PowerPoint Chapter 17 Flashcards
____ ____ ____ die suddenly from a Cardiac event each year in US?
2500 young athletes die suddenly from a Cardiac event each year in US
What age must a person be to be able to die from sudden cardiac death?
<35
What percents of athletes have an abnormal ECG?
40-50%
What are four categories can athlete death vary by?
Age (< 20y/o)
Gender (Women (22%) < Men (45%))
Ethnicity (Black NFL players > White NFL players ECG abnormalities)
Sport (endurance sports)
____ can cause adaptative changes to physiology?
Exercise can cause adaptative changes to physiology
The majority of ECG changes in athletes listed are ____?
The majority of ECG changes in athletes listed are benign
What are five ECG changes/rhythms that may be seen in athletes?
Sinus Bradycardia
Sinus Arrhythmia
Junctional Escape
1st-degree AV block
2nd degree AV block
What causes sinus bradycardia in an athlete?
Results from increased vagal tone
When should sinus bradycardia in an athlete be evaluated?
Lower than 30bpm and sinus pauses > 3 sec need more eval
What is sinus arrhythmia linked to?
Sinus Arrythmia – linked to respiration
What occurs in a junctional escape rhythm in an athlete and what resolves it?
Junctional Escape – Resting HR is lower than junctional escape. Exercise resolves escape bc of Increased HR.
What percent of athletes have a 1° AV heart block on their ECG?
35%
What does a 1° AV heart block result from in an athlete?
Increases PSNS tone and Decreased Resting SNS tone from exercise
What percent of athlete ECGs contain a 2° AV heart block?
10%
What causes a 2° AV heart block in athletes and how can it be relieved?
Same cause as 1st degree AV block. (Increases PSNS tone and Decreased Resting SNS tone from exercise) Vagal maneuver relieves rhythm.
What are the six types of vagal maneuvers?
Valsalva maneuver
Cough
Gag
Hold your knees against your chest
Cold water treatment
Carotid sinus massage
What is the Valsalva maneuver?
Valsalva maneuver
Hold your nose, close your mouth, and try to blow the air out. This creates pressure in your chest that may activate the vagus nerve. Sitting or squatting may help. Try it for 10 seconds.
What is the cough vagal maneuver?
Cough
You need to cough hard to generate pressure in your chest and stimulate the vagus nerve. Children with tachycardia may not be able to cough hard enough to get a response from the vagus nerve.
What is the gag vagal maneuver?
Gag
You can try it with a finger. Your doctor might use a tongue depressor.
What is the hold your knees against your chest vagal maneuver?
Hold your knees against your chest:
Do it for a minute. This may work best for babies and children.
What is the cold water treatment vagal maneuver?
Cold water treatment
You might hear this called the diving reflex. You may need to put a plastic bag of ice on your face for 15 seconds. Or you can immerse your face in icy cold water for several seconds. It might also work to step into a cold shower or a cold bath.
What is the carotid sinus massage vagal maneuver?
Carotid sinus massage
Only a doctor should perform this one: Lie down and stick out your chin. The doctor will put pressure on your carotid sinus, a bundle of nerves surrounding the carotid artery in your neck just below your jaw. You’ll be monitored during the procedure.
What are three expected changes that might occur in an athlete’s ECG?
Incomplete RBBB – QRS Complex > 100ms
Left Ventricular Hypertrophy
Early Repolarization and ST segment Elevation
In what percent of athletes is Incomplete RBBB – QRS Complex > 100ms seen in?
35-50%
Who sees more Incomplete RBBB and QRS Complex > 100ms?
Males > females
What is the difference between a RBBB and Incomplete RBBB – QRS Complex > 100ms seen in athletes?
R chamber dilation and muscle mass as opposed to electrical conduction block
What is the treatment for Incomplete RBBB – QRS Complex > 100ms?
Treatment – decondition to resolve block
What causes LVH in athletes?
Increased training load –> LV wall thickening, ↑ chamber dilation
What percent of athletes show LVH on an ECG?
60%
What are ECG signs of LVH?
Increased QRS voltage – sum of S wave in V1 and R wave in V5 or V6 = >35mv
Left Axis Deviation
What percent of athletes show early repolarization on ECGs?
50-80%
Who may have early repolarization and ST-segment elevation?
Young healthy people <50 y/o
What can Early Repolarization and ST segment Elevation mimic?
It may mimic pericarditis or acute MI.
What to look for in an ECG with Early Repolarization and ST segment Elevation?
Watch for J point elevation at baseline with a slurring of the QRS.
-Looks like it slides over into a T wave.
-.1mm or greater
ATHLETE
What is an increase in vagal tone from exercise training called?
Hypervagaltonia
In what percent of ECGs do pathological changes occur?
<5%
What can pathological ECG changes predispose someone to?
Sudden death
What are seven pathological conditions that can be seen in an ECG?
-Arrhythmogenic right ventricular cardiomyopathy
-Hypertrophic cardiomyopathy
-Aortic valve stenosis
-Long QT syndrome
-Brugada syndrome
-Short QT syndrome
-Wolf-Parkinson-White syndrome
What is short Q-T syndrome?
(when discovered)
Rare Congenital defect of the heart causing an abnormal heart rhythm.
-Discovered in 1999
-Defect in the heart’s ion channels (Channelopathy)
The heart beats at a normal rate but the refractory time of ventricles is much shorter than normal
Pt’s with SQTS (short Q-T syndrome) demonstrate a Q-T interval that does not change with ____ ____ ____?
Pt’s with SQTS demonstrate a Q-T interval that does not change with Heart Rate changes
Normal Q-T intervals ____ with slower HR’s and ____ with faster HR’s?
Normal Q-T intervals lengthen with slower HR’s and shorten with faster HR’s.
What does short SQTS (short Q-T syndrome) predispose one to?
Condition Predisposes you to Atrial Fib, V-Tach, V-Fib/sudden death
What is the treatment for SQTS?
Treatment – Implantable cardiac defibrillator (ICD), Medication to regulate HR.
What is a normal QT vs a short QT?
Normal QT
Resting Rate:60 bpm
QT Interval:350-440 milliseconds
Short QT
Resting Rate:60 bpm
QT Interval:210 to 340 milliseconds
Who is diagnosed with short QT syndrome?
Pts Young, Healthy with no structural heart abnormalities
What age range of people present with short QT syndrome?
Presentation ranges from few months to 60yrs old
What is the most common presentation/symptoms of short QT syndrome?
Most common initial presentation = Cardiac Arrest
Palpitations w/ syncope
What is sudden infant death syndrome?
Witnessed cardiac arrest in first year of life and unexplained deaths of infants
What are three ECG features of short QT syndrome and two common conditions it may be seen in?
-Short QT interval
-Peaked T waves (precordial leads)
-Short or absent ST seg
-Paroxysmal Atrial Fib or VFib
When was Brudaga Syndrome discovered?
1992
What is Brugada’s Syndrome (triggered by and who is it common in)?
-Affects the way Electrical signals pass through the heart
-Defect in Heart Ion channels (Channelopathy)
-Often undetected Irregular rhythm that can lead to sudden cardiac death.
-Triggered by high temp, excessive Alcohol consumption, Dehydration
-More Common in Men.
What are the symptoms of Brugada’s Syndrome?
Heart palpitations
V-Tach
Syncope
A-Fib
Cardiac Arrest
Seizure
ECG appearance of Brugada Syndrome (which leads)?
Look for ST segment Elevation in V1, V2, V3
Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave.
What are less obvious ECG findings?
T Wave Inversions (TWI) ( >2mm or more. In 2 or more adjacent leads. Not benign as previously thought. Points to AVRC)
Non-Voltage Criteria for LVH (isolated QRS voltage for LVH common in athletes but not for HCM)
ST segment depression in 2 or more leads
(Resting ST seg depression is Rare with TWI)
Pathological Q waves ( > 3 mm in depth or > 40ms in duration
Exclude lead III and aVr)
What are ECG findings that suggest pathology in athletes (10)?
Conduction blocks
Prolonged QRS
Left Axis Deviation
Left Atrial Enlargement
Right Axis Deviation
Right Atrial Enlargement
Right Ventricular Hypertrophy
Ventricular pre-excitement Syndrome/Wolf Parkinson White Syndrome
Long QT Interval
Brugada like ECG pattern
