Week 4 The Athletes Heart Flashcards
is left ventricular hypertrophy healthy or normal for people?
ye, if it is reversible. Aerobically trained individuals can have this.
what happens with left ventricular hypertrophy
the wall is thicker, and the cavity size is thicker, so there can be more filling, and then more CO when the HR is high
what are some other normal responses to exercise
bradycardia, increased VO2, sinus arrhythmia, a transient split in S2.
how does a transient S2 change
changes with inspiration and expiration, and less common in adults.
what is post exercise syncope
exhaustion, exercise induced hyponatremia, head illness, rapid reduction in preload and sympatholysis.
what happens when we have syncope with exercise ?
this is more concerning, as this is related to things like HCOM, arrhythmogenic right cardiomyopathy.
how does syncope even happen
you stop exercising, suddenly. But you are still vasodilated. you also stop having the muscle pumping returning blood to the heart, and you decrease the preload. So the pressure will drop pretty dramatically.
what can dehydration do to CO and SV
it can decrease it.
TF: you are more able to handle hyperthermia when you are dehydrated
false, less able to handle it.
what can severe dehydration do to the heart
can cause arrhythmia.
what happens to your output, SV and HR when you are dehydrated.
SV and CO decrease, and HR increases.
what happens with acute, post exercise RV remodeling
you get an elevation in proBNP and cardiac troponin T levels, which can exceed the threshold to diagnosis an MI. you can get this in a non elite runner, like after a marathon, or even in ultra marathon runners. But it reverses
what happens with chronic, post exercise RV remodeling
you get the accumulation of calcium in the coronary artery, and myocardium fibrosis. the fibrosis comes from episodic volume and pressure overload, and you can get a-fib.
how does the right ventricle function after a race
it is decreased in all aspects, like EF, FAC and global SRs.
what is the leading cause of non traumatic death in athletes
sudden cardiac death, SCD
what sports, gender and face is SCD most common in
football and basketball
men
blacks
what is the most common cause of SCD in adults and kids
kids: HCM
Adults: undiagnosed CAD or a plaque rupture.
the most common mechanism of death from SCD is
ventricular tachyarrhythmia.
do you see more SCD from competitive sports in younger or older people
younger
what age range has the most SCD deaths
40-60
what are some causes of SCD
structural anomalias acquired anomalies (infection, trauma, toxicity, enviro) electrical anomalies
what is HCOM
hypertrophic cardiomyopathy
TF: HCOM has a strong genetic link
true
in HCOM, how does the ejection murmur change with position
it is soften in sitting and squatting, and amplified with standing and valsalva
in HCOM, what happens to the splitting S2
the splitting is permanent, and does not change with breath holds.
TF: you never get an S4 with HCOM
false, you can, if it is stiff enough and big enough.
is hypertrophy of the heart normal? what makes HCOM abnormal.
normally, you see a decrease in size when you detrain. In HCOM, you do not see this decrease in size.
what are two signs we see during exercise if you have HCOM
syncope and dyspnea.
does HCOM increase or decrease your ability to deliver O2
decreases
how do coronary anomalies play into SCD
you have anomalies in the vessels, that when you exercise, they are compressed, and blood flow in impaired. Then, you can get an arrhythmia.
what is a myocardial bridge
this is when an epicardial coronary artery is tunneled in the myocardium, and there is a compression of the tunneled segment. most people are asymptomatic, or can have chest discomfort and ECGs are usually normal.
how does a stress test affect someone with myocardial bridge
can induce non specific signs of ischemia, or disturbances and arrhythmia.
what are some of the complications of having a myocardial bridge
you can get ischemia, angina, MI, dysfunction of the chambers, AV node blocks and even tachy.
what is Marfans syndrome
a gene mutation that causes the overproduction of transforming growth factor beta (TGF beta).
what kind of cardio disorders are found in people with marfans
aortic ruptures or teats, mitral valve prolapse, or regurgitation, and arrhythmia.
what is commotio cordis
this is sudden blunt impact to the chest that can cause sudden death. usually in baseball, or anything that can attack you
commotion cordis triggers…
ventricular fibrillation
how can we prevent commotio cordis
by using shields and having AEDs on site. also, educating kids and coaches to turn away from a ball that is coming at you.
what does exercise do to your chance of dying, when you are an older adult
it decreases it.
what happens to all cause mortality when people begin walking
decreases
according to the AHA screening recommendations, what age group should be screened
12 -25 year olds,
does the AHA support the usage of ECG screenings
no, but they should. they do not because they cost money and you can get false positives.
does the risk of SCD decrease when you get an ECG
yes
what is the most common cause of SCD in patients less than 35
HCOM
in HCOM, the ECG is abnormal what percent of the time
90%
what are some positive findings in athletes ECG
Brady, arrhythmia, ectopic atrial rhythms, first degree AV node block, and second degree too, early repolarization.
in Italy, they mandate screening, and their SCD increases or decreases
decreases.
for someone who has never exercised before, we should gradually increase activity starting at what MET
3, so this is like walking.
what else does this implicate for PT
we should do submax, take it easy on exercise intensity with patients. know CPRs, have AED and climate control the facility.
