Cardiac Pathology in Cardiac Pathology in AthletesAthletes
Sudden DeathSudden Death
About 25 young patients die each About 25 young patients die each year nationally in sudden-initially year nationally in sudden-initially unexplained deaths on the field in all unexplained deaths on the field in all sports ~ usually heart related.sports ~ usually heart related.
Usually hypertropic cardiomyopathy Usually hypertropic cardiomyopathy or congenital abnormalitiesor congenital abnormalities
10:1 ratio male to female10:1 ratio male to female Football & Basketball see the highest Football & Basketball see the highest
incidents.incidents.
DefinitionDefinition
Sudden Death:Sudden Death:
90% collapse during or after activity90% collapse during or after activity 62% High School Age 62% High School Age
Heart Anatomy ReviewHeart Anatomy Review
Causes of Sudden DeathCauses of Sudden Death
Hypertrophic Cardiomyopathy (HCM)Hypertrophic Cardiomyopathy (HCM)
Aortic StenosisAortic Stenosis
Congenital Coronary Artery AnomaliesCongenital Coronary Artery Anomalies
Marfan SyndromeMarfan Syndrome
Mitral Valve ProlapseMitral Valve Prolapse
Hypertrophic Hypertrophic CardiomyopathyCardiomyopathy
DefinitionDefinition
Can occur c or s obstructionCan occur c or s obstruction
What happens then?What happens then?
Hypertrophic Cardiomyopathy Hypertrophic Cardiomyopathy cont.cont.
Clinical Presentation:Clinical Presentation:– HistoryHistory
– Physical ExamPhysical Exam
– The first clinical presentation of this The first clinical presentation of this condition may be sudden cardiac death!condition may be sudden cardiac death!
Hypertrophic Cardiomyopathy Hypertrophic Cardiomyopathy cont.cont.
Diagnostic tests:Diagnostic tests:
Bethesda Guidelines – HCMBethesda Guidelines – HCM– Patients with unequivocal diagnosis of Patients with unequivocal diagnosis of
HCM should not participate in most HCM should not participate in most competitive sports with possible competitive sports with possible exception of low intensity sports (i.e. exception of low intensity sports (i.e. BOWLING)BOWLING)
Coronary Artery Coronary Artery AbnormalitiesAbnormalities
Presentation:Presentation:
The 1The 1stst clinical presentation of this clinical presentation of this condition may sudden cardiac death!condition may sudden cardiac death!
Diagnostic Tests:Diagnostic Tests:
Marfan SyndromeMarfan Syndrome
5% of death due to rupture of aortic 5% of death due to rupture of aortic valvevalve
Abe LincolnAbe Lincoln Clinical physical signs:Clinical physical signs:
Bethesda Guidelines – Marfan’sBethesda Guidelines – Marfan’s– Patients s a family hx of sudden death & s Patients s a family hx of sudden death & s
aortic root dilitation ca participate in low & aortic root dilitation ca participate in low & moderate intensity sportsmoderate intensity sports
Rare causes of Sudden Rare causes of Sudden DeathDeath
Long QT SyndromeLong QT Syndrome: electrical : electrical abnormalityabnormality
Bethesda Guideline: QTBethesda Guideline: QT– Restrict from ALL competitive sportsRestrict from ALL competitive sports
Mitral Valve ProlapseMitral Valve Prolapse
Two flapped valve between LA and Two flapped valve between LA and LV balloons back into the LA with LV balloons back into the LA with each HB.each HB.
YOU NEED A CARDIAC YOU NEED A CARDIAC EVALUATION!EVALUATION!
When do you need to refer a When do you need to refer a patientpatient
Referrals/Common Cardiac Referrals/Common Cardiac S/SS/S
Syncope Syncope Chest painChest pain Decreased exercise toleranceDecreased exercise tolerance Tachycardia or palpitations c exerciseTachycardia or palpitations c exercise New or loud murmurNew or loud murmur HypertensionHypertension Finding of Marfan syndromeFinding of Marfan syndrome Family HxFamily Hx
Referrals/Common Cardiac Referrals/Common Cardiac S/SS/S
DyspneaDyspnea
FatigueFatigue
ClaudicationClaudication
Skin Color, Temp and AprearanceSkin Color, Temp and Aprearance
Generalized EdemaGeneralized Edema
Cardiac ExaminationCardiac Examination
Inspection:Inspection:
Palpation:Palpation:
Blood Pressure:Blood Pressure:
Pulse:Pulse: Auscultations:Auscultations:
AuscultationsAuscultations
A: (UR)A: (UR)
P: (UL)P: (UL)
T: (LL)T: (LL)
M: (Apex)M: (Apex)
Diagnostic TestingDiagnostic Testing
EKGEKG CXRCXR ECHOECHO Stress ECHOStress ECHO Transesophageal ECHOTransesophageal ECHO Thallium ScanThallium Scan Cardiac CatheterCardiac Catheter
You need a cardiac Work-Up You need a cardiac Work-Up if:if:
Pathological Murmur during DiastolePathological Murmur during Diastole If S1 or S2 not heard clearlyIf S1 or S2 not heard clearly Murmur in UL or UR (pulmonary/aortic)Murmur in UL or UR (pulmonary/aortic) Any murmur > IIAny murmur > II
– Scale: Scale: I= only cardiologist will hearI= only cardiologist will hearII= Softest of SoftestII= Softest of SoftestIII= SoftIII= SoftIV= Stethoscope flatIV= Stethoscope flatV= Stethoscope tiltedV= Stethoscope tiltedVI= Stethoscope nearly touchingVI= Stethoscope nearly touching
Commotio CordisCommotio Cordis
Blunt chest trauma resulting in Blunt chest trauma resulting in severe cardiac contusionsevere cardiac contusion
Immediate LOC, hypotension, rhythm Immediate LOC, hypotension, rhythm disturbancedisturbance
Tx: Precordial chest thumpTx: Precordial chest thump AED & Early CPRAED & Early CPR
SummarySummary
Sudden Death is a rare eventSudden Death is a rare event
Work-up depends on (+) Hx, as PE is Work-up depends on (+) Hx, as PE is subtle or often normalsubtle or often normal
The first presentation of sudden The first presentation of sudden death may be the event itselfdeath may be the event itself
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