Cardiac Pathology in Athletes

Sudden Death About 25 young patients die each year nationally in sudden-initially unexplained deaths on the field in all sports ~ usually heart related. About 25 young patients die each year nationally in sudden-initially unexplained deaths on the field in all sports ~ usually heart related. Usually hypertropic cardiomyopathy or congenital abnormalities Usually hypertropic cardiomyopathy or congenital abnormalities 10:1 ratio male to female 10:1 ratio male to female Football & Basketball see the highest incidents. Football & Basketball see the highest incidents.

Definition Sudden Death: Sudden Death: 90% collapse during or after activity 90% collapse during or after activity 62% High School Age 62% High School Age

Heart Anatomy Review

Causes of Sudden Death Hypertrophic Cardiomyopathy (HCM) Hypertrophic Cardiomyopathy (HCM) Aortic Stenosis Aortic Stenosis Congenital Coronary Artery Anomalies Congenital Coronary Artery Anomalies Marfan Syndrome Marfan Syndrome Mitral Valve Prolapse Mitral Valve Prolapse

Hypertrophic Cardiomyopathy Definition Definition Can occur c or s obstruction Can occur c or s obstruction What happens then? What happens then?

Hypertrophic Cardiomyopathy cont. Clinical Presentation: –H–H–H–History –P–P–P–Physical Exam –T–T–T–The first clinical presentation of this condition may be sudden cardiac death!

Diagnostic tests: Bethesda Guidelines – HCM –P–P–P–Patients with unequivocal diagnosis of HCM should not participate in most competitive sports with possible exception of low intensity sports (i.e. BOWLING)

Coronary Artery Abnormalities Presentation: Presentation: The 1 st clinical presentation of this condition may sudden cardiac death! The 1 st clinical presentation of this condition may sudden cardiac death! Diagnostic Tests: Diagnostic Tests:

Marfan Syndrome 5% of death due to rupture of aortic valve 5% of death due to rupture of aortic valve Abe Lincoln Abe Lincoln Clinical physical signs: Clinical physical signs: Bethesda Guidelines – Marfan’s Bethesda Guidelines – Marfan’s –Patients s a family hx of sudden death & s aortic root dilitation ca participate in low & moderate intensity sports

Rare causes of Sudden Death Long QT Syndrome: electrical abnormality Bethesda Guideline: QT –R–R–R–Restrict from ALL competitive sports

Mitral Valve Prolapse Two flapped valve between LA and LV balloons back into the LA with each HB. Two flapped valve between LA and LV balloons back into the LA with each HB.

YOU NEED A CARDIAC EVALUATION! When do you need to refer a patient

Referrals/Common Cardiac S/S Syncope Syncope Chest pain Chest pain Decreased exercise tolerance Decreased exercise tolerance Tachycardia or palpitations c exercise Tachycardia or palpitations c exercise New or loud murmur New or loud murmur Hypertension Hypertension Finding of Marfan syndrome Finding of Marfan syndrome Family Hx Family Hx

Referrals/Common Cardiac S/S Dyspnea Dyspnea Fatigue Fatigue Claudication Claudication Skin Color, Temp and Aprearance Skin Color, Temp and Aprearance Generalized Edema Generalized Edema

Cardiac Examination Inspection: Inspection: Palpation: Palpation: Blood Pressure: Blood Pressure: Pulse: Pulse: Auscultations: Auscultations:

Auscultations A: (UR) A: (UR) P: (UL) P: (UL) T: (LL) T: (LL) M: (Apex) M: (Apex)

Diagnostic Testing EKG EKG CXR CXR ECHO ECHO Stress ECHO Stress ECHO Transesophageal ECHO Transesophageal ECHO Thallium Scan Thallium Scan Cardiac Catheter Cardiac Catheter

You need a cardiac Work-Up if: Pathological Murmur during Diastole Pathological Murmur during Diastole If S1 or S2 not heard clearly If S1 or S2 not heard clearly Murmur in UL or UR (pulmonary/aortic) Murmur in UL or UR (pulmonary/aortic) Any murmur > II Any murmur > II –Scale: I= only cardiologist will hear II= Softest of Softest III= Soft IV= Stethoscope flat V= Stethoscope tilted VI= Stethoscope nearly touching

Commotio Cordis Blunt chest trauma resulting in severe cardiac contusion Blunt chest trauma resulting in severe cardiac contusion Immediate LOC, hypotension, rhythm disturbance Immediate LOC, hypotension, rhythm disturbance Tx: Precordial chest thump Tx: Precordial chest thump  AED & Early CPR

Summary Sudden Death is a rare event Sudden Death is a rare event Work-up depends on (+) Hx, as PE is subtle or often normal Work-up depends on (+) Hx, as PE is subtle or often normal The first presentation of sudden death may be the event itself The first presentation of sudden death may be the event itself