Cardiac Conditions in Physically Active Individuals

Question 1

Sudden Cardiac Arrest

Answer 1

Occurring during or within 1 hr. after exercise because of cardiovascular disorder

Abrupt stop of heart beat, typically caused by abnormal electrical signal, structural abnormality or other cause.

Leading cause of death in young (under 35) athletes on the field

adults older than 35-40: Coronary Artery Disease: Plaque builds up inside coronary arteries

Question 2

SCA is more likely to occur in which groups?

Answer 2

Athletes
Males
Black Athletes
Basketball and Football players

Question 3

Hypertrophic Cardiomyopathy

Answer 3

Asymmetric thickening of walls of bottom ½ of heart with fiber disorganization

Up to a 1/3 of cardiac deaths in young athletes

when fibers are disorganized, conduction becomes disorganized

this only becomes a problem when you are an athlete and your rhythm conduction needs to change rapidly

screening tests are not done for this until the athlete reaches high school

Question 4

Coronary Artery Anomolies

Answer 4

Typically involve either sharp angles or being buried within the muscle

About 15% of cardiac deaths in you athletes in US

Question 5

Myocarditis

Answer 5

Inflammation of heart muscle, typically non-communicable virus

Inflammation & Scar tissue lead to conduction disruption & perhaps dilated chambers

About 7% of sudden cardiac deaths in US athletes

Question 6

Arryhthmogenic Right Ventricular Cardiomyopathy

Answer 6

Progressive fibro-fatty replacement of the right side of the heart, causing wall thinning

1 in 5,000 people

Suspected in 4% of sudden cardiac deaths in US athletes

Question 7

Aortic Rupture/Marfan Syndrome

Answer 7

Inherited disorder of connective tissue affects multiple organ systems, causing progressive dilation & weakness of the aorta that can lead to rupture & sudden death

genetic disorder that affects connective tissue that leads to aortic dissection, the tear between layers of the aortic wall

2– 3 out of 10,000

Question 8

Ion Channel Disorders

Answer 8

Electrical problems without structural problems

Proteins are not coded correctly, so ion channels do not function correctly

Not seen on autopsy; only genetic screening will diagnose (must be specific for the protein marker – expensive)

Account for 3% of confirmed cases; probably 40% - difficult and expensive to confirm

More common in males

Question 9

•Commotio cordis

Answer 9

Most common in boys (less adipose tissue on chest)

Heart stops conducting

80% occur when an object strikes the athlete (must hit the mid-clavicular space between the 5th intercostal space), must be the right size, density, and velocity

Remaining 20% result from contact with another

Common in fast-pitch baseball

Can occur in anyone; any healthy person

Reversible with AED

Question 10

What is the estimated number of young athletes with an underlying heart problem that puts them at risk for SCA?

Answer 10

1 in 300

Question 11

ECG/Echo/Electrodiagnostic Panel

Answer 11

Pick-up 65% of causes of SCA in young athletes

Detects conduction issues, not structural

10-15% to 25% false positive in athletes

Electrodiagnostic Panel is expensive

Cost and benefit are not worth it

Question 12

Seattle Criteria

Answer 12

Captures ECG training on an athlete, anyone can be trained to this in a short amount of time, and can be done online

16 sec capture

Different evaluative criteria than ECG

False positive is only 3%; lower than that of a standard ECG done by a cardiologist

Quick, inexpensive, effective; free outside of office (public service)