WK7 - Infections, Asthma, Cardiac Conditions, Female Athletes Flashcards
What are the common organs affected in athletes?
- respiratory system
- skin
- gastrointestinal (some protection in form of gastric juices, enzymes)
Due to exposure to external environment
What does ‘itis’ mean?
refers to inflammation and infection
What does a droplet route of transmission commonly cause?
Direct contact
Most common infection route –> speaking, spitting, sneezing
- rhinovirus
- influenza
- measles
- glandular fever (mono)
What does direct contact of route of transmission commonly cause?
Due to direct contact
Cause from bacteria - skin breach
- staphylococci
- streptococci
What do viruses as a route of transmission commonly cause?
Due to close contact
- warts (HPV)
- cold sores (HSV) - can be recurring
Anything that decreases area integrity = likely if allergy, sunburn or anything that causes rubbing around mouth
What do fungal infections commonly cause?
From direct contact!
Tinea
- toes, sweaty feet
- transmitted on wet surfaces
- wet environments
Candida
- moist areas
- armpits
- groin
- breasts
Water and food are common places with infections can be transmitted, list some common infections?
Bacteria = salmonella, campylobacter (infected chicken/raw egg), E.Coli (waste, from dirty water sources)
Viruses = norovirus, rotavirus, Hep A
what are the risks of being in contact with body fluids?
Blood - must be removed and cleaned up. Clothing either thrown or kept in bag to be washed
Needle - accidental, IV drugs, tattoos
Sexual contact
sweat
saliva
What diseases can be contracted from animal vectors?
dengue (aedes aegypti)
ross river
culex annulirostris
aedes vigilax
malaria (not in Aus, but prevent in SEA, and PNG still –> ensure tablets/vax if travelling to countries with these viruses
What are the main infectious agents?
virus
bacteria
fungi
parasites
What are viral infections in sport?
- glandular fever (no contact sport if enlarged spleen)
- respiratory virus (fever, myaliga, arthralgia - rest)
- influenza (severe illness)
- human papilloma virus ( warts, stubborn to treat, increase risk of some cancers)
- Herpes Simplex (cold sores, sexual contact, no vaccine)
- molluscum contagiosum (viral skin infection)
- Hep A (faecal/oral, food/water, mild-severe illness, no chronic risks, fever)
- Hep B (body fluids, vomit, yellow skin, tiredness, dark urine, ab pain)
- Hep C (blood, IV drug use, no vacc, improved antiviral therapy)
Provide a summary of viral infections in sport.
systemic illness = no sport
- fever >37.5
- generalised myalgia and arthralgia
What are the common bacterial infections in sport?
- pimples
- acne
- abscess (boil) - pus needs to be drained under sterile conditions. Dont need antibiotics unless large area
- Impetigo (superficial infection on skin, antibiotics)
- Cellulitis (red, hot, swolling, tender)
- Otitis Externa - outer ear infection (ear canal, AKA swimmers/tropical ear, use ‘alcohol’ eardrops and topical antibacterial/steroid)
Provide summary of treating bacterial infections.
localised infections - drain pus
more serious infections - antibiotics
What are common fungal infections in sport?
Tinea (dermatophyte) - athletes foot, jock rash, underboobs/armpits, anywhere humid/sweaty. Use antifungal cream, dry area, remove wet clothing
Thrush - oral thrush in children, armpits/mouth/knees/back of legs, candida albicans most common, warm moist surfaces
Pityriasis versicolor - whitish areas of fungus, interferes with tanning melanocytes, treat with dandruff shampoo
Nail fungus - onychomycosis, dermatophyte most common, trimming + topical antifungal agents, prolonged oral antifungals
How to prevent fungal infections?
- wash hands and feet regularly
- wear sweat-absorbing socks/change socks throughout day
- shoes made of material that breathe
- discard old shoes or treat them with disinfectants/antifungal powders
- wear footwear in pool areas and locker rooms
- wear open footwear when possible
- ensure airflow!
What are common parasitic infections in sport?
Giarida - pools, microscopic protozoan, diarrhea, fatigue, malaise, ab cramps, nausea, weight loss (antibiotics)
List prevention methods of infections (always better than cure!).
Education!
- hand hygiene
- minimise droplet spread
- quarantine unwell athletes
- don’t share waterbottles
- separate towels/jerseys
- safe sex
- IV drugs
- immunisation
- vaccinations
- traveling
- influenza
Where to find vaccination record?
- medicare
- medicare card
- HEP b serology
List a few sport participation practical tips.
- thermometer - quantitative date to athlete
- fever >37.5
- subjective
- generalised muscle/joint pain
- high index of suspicious of infection
- glandular fever - no contact sport
What is the prevalence of asthma?
- common
- 10-20% children
- 10% adults
- 80% asthmatics get Ex induced asthma
What is the pathology of asthma?
Bronchospasm - constriction of smooth muscle around airways (wall of bronchioles) –> restricting airflow within bronchioles
Airway swelling - wall of bronchiole increases in size, narrow airway
Increased mucous production - plugs of mucous block bronchioles. Wall significantly swollen, thin wall lumen filled with mucous
List the triggers of asthma.
Ex - increased breathing rate, dries out air
Cold dry air - mostly likely to have attack in this env
Viral illness
Allergens (dust, mold, pollen, animal dandruff)
How to recognise asthma?
- shortness of breath
- wheezing when expiring (may move little air to avoid wheezing, severity not indicated by wheezing!)
- dry cough (tight)
Absence of wheeze does not rule out asthma –> cough variant asthma
How to recognise severe asthma attack?
- difficulty speaking (no complete sentences, 1 word at time)
- physically and emotionally distressed
- exhausted
- breathing effort (hollowing out collar bones, greater effort)
What are the ways of managing asthma?
Reliever (blue puffer)
- acute treatment, bronchodilators (relax smooth muscle), fast acting, can be used pre-sport. SE: shaking hands, increased HR, increased anxiety
Preventer (orange/brown puffer)
- reduce airway sensitivity, dry out mucous, reduce swelling
- used daily
- may require few weeks for results
- not used acutely, will not help on sporting field
- inhaled corticosteroids
What are the inhaling techniques for asthma?
If severe 4 puffs into spacer –> 4 breaths in/out, repeat every 4mins until ambulance arrives
No spacer
- shake inhaler
- deep breath in/out to empty lungs
- place puffer in mouth
- fire 1 puff, inhaling slowly/steadily
- hold breath 10s before breathing out
Turbuhaler
-Requires no coordination
-Shake inhaler
-Remove cap
-Keep upright at all times
-Twist base anticlockwise then clockwise until hear click
-Place mouthpiece in mouth
-Deep breath in, hole 10s
With spacer
-Shake inhaler
-Insert inhaler into spacer
-Place spacer mouthpiece in mouth
-Fire 1 puff – breathe in and out normally for 4 breaths through spacer
-repeat
Spacer
= increase dose in lungs
= reduce SE
= easy to use
What is the process of severe asthma first aid?
- sit upright
- reassure / remain with patient - give 4 separate puff of BLUE reliever
- shake puffer
- 1 puff into spacer - take 4 breaths - repeat - wait 4 mins
- if not better, give 4 more separate puffs, shake, 1 puff, 4 breaths - no improvement - call ambulance
- tell operator “asthma attack”. Keep giving 4 separate puffs every 4mins
What is the prevalence of sudden cardiac arrest (SCA) and death (SCD) in sport?
although sporting activity appears to increase relative risk of SCD, absolute no. of cases is larger in nonsporting population.
Clinical guidance
- athletes with CVD recommended shared-decision making (GP, cardiologist, coach, athlete, family)
What is the occurrence of SCA and SCD?
-Estimate of SCD rate range from ~1:100000 to 300000+
-Sport activity and training poses ~2.5x increased risk compared to that in non-athletes and recreational athletes
-3-5x higher incidence in males vs females
-NCAA data indicates black athletes have incidence ratio of 3.2 compared to white counterparts
What are the 3 major SCD categories in sport?
- structural cardiac abnormalities (usually genetic)
- electrical cardiac abnormalities
- acquired cardiac abnormalities (trauma / infection)
Provide examples of structural cardiac abnormalities.
- hypertrophic cardiomyopathy
- arrhythmogenic right ventricular cardiomyopathy
- congenital coronary artery anomalies
- marfan syndrome
- mitral valve prolapse/aortic stenosis
Provide examples of electrical cardiac abnormalities.
- Wolff Parkinson White syndrome
- congenital long QT syndrome
- Brugada syndrome
- catecholaminergic polymorphic ventricular tachycardia
Provide examples of acquired cardiac abnormalities.
- infection (myocarditis)
- trauma (commotio cordis)
- toxicity (illicit/performance-enhancing drugs)
- environment (hypo/hyperthermia)
What are the potential causes of conditions associated with SC in younger athletes (<35y)?
- 20-30% unknown (even post-mortem, hard to diagnose)
- 30-40% hypertrophic cardiomyopathy
- 7-17% congenital anomalies of coronary arteries (artery comes off wrong place of aorta)
- 5-10% arrthmogenic R ventricular cardiomyopathy (ARVC)
- 5% Marfan’s syndrome (genetics, deficiencies in collagen tissue)
- 5% myocarditis (infection/inflammation)
What is hypertrophic cardiomyopathy (HCM)?
~30-40% of SCD in young athletes due to HCM or possible HCm/idiopathic L ventricular hypertrophy
- extreme asymmetrical ventricular wall thickening
- prominent in septum
- blood volume out of ventricle reduced
- familial - genetic, autosomal dominant disease
- equal male and female no.
- 10 genes commonly associated with causing HCM
What are the symptoms of hypertrophic cardiomyopathy (HCM)?
-Sudden collapse and cardiac death (first symptom in many cases)
-Exertional dyspnea
-Chest pain
-Palpitations
-Syncope/presyncope
*Fainting/feeling faint
How to examine HCM?
-History but frequently normal
-ECG –> left ventricular hypertrophy (ST/T wave changes)
- Chest x-ray –> may show enlarged heart but frequently normal
- ECGraph–> left ventricular hypertrophy without dilation >15mm diagnostic
*Normal adaptation for athletes but once past 15mm differentiates the normal vs pathological
* Sluggish on echocardiogram, small ventricle and volume
Investigate using MRI
- visualise myocardial scarring using contrast agents (late enhancing gadolinium)
- significant prognostic relevance
What is the clinical recommendation for HCM?
Avoid competitive sport to reduce risk of SCD during/just after exercise
*Restricted outflow due to the scarring
*Abnormal pathways in heart, blocking and arrythmias
What is the pathology of arrhythmogenic R ventricular cardiomyopathy (ARVC)?
- fatty infiltration of RV
- fibro-fatty infiltration (scar tissue replacing myofibrils/myocytes)
- fibres replaced by fat/scar tissue
- predispose to severe arrhythmias during Ex - cease sport
40/10k in Italy have it, most common cause of SCD in young
What is the prevalence of ARVC?
- predominantly in males
- inherited autosomal dominant pattern
Ex related symptoms - 80% have symptosm
- dyspnoea
- syncope
- palpitations
- R ventricular outflow tract tachycardia
What is Coronary Artery Anomalies (CAAs)?
- Artery coming off wrong place
- congenital
- anomalous aortic origin of coronary artery (AAOCA)
- anomalous origin of coronary artery from pulmonary artery
- interarterial ALCA (L) and ARCA (R) associated with increased SCD risk
- 38-66^ of ALCA/ARCA patients have no pre-existing symptoms (first can result in SCD)
What are the mechanisms behind CAAs?
- occlusion (squeezed) or compression of anomalous vessels during exercise
Lead to myocardial ischaemia and subsequent lethal ventricular arrhythmia (ventricular tachycardia/fibrillation
What are recommendations for athletes with CAAs?
- WIth ALCA where artery passess between pulmonary artery and aorta –> restriction from all competition sports while waiting for surgical repair
After surgery –> return to intense activities may be considered IF asymptomatic and Ex stress test show no evidence of ischaemia/cardiac arrhythmias
What is myocarditis?
inflammation of myocardium,
- most often infection by common virus
In SCD, likely during chronic phase of myocarditis
- had disease, recovered but scarring on heart tissue
- inappropriate firing/no firing
- arrhythmias
What happens during the infected/recovered stage of myocarditis?
During
- avoid all aerobic Ex
- withdrawn from sport and training for 6months
Recovered
- when all ventricle function returns to normal/show no signs of arrhythmias
What is Marfan’s syndrome?
Genetic disorder of connective tissue, autosomal dominant disorder
- mutation to gene that makes fibrillin
- affects heart, lenses, aorta, lungs
Tall and thin, long arms, legs, fingers and toes
- occurs equally in males and females
What are the potential cardiac issues with Marfan’s syndrome?
- Aortic root dilation
*Assess and follow up with ECHO
*Beta blockers
*Moving away from high intensity sports to low intensity
*May need aortic/mitral valve replacements - Aortic Aneurysm
- Aortic dissection
*Most often fatal
*Surgical emergency
