A Few More Cardiac Things Flashcards
Marfans Disorder
Inheritable disorder of the connective tissue
Connective tissue affects:
Growth and development
Cushioning of joints
Vital organs
Not tied to any particular sex, race, or ethnic group
1 in 5,000 people in US have disorder
Marfan’s Skeleton
Tall and slender Disproportionately long appendages Indented or protruding sternum Arched palate, overcrowded teeth, receding mandible Curvature of spine
Heart and Blood Vessels in Marfan’s Disorder
Weakened middle layer of aortic wall Stretched aortic valve leaflets Aneurysm may form Aortic regurgitation Left ventricle must compensate Chest pain, heart failure Tears in inner and middle aortic layers Middle layer separates New channels for blood flow Enlargement of the aorta Aortic Dissection Aortic Dilation Aortic Valve regurgitation Mitral valve prolapse Medications Lower blood pressure Angiotensin receptor blockers Beta blockers Regular Echocardiograms
Physical activity in Marfan’s Disorder
Avoid contact and strenuous sports because of the risk of damaging the aorta and injuring the eyes
Individual restrictions based on severity and discussed with physician
Pre-Participation Physical Exam (PPE)
A tool for injury prevention, used to gather medical information about athletes to ensure that they are ready to participate in sports
The athlete’s initial exposure to the sport’s medicine team
PPE Cardiovascular Tests
The AHA states it is not necessary to recommend the use of highly expensive cardiovascular disease tests such as: electrocardiography, echocardiography or graded exercise testing
HOWEVER, they do not discourage the use of these tests
More likely # false-positive > # true-positive test results
May cause:
1. anxiety in athletes and families
2. restriction from competition and sport
3. exclusion from life insurance coverage
Detect between 1:100,000 and 1:300,000 athletes at risk of sudden cardiac death
Reliability does not = cost efficiency of CV PPE
(AHA, 1996)
AHA Cardiovascular PPE Recommendations
1st yr at institution/high school:
- Comprehensive personal and family history
- physical examination by qualified examiner
- CV PPE every 2 years after initial screening
- During intervening years: history (AHA, 1996)
Rewritten in 1998 for collegiate athletes:
Each year after initial CV PPE:
- history
- blood pressure measurement
Components of the CV PPE- HIstory
Include key questions:
PMHx of:
exertional chest pain/discomfort
Syncope
excessive, unexpected, and unexplained dyspnea or fatigue associated with exercise
heart murmur or increased systemic blood pressure
- Family history of premature death or significant disability from cardiovascular disease
Components of the CV PPE- Physical Exam
Physical exam
Should emphasize but is not limited to:
auscultation in both supine and standing positions
assessment of the femoral artery pulses
recognition of the physical characteristics of Marfan syndrome
brachial blood pressure measurement in sitting position
Athletes with CV conditions
referred to a cardiovascular specialist for further evaluation and/or confirmation
refer to 36th Bethesda Conference guidelines
Written in 2005 by American College of Cardiology
Recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities
(Maron, 2005)
Judgment of Participation
The American Academy of Pediatrics states:
Along with specialist and Bethesda guidelines, should consider:
risks of participation
the advice of knowledgeable experts
current health status
the level of competition, position and sport
availability of effective protective equipment
availability of Rx
sport can be modified?
ability of the athlete and parents to understand and accept risks involved in participation
How strenuous the sport is, is another factor that should be considered for athletes with cardiovascular problems
A strenuous sport places many demands on the cardiovascular system
