiac Death in Sport: The Importance of Autopsy and Specialist Examination of the Heart 209  
        Introduction 209  
        Disorders of the Coronary Arteries 209  
        Disorders of the Heart Muscle 212  
        Cardiac Valve Disease 216  
        Morphologically Normal Heart 216  
        Conduction System 217  
        Aortic Dissection 217  
        Blunt Chest Trauma 218  
        Sickle?Cell Disease 218  
        Conclusion 219  
        References 219  
  Section 2 Inherited and Congenital Cardiovascular Pathologies 221  
     Chapter 19 Hypertrophic Cardiomyopathy 223  
        Introduction 223  
        Epidemiology 223  
        Genetics 224  
        Diagnosis 224  
        Electrocardiogram Abnormalities 227  
        Left Ventricular Outflow Tract Obstruction 227  
        Differentiation from Athlete’s Heart 227  
        Natural History and Clinical Course 228  
        Management Considerations 229  
        Conclusion 233  
        References 233  
     Chapter 20 Arrhythmogenic Right Ventricular Cardiomyopathy 235  
        Introduction 235  
        Pathophysiology and Natural History 235  
        Diagnosis 237  
        Prevention of ARVC?Related Sudden Death 241  
        Clinical Management of Athletes with ARVC 244  
        Acknowledgments 247  
        References 247  
     Chapter 21 Dilated Cardiomyopathy, Left Ventricular Hypertrabeculation and Noncompaction 249  
        Introduction 249  
        Dilated Cardiomyopathy 249  
        Left Ventricular Noncompaction 252  
        Conclusion 256  
        References 256  
     Chapter 22 Marfan Syndrome and Aortopathies 258  
        What is Marfan Syndrome? 258  
        Salient Features 258  
        Diagnosis 259  
        Cardiac Problems 260  
        Impact on Physical Activity 260  
        Guidelines 261  
        Medication Impact on Physical Activity 262  
        Problems Encountered by Patients 262  
        Who Should be Aware? 263  
        What Advice is Needed? 263  
        After Surgery 263  
        Other Aortopathies 263  
        Conclusion 264  
        References 264  
     Chapter 23 Valvular Disease 265  
        Basic Principles 265  
        Aortic Valvular Disease 271  
        Mitral Valvular Disease 275  
        Right Heart Valvular Disease 278  
        Prosthetic Valves 278  
        Conclusion 279  
        References 279  
     Chapter 24 Congenital Heart Disease 281  
        Introduction 281  
        Epidemiology of CHD 281  
        Aetiology of CHD 281  
        CHD in the Athlete Population 282  
        Mortality Risks of Sudden Cardiac Death in CHD 282  
        Activity and Sports in CHD 283  
        Assessment Tools in CHD 284  
        General Considerations in Athletes with CHD 285  
        Athletic Performance and Complications in Common Specific Lesions 288  
        Conclusion 291  
        References 291  
     Chapter 25 Congenital Coronary Artery Anomalies 293  
        Introduction 293  
        Anomalous Origin of a Coronary Artery from the Pulmonary Trunk 293  
        Anomalous Coronary Artery Origin from a Wrong Aortic Sinus 294  
        Other CCAAs from the Aorta: Variants of Uncertain Significance 295  
        In Vivo Diagnosis of CCAA Carrying a Risk of Sudden Death 298  
        Risk Stratification and Clinical Management 299  
        CCAA and Consensus Guidelines for Eligibility/Disqualification 300  
        Conclusion 302  
        Acknowledgement 302  
        References 302  
  Section 3 Ion Channelopathies, Accessory Pathways and Electrical Disease 305  
     26 Long QT Syndrome 307  
        Introduction 307  
        Clinical Presentation of Long QT Syndrome 307  
        Diagnostic Approach for an Athlete with Suspected Long QT Syndrome 308  
        Genetic Basis for Long QT Syndrome 313  
        Risk Stratification in Long QT Syndrome 314  
        Disease Management in Long QT Syndrome 316  
        Considerations in the Context of Exercise and Physical Activity 317  
        References 319  
     27 Brugada Syndrome 321  
        Concept and Epidemiology 321  
        Genetic Basis 321  
        Clinical Presentation 322  
        Diagnostic Criteria 326  
        Risk Stratification 327  
        Management 328  
        Exercise Considerations 329  
        Conclusion 331  
        References 331  
     28 Wolff–Parkinson–White Syndrome 333  
        Introduction 333  
        Epidemiology 333  
        Aetiology 333  
        Genetics 334  
        Associated Cardiac Abnormalities 334  
        ECG Criteria for Diagnosis 334  
        Clinical Presentation 334  
        Risk assessment of WPW 336  
        Transcatheter Ablation 338  
        Management Summary 340  
        References 340  
     29 Catecholaminergic Polymorphic Ventricular Tachycardia 342  
        Introduction 342  
        Genetics and Pathophysiology 342  
        Contribution to SCD 343  
        Evaluation of Suspected CPVT 344  
        Risk Stratification 345  
        Management 345  
        Future Directions 347  
        References 347  
     30 Idiopathic Ventricular Tachycardia/Ventricular Fibrillation 349  
        Definitions 349  
        Idiopathic Ventricular Tachycardia 349  
        Idiopathic Ventricular Fibrillation 355  
        References 356  
  Section 4 Acquired Disorders 359  
     Chapter 31 Commotio Cordis 361  
        Introduction 361  
        Prevalence 361  
        Clinical Profile 361  
        Experimental Model 362  
        Prevention 364  
        Treatment 364  
        Conclusion 364  
        References 367  
     32 Myocarditis 368  
        Introduction 368  
        Aetiology and Epidemiology 368  
        Clinical Manifestations 369  
        Pathophysiology 373  
        Myocarditis and Athletics 374  
        Long?Term Sequelae 374  
        Treatment 374  
        Conclusion 375  
        References 375  
  Section 5 Other Causes of Sudden Death 377  
     Chapter 33 Alternative Noncardiac Medical Causes of Sudden Death: Sickle-Cell Trait, Exertional Heatstroke, Exercise Rhabdomyolysis, Asthma and Extreme Environmental Conditions 379  
        Introduction 379  
        Sickle-Cell Trait 379  
        Exertional Heatstroke 383  
        Other, Less Frequent Causes of Noncardiac Sudden Death 385  
        References 386  
  Part 4 Cardiovascular Management 389  
     Chapter 34 Guidelines for Sports Practice in Athletes with Cardiovascular Disease 391  
        Cardiomyopathies, Myocarditis and Pericarditis 392  
        Primary Electrical Disease 395  
        Aortopathies, Coronary Artery Disease and Hypertension 397  
        Valvular Heart Disease 401  
        Congenital Heart Disease 401  
        References 401  
     Chapter 35 Management of the Symptomatic Athlete 403  
        Introduction 403  
        General Considerations 403  
        Syncope 404  
        Palpitations 407  
        Chest Pain 408  
        Exertional Fatigue and Performance Decline 411  
        Conclusion 411  
        References 412  
     Chapter 36 Management of Abnormal Physical Examination Findings in Athletes 413  
        Introduction 413  
        General Inspection 413  
        Examination of the Hands 414  
        Assessment of Resting Blood Pressure 415  
        Examination of the Face and Neck 417  
        Examination of the Thorax 417  
        Examination of the Heart 418  
        Examination of the Lungs 421  
        Examination of the Abdomen 421  
        Examination of the Lower Limbs 421  
        Conclusion 422  
        References 422  
     Chapter 37 Management of Atrial Fibrillation in Athletes 424  
        Introduction 424  
        Epidemiology and Relevance 425  
        Clinical Presentation 426  
        Pathology 426  
        Therapeutic Approach 427  
        Prevention 430  
        Conclusion 430  
        References 431  
     Chapter 38 Implantable Cardioverter-Defibrillators in Athletes 433  
        Introduction 433  
        ICD Structure and Function 433  
        Subcutaneous ICDs 436  
        ICDs in Athletes: Underlying Diagnosis 436  
        ICDs in Athletes: Implications for Return to Play 439  
        How to Care for an Athlete with an ICD: Practical Considerations 441  
        Medical Equipment that may Interfere with an ICD 441  
        Conclusion 442  
        References 442  
     Chapter 39 Management of Hypertension in Athletes 445  
        Introduction and Epidemiology 445  
        Considerations Relating to Sports Participation and Blood Pressure in Athletes 445  
        Definition and Classification of Arterial Hypertension in Athletes 446  
        Challenges of Diagnosing Hypertension in Athletes 446  
        How to Assess Blood Pressure in Athletes 447  
        Definition of EIAH at the Peak of Exercise 449  
        Definition of EIAH at Submaximal Exercise 449  
        Abnormal Blood Pressure Response in Recovery 449  
        Diagnostic Evaluation of the Hypertensive Athlete 450  
        Drugs Associated with Hypertension in Athletes 451  
        Hypertension in Paralympic Athletes with Spinal Cord Injuries 451  
        Physical Examination of the Hypertensive Athlete 452  
        Cardiovascular Risk Stratification of the Hypertensive Athlete 452  
        Cardiovascular Risk Factors 452  
        Target Organ Damage 452  
        Aetiology Assessment: Primary versus Secondary Hypertension 453  
        Management of Hypertension in Athletes 453  
        Eligibility for Sports Participation in Hypertensive Athletes 455  
        References 456  
  Part 5 Conundrums in Sports Cardiology 457  
     Chapter 40 Distinguishing Physiological Left Ventricular Hypertrophy from Hypertrophic Cardiomyopathy in Athletes 459  
        Introduction 459  
        Establishing the ‘Grey Zone’ 459  
        History and Familial Evaluation 461  
        Echocardiography 461  
        Electrocardiography 462  
        Cardiac Magnetic Resonance 463  
        Cardiopulmonary Exercise Testing 464  
        Ambulatory ECG Monitoring 464  
        Genetics 464  
        De?training 465  
        Potential Role of Biomarkers 465  
        Conclusion 465  
        References 466  
     Chapter 41 Screening for Cardiovascular Disease in the Older Athlete 467  
        Introduction 467  
        Risk–Benefit of Physical Activity 467  
        Coronary Artery Disease: Pathogenesis 468  
        SCD due to CAD in Senior Athletes 468  
        Clinical Presentation of CAD 469  
        Positive Effects of Physical Activity 469  
        Evaluation of Older Individuals before Participation in Sports 469  
        Conclusion 473  
        References 473  
     Chapter 42 Is Ultra-Endurance Exercise Damaging to the Right Ventricle? 475  
        Introduction 475  
        From Physiological to Pathological Remodelling in Athletes: the Atrial Example 476  
        From Physiologic to Pathologic Remodelling in Athletes: and the Ventricles? 477  
        Why is the Right Ventricle Affected? 477  
        Genetic Predisposition? 480  
        Doping? 481  
        Who is at Risk? 481  
        Conclusion 484  
        References 484  
     Chapter 43 Clinical Implications of Performance-Enhancing Drugs for Cardiovascular Health 486  
        Introduction 486  
        Anabolic Agents 486  
        Peptide Hormones, Growth Factors and Related Substances 489  
        Stimulants 490  
        Beta-2 Agonists 490  
        Masking Agents 491  
        Conclusion 491  
        References 491  
     Chapter 44 Cardiovascular Concerns in the Paralympic Athlete 493  
        Introduction 493  
        Cardiovascular Concerns in Athletes with SCI 493  
        Other Important Considerations for the Team Physician 498  
        Conclusion 500  
        References 500  
  Part 6 Emergency Cardiac Care 501  
     Chapter 45 Emergency Cardiac Care in the Athletic Setting: From School Sports to the Olympic Arena 503  
        Introduction 503  
        Epidemiology 503  
        Planning 504  
        Training 504  
        Personnel 504  
        Equipment 505  
        Communications 506  
        Onsite Emergency Cardiac Care Protocol 507  
        Transport 508  
        Definitive Cardiac Critical Care 508  
        Post-SCA Debrief 508  
        Conclusion 509  
        References 509  
  Part 7 Sports Cardiology Training 511  
     Chapter 46 Recommendations for Sports Cardiology Training for the Sports Medicine Physician 513  
        Introduction 513  
        Sports Cardiology Curriculum 514  
        Training Environment and Infrastructure 516  
        Strategies for Learning and Assessment 516  
        Conclusion 519  
        References 519  
  Index 521  
  EULA 530  


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