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Sudden Cardiac Death in Sport: Pre-selection of participating athletes
Definition
Sudden death in Sport (SD) is defined as natural death occurring within one hour after onset of symptoms in an individual involved in the form, usually an elite sport. Sudden cardiac death contributes to 93% of sudden deaths in sport. Apparently, this happens in a person without acknowledging the conditions Cardiovascular predisposition. In some cases, pre-existing symptoms and may have been present, but time and circumstances of death are unexpected. This excludes cerebrovascular, respiratory, traumatic and causes related to drugs that are the source of the other 7% of all sudden deaths. "A major cause of death in contact sports is the shock CORDIS, which referred to one of my article.
Impact
The incidence of SD is estimated that about one death in 1 in 200,000 years with an average of 300 deaths per year, but the effect in May be higher, according to some European studies. An Italian study suggested the incidence of 1.6 to 2.3 per 100,000 athletes per year (2.1 per 100,000 per year due to cardiovascular causes) and 0.8. This clearly reflects a higher incidence in athletes.
Symptoms
Most cases are asymptomatic
Otherwise, the symptoms occur before the cards are SD
i. angina (chest pain thoracic)
II. dyspnea (breathing difficulty)
III. palpitations (awareness of heartbeat)
IV. Previous syncope or syncope (dizziness or fainting)
Etiology
Cardiovascular causes of sudden death
– Hypertrophic cardiomyopathy (HCM) nonobstructive, obstructive, ischemic, etc. – the disease of the aortic valve stenosis, prolapse of the aortic valve mitral
– Coronary Heart Disease
– Congenital anomalies of coronary arteries
– Idiopathic concentric left ventricular hypertrophy
– Out of the aorta
– Right ventricular dysplasia (ARVC)
– Myocarditis: Viral, sarcoidosis, amyloidosis
– Arrhythmias and conduction disturbances, congenital heart disease: Marfan syndrome WPW
– Pulmonary embolism
Drugs
– Increased QT erythromycin cisapride, domperidone, chlorpromazine, haloperidol, pimozide and clarithromycin
– The adrenaline, ephedrine, cocaine, etc.
– Improves performance: erythropoietin (hyperviscocity and thrombogenesis) anabolic
CORDIS Shock (CC)
Sudden Impact over the heart during a vulnerable period of cardiac cycle because of ventricular fibrillation and sudden death, without any visible lesion in the sternum or ribs, for example, contact sport. In 80% of cases of cardiovascular death in athletes sudden, the cause has been found that arrthymogenic cardiomyopathy or hypertrophic cardiomyopathy the right ventricle.
Considerations of age
In general, athletes> 35 years of age, of atherosclerotic coronary vascular disease is the leading cause, while <35 years, is often caused Ho Chi Minh, a silent heart disease is revealed during execution.
Geographical considerations in the etiology
In the United States, the Hypertrophic cardiomyopathy is the leading cause of SD. In contrast, in Europe, cardiac arrhythmia and abnormal arterial anatomy of the heart is supposed to be the main cause. An interesting fact is that all sudden deaths in the United States, 50% are among the athletes of African Americans. In Asia, however, (Philippines, Thailand, Japan), Brugada syndrome appears to be the most common cause of death among men of natural resources within 50 years. This is referred to cardiac arrest during sleep or rest and not during an athletic performance. An important observation is that these cases had experienced episodes reporting nightmares occur before the event. This may suggest a role of the sympathetic nervous system.
Risk stratification Sudden cardiovascular death
Clinique
a. Double push with each contraction ventricular apical
b. Unequal carotid pulse double pulse known as bisferiens
c. Ejection systolic murmur
Laboratory tests
Noninvasive
a. ECG: left ventricular hypertrophy, suggesting a depression there is also ST segment, inverted T wave higher, pathological Q waves, and the suggestion of a left bundle branch block, a left axis deviation
b. 2D echo to measure the thickness of the left ventricular wall, and anatomical variations of the mitral valve
c. Angio-CT
d. RM
e. Doppler: access blood flow in the chambers
f. Ambulatory Holter invasive cardiac catheterization: To evaluate the pressure gradient between the LV and ascending aorta in the normal heart, because there no such difference
Participation in screening / stress testing of athletes
Overwhelming majority of Researchers agree the sport need for screening before participation in sports. is mandatory in the United States and Italy. In Australia, it became mandatory in some sports. The American Heart Association has developed specific recommendations for the selection of athletes. They claim that "some form of pretest cardio-vascular involvement of high school and college athletes is justifiable and compelling reasons based on ethical, legal and medical. Non-invasive tests can improve the diagnostic potential classic history and physical examination, but it is unwise to make use systematic testing of 12-lead ECG, echocardiography, or exercise calibrated for detection of cardiovascular disease in large populations of athletes. Lausanne Recommendations have also established specific guidelines for the pre-selection. However, coaching by various organizations have given rise to much debate and there is no single guideline can be considered satisfactory.
Treatment
In general, the underlying mechanism of fibrillation of sudden cardiovascular death is ventricular, so that these can be treated with defibrillation. Thus, in elite sport, up gradation of infrastructure of sports first aid with the systematic use of defibrillators Automated External (AED) is the need of the hour. Bearing in mind the ABCs of resuscitation, sports surviving person is then transported in a health unit of reference for research into the causes of the event. Admission to the ICU for observation or management is often justified.
Discussion
In general, much research has been done and written about the sudden death cardiovascular-related sports, but thank you to the different results of different studies, confusion prevails over the exact definition of the disease and in fact, what exactly is the cause. While we know the conditions that predispose to sudden death in May, we can not yet, on the basis of testing or procedures available to say with certainty what state (s) would undoubtedly lead to sudden death. For example, the dilemma surrounding the ban on the athletes for competition. On one side there is the ethical problem of prevention of risks that can lead to death, while the other side there is the idea to ban an athlete if you do not know if his condition is in fact a medical condition. It could be argued to take risks is part and parcel of the sport, esp. , Boxing car race, etc., but the risks to life should be a strict "no-no." In conclusion, exercise or sport can lead to sudden death, but the benefits of exercise far outweigh the risks. Even athletes elite, the relation risk / benefit should be considered when you are disqualified or competition. It is very important to judge if the thickness of the left ventricular wall is a measure of physiological adaptation to exercise or refers to a heart disease. Exercise that this does not cause cardiovascular mortality. Is it therefore unmask heart disease due to a heart attack that would otherwise not have occurred if the person does not exercise or play sports? That is the question for the medical community to respond. With society increasingly concerned about the medical conditions associated with a sedentary lifestyle and eating habits, humanity can not afford discourage participation in sport or exercise in any case unless compelling evidence exists that kill performance.
About the Author
Dr Deepak S Hiwale
Sports Medic Aberdeen UK
drdeepakhiwale@aol.com
What is the best treatment for heart SVD? Where? for a diabetic patient?
Echo Report No change in regional wall motion Gross, normal LV systolic function with LVEF 60%, diastolic dysfunction, GR-1, concentric left ventricular hypertrophy, MR sweet without pericardial effusion / intracardiac clot. Conclusions CAG: Single Vessel Disease (thrombus containing lesion mi – DAL)
This can be well treated in any way the parameters of Cardiology interventional. The place where it was reported that should be good enough.
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