Clinics in Sports Medicine Volume 34, Issue 3, Pages 381-594 (July 2015) Sports Cardiology

    • The Impact of Sports Cardiology on the Practice of Primary Care Sports Medicine: Where Were We, Where Are We, Where Are We Headed?

      Review Article
    • Pages 381-390
    • Siobhan Statuta, Dilaawar J. Mistry, Robert W. Battle
    • This article is a commentary on the role of sports cardiologists in the athletic arena and the beneficial impact they offer sports medicine in the comprehensive care of competitive athletes. The focus is a dialogue on current recommendations for primary prevention of sudden cardiac arrest (SCA), incorporating elements of the preparticipation evaluation and continuing care of athletes with diagnosed heart disease (HD). The feasibility and potential advantages of implementing well-designed preparticipation cardiovascular screening programs and the role of sports cardiologists to educate primary care team physicians on secondary prevention of SCA and proper treatment of underlying HD are discussed.

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    • The Cardiovascular Physiology of Sports and Exercise

      Review Article
    • Pages 391-404
    • Mildred A. Opondo, Satyam Sarma, Benjamin D. Levine
    • Athletes represent the extremes of human performance. Many of their remarkable abilities stem from a cardiovascular system that has adapted to meet the metabolic needs of exercising muscle. A large and compliant heart is a hallmark feature of athletes who engage in highly aerobic events. Despite high fitness levels, athletes may present with symptoms that limit performance. Understanding and dissecting these limitations requires a strong background in sports science and the factors that determine sports capabilities. This article reviews the basic principles of exercise physiology, cardiovascular adaptations unique to the “athlete’s heart,” and the utility of exercise testing in athletes.

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    • Cardiovascular Adaptation and Remodeling to Rigorous Athletic Training

      Review Article
    • Pages 405-418
    • Rory B. Weiner, Aaron L. Baggish
    • Exercise-induced cardiac remodeling is a complex process by which the cardinal hemodynamic stresses of pressure and volume lead to a host of structural or functional adaptations. In aggregate, the constellation of changes that accompany this process serve to facilitate athletic performance by minimizing the cardiac work inherent in athletic activity. Although several key determinants of athletic cardiac adaptation have been described, observed variability across athlete cohorts remains an incompletely understood area. Ongoing and future work are required to further understand this process and ultimately to determine where the boundary lies between adaptive physiology and maladaptive disease.

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    • The Electrocardiogram in Highly Trained Athletes

      Review Article
    • Pages 419-431
    • Keerthi Prakash, Sanjay Sharma
    • Regular intensive exercise is associated with a constellation of several structural and functional adaptations within the heart that permit the generation of a large and sustained increase in cardiac output and/or increase in blood pressure. The magnitude with which these markers of physiological remodeling manifest on the surface electrocardiogram is governed by several factors and some athletes show electrical and structural changes that overlap with those observed in cardiomyopathy and in ion channel diseases, which are recognized causes of sudden cardiac death in young athletes. This article provides a critical appraisal of the athlete's ECG.

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    • Advanced Imaging of Athletes: Added Value of Coronary Computed Tomography and Cardiac Magnetic Resonance Imaging

      Review Article
    • Pages 433-448
    • Matthew W. Martinez
    • Cardiac magnetic resonance imaging and cardiac computed tomographic angiography have become important parts of the armamentarium for noninvasive diagnosis of cardiovascular disease. Emerging technologies have produced faster imaging, lower radiation dose, improved spatial and temporal resolution, as well as a wealth of prognostic data to support usage. Investigating true pathologic disease as well as distinguishing normal from potentially dangerous is now increasingly more routine for the cardiologist in practice. This article investigates how advanced imaging technologies can assist the clinician when evaluating all athletes for pathologic disease that may put them at risk.

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    • Cardiovascular Concerns in Water Sports

      Review Article
    • Pages 449-460
    • Alfred A. Bove
    • The cardiac effects of aquatic sports have increased in interest with the experience of cardiac responses to swimming and diving. The syndrome of swimming-induced pulmonary edema is likely caused by a combination of central blood shifts, sudden onset of high exercise demands, and impaired diastolic relaxation of the left ventricle. Divers also develop venous gas emboli caused by nitrogen supersaturation in blood and tissues during ascent from depth. The physiology and physics of water immersion and diving are unique. Knowledge of pressure effects, gas solubility, and changes in gas volumes with depth is needed to understand the disorders related to these activities.

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    • Diseases of the Aorta in Elite Athletes

      Review Article
    • Pages 461-472
    • Aline Iskandar, Paul D. Thompson
    • Sudden cardiovascular deaths in athletes are rare and only a fraction are due to aortic events. There has been concern that the hemodynamic load during exercise may lead to aortic dilation, but aortic dimensions in endurance and strength-trained athletes are only slightly larger than those in sedentary comparison subjects. The presence of a bicuspid aortic valve without significant valvular dysfunction and normal aortic dimensions should not influence eligibility to practice sport. Patients with genetic syndromes associated with aortopathy generally should be restricted from vigorous sports participation. This article reviews the diagnosis and management of diseases of the aorta in athletes.

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    • Athletes with Implantable Cardioverter Defibrillators

      Review Article
    • Pages 473-487
    • Shiva P. Ponamgi, Christopher V. DeSimone, Michael J. Ackerman
    • Athletes with an implantable cardioverter defibrillator (ICD) represent a diverse group of individuals who may be at an increased risk of sudden cardiac death when engaging in vigorous physical activity. Therefore, they are excluded by the current guidelines from participating in most competitive sports except those classified as low intensity, such as bowling and golf. The lack of substantial data on the natural history of the cardiac diseases affecting these athletes as well as the unknown efficacy of ICDs in terminating life-threatening arrhythmias occurring during intense exercise has resulted in the restrictive nature of these now decade old guidelines.

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    • Sports and Exercise in Athletes with Hypertrophic Cardiomyopathy

      Review Article
    • Pages 489-505
    • Craig Alpert, Sharlene M. Day, Sara Saberi
    • Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease and one of the most common causes of sudden cardiac death (SCD). Current guidelines restrict the participation of patients with HCM in competitive sports, limiting the health benefits of exercise. However, many individuals with HCM have safely participated in sports, with a low incidence of SCD. Improved stratification of patients and desired activity may allow most individuals with HCM to engage in physical activity safely. Therefore, physicians should create an individualized approach in guiding each patient with HCM eager to enjoy the benefits of physical activity in a safe manner.

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    • Legal and Ethical Issues in the Cardiovascular Care of Elite Athletes

      Review Article
    • Pages 507-516
    • Michael S. Emery, Eric F. Quandt
    • This article presents an overview of the legal and ethical issues in the cardiovascular care of elite athletes. An important distinction between the assessment and care of elite athletes and the general population necessitates an understanding of the applicable legal standard and the limitation of potential exposures. Important recommendations and pertinent case law is presented that can assist the medical provider in comprehending important considerations with regard to preparticipation evaluations, return-to-play decisions, and second opinions in elite athletes.

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    • Something Old, Something New: Using Family History and Genetic Testing to Diagnose and Manage Athletes with Inherited Cardiovascular Disease

      Review Article
    • Pages 517-537
    • Matthew J. Thomas, Robert W. Battle
    • A primary objective of the preparticipation physical examination is to identify athletes at increased risk for sudden cardiac arrest (SCA). Review of an athlete’s family history may identify those at risk for SCA. Genetic testing for inherited cardiovascular disease has emerged as a valuable addition to the repertoire of cardiologists facing the decision of clearing athletes with concerning clinical signs and/or family histories. Genetic testing may lead to various outcomes for an athlete including: reassurance, diagnosis in those with borderline clinical features, finding disease predisposition prior to the onset of clinical signs (ie, genotype-positive/phenotype-negative), or continued uncertainty.

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    • How to Practice Sports Cardiology: A Cardiology Perspective

      Review Article
    • Pages 539-549
    • Christine E. Lawless
    • The rigorous cardiovascular (CV) demands of sport, combined with training-related cardiac adaptations, render the athlete a truly unique CV patient and sports cardiology a truly unique discipline. Cardiologists are advised to adopt a systematic approach to the CV evaluation of athletes, taking into consideration the individual sports culture, sports-specific CV demands, CV adaptations and their appearance on cardiac testing, any existing or potential interaction of the heart with the internal and external sports environment, short- and long-term CV risks, and potential effect of performance-enhancing agents and antidoping regulations. This article outlines the systematic approach, provides a detailed example, and outlines contemporary sports cardiology core competencies.

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    • The Management of Athletes with Congenital Heart Disease

      Review Article
    • Pages 551-570
    • Silvana Molossi, Michelle Grenier
    • Although rare, sudden cardiac death (SCD) is devastating to families and communities. Screening of athletes prior to sports participation by trained professionals is useful in identifying individuals who carry known risk factors for SCD. Inclusive in this population are those athletes with congenital heart disease. Sports medicine specialists should be able to identify those at risk for adverse events surrounding vigorous activity and direct appropriate evaluation by the specialist (ie, cardiologist) as deemed appropriate. Equally importantly, they should be able to coach individuals in order to improve performance and quality of life with exercise in a safe environment.

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    • The Historical Perspective of Athletic Sudden Death

      Review Article
    • Pages 571-585
    • Walter J. Hoyt Jr., Peter N. Dean, Robert W. Battle
    • Since antiquity, the athlete has been elevated to a heroic status both within small communities and at the international level. Although numerous population studies have estimated athletic sudden death to be a rare event, the consequences resonate far beyond those directly affected. Sports cardiology has evolved as a result of these tragedies, which highlighted a need for safer play and more programmatic protection of the athlete in play. In this article, athletic sudden death is analyzed from a historical and literary perspective and the development of modern initiatives to protect athletes from sudden death is reviewed.

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Autor / Fonte:Clinics in Sports Medicine Volume 34, Issue 3, Pages 381-594 (July 2015) Sports Cardiology
Link: http://www.sciencedirect.com/science/journal/02785919