Provides a critical update and review of salient topics needed for the proper cardiac evaluation and care of athletes
Discusses screening modalities for asymptomatic athletes, the management of existing cardiovascular disorders, and "sideline" management for acute cardiac conditions
Essential for all health care providers who evaluate and treat athletes, including sports cardiologists, general cardiologists, sports medicine specialists, team doctors and athletic trainers
Providing a critical update and review of salient topics needed for the proper cardiac evaluation and care of athletes, this text is designed to be the most up-to-date and practical manual for all health care providers who evaluate and treat athletes, including sports cardiologists, general cardiologists, sports medicine specialists, team doctors and athletic trainers.
The book is divided into three key sections. The first section discusses essential topics pertaining to the pre-participation cardiac screening of athletes, providing a framework for how best to perform pre-participation cardiac evaluations and optimize the interpretation of cardiac screening test results, and a guide to assist the streamlining of appropriate downstream testing when required. The second section reviews the management and care of athletes with specific, existing cardiovascular disorders, providing the reader with fundamental principles to help recognize and advise levels of sport participation to athletes with these disorders. The final section deals with acute sideline management of the symptomatic athlete and will again provide practical algorithms for cardiologists and non-cardiologists alike who are responsible for athlete health and safety in the sports arenas and training facilities.
Written and edited by highly regarded experts in the field of sports cardiology, including several cardiologists who are collegiate and professional team physicians and who work with professional sports organizations on developing policies for cardiac screening and monitoring, Sports Cardiology is an excellent practical resource for all clinicians working in the field.
Author(s): David J. Engel, Dermot M. Phelan
Edition: 1
Publisher: Springer
Year: 2021
Language: English
Pages: 402
Tags: Cardiology; Sports Cardiology; Sports Medicine; Athletic Heart
Preface
Contents
Contributors
Chapter 1: The Cardiovascular History and Examination
Introduction
The Cardiovascular Component of the PPE
Organization and Planning
Setting and Implementation
Personal and Family History
Physical Examination
Limitations of the History and Physical Examination
Determination of Clearance and Coordination of Follow-Up
Conclusion
References
Chapter 2: Using an Electrocardiogram as a Component of Athlete Screening
Should Every Athlete Have an ECG Added to Their Pre-participation Screening Exam? Findings from Epidemiological Studies
Strengths and Pitfalls of the ECG in Athlete Screening
Strengths of the ECG
Pitfalls of the ECG
Medical Society Guidelines and Position Statements
How Do We Interpret Athlete ECGs?
Development of Athlete-Specific ECG Interpretation Criteria
2017 International Recommendations
Conclusions
References
Chapter 3: Diagnostic Approach after Initial Abnormal Screening
Introduction
Overview of Downstream Testing
Use of Downstream Testing Following an ECG
When to Avoid Downstream Testing
When Downstream Testing Is Optional
Left Ventricular Hypertrophy Voltage Criteria
When Downstream Testing Is Required
T Wave Inversions (TWI)
ST Segment Depression
Pathologic Q Waves
Wolff-Parkinson-White (WPW) ECG Pattern
Complete Left Bundle Branch Block (LBBB)
Epsilon Waves
When Continued Surveillance Is Required
Symptoms That May Warrant Downstream Testing
Exertional Chest Discomfort
Syncope or Near Syncope
Palpitations and Arrhythmias
Inappropriate Exertional Dyspnea
Athletic Performance Decrement or Loss of Power
Special Populations
Athletes 40 Years and Older
Pediatric Athletes and Congenital Heart Disease (CHD)
Conclusions
References
Chapter 4: Practical Use of Genetic Testing in Athletes
Introduction
General Principles of Genetic Testing
Approaches to Genetic Testing
Genetic Diseases Associated with Sudden Cardiac Death
Specific Genetic Disorders in Which Competitive Exercise Is Discouraged
Arrhythmogenic Cardiomyopathy
Catecholaminergic Polymorphic Ventricular Tachycardia
Genetics and Sports Performance
Concerns Regarding Genetic Testing for Sports Employment
Conclusions
References
Chapter 5: Management of Hypertension in Athletes
Introduction
Hypertension and Cardiovascular Risk
Blood Pressure Measurement
Diagnosing Hypertension
Workup of Hypertension
Treatment of Hypertension
Clearance for Participation in Sport
Conclusions
References
Chapter 6: Valvular Heart Disease
Introduction
Aortic Valve Disease
Aortic Stenosis
Aortic Regurgitation
Mitral Valve Disease
Mitral Stenosis
Mitral Regurgitation
Tricuspid and Pulmonary Valve Disease
Valvular Interventions and Recommendations for Return to Play
Conclusion
References
Chapter 7: Hypertrophic Cardiomyopathy
Introduction
Differentiating Athlete’s Heart from Hypertrophic Cardiomyopathy
Clinical Course and Management
Prognosis
Benefits of Exercise in HCM
Current Recommendations for Sports Participation in HCM
Shared Decision-Making
Conclusion
References
Chapter 8: Other Cardiomyopathies
Introduction
EICR and Basic Physiologic Principles
Differing Characteristics of EICR Associated with Strength Versus Endurance Athletics
Distinguishing EICR from Cardiomyopathy: The Gray Zone
Dilated Cardiomyopathy
Distinction of DCM from EICR
Guidelines for Established Dilated Cardiomyopathy
Left Ventricular Non-compaction
Echocardiography and Cardiac MRI
Distinguishing LVNC and EICR
Guidelines for Established LVNC
Arrhythmogenic Right Ventricular Cardiomyopathy
Distinction Between Pathology and RV Adaptation in Athletes
Guidelines for ARVC
Infiltrative Cardiomyopathies
Guidelines for Infiltrative Cardiomyopathies
Conclusion
References
Chapter 9: Inflammatory Cardiac Disorders in the Athlete
Introduction
Myocarditis
Current Guideline Recommendations for Athletes with Myocarditis
American Heart Association (AHA)/American College of Cardiology (ACC) Guidelines
European Association of Preventive Cardiology (EAPC) Guidelines
Evidence for the Guidelines
Pathologic Mechanism of Myocarditis
Pericarditis
Current Guideline Recommendations for Athletes with Pericarditis
AHA/ACC Guidelines
EAPC Guidelines
Evidence for the Guidelines
Return to Play
Conclusion
References
Chapter 10: Atrial Fibrillation
Introduction
Epidemiology
Role of Training Intensity, Duration, and Sport
Pathophysiology
Animal Models
Left Atrial Enlargement
Vagal Tone
Myocardial Inflammation and Fibrosis
Other Factors
Clinical Evaluation
Management
Ongoing Training and Competition
Medical Therapy
Catheter Ablation
Anticoagulation
Conclusion
References
Chapter 11: Sports Participation in Patients with Congenital Long QT Syndrome
Introduction
Challenges of QTc Measurement in Athletes
Pathophysiology of Malignant Arrhythmia in LQTS
Diagnosis of LQTS
Utility of Beta Blockade and Other Treatments in LQTS
Role of ICD in the Management of LQTS
Surgical Management in LQTS
History of LQTS and Sports Participation
Current Risk Stratification in Athletes
Beyond Medical Therapy- Counseling and Preparedness on the Field
Role of Shared Decision Making in Athletes with LQTS
Future Directions
References
Chapter 12: Other Arrhythmic Disorders: WPW, CPVT, Brugada and Idiopathic VF/VT
Introduction
Wolff-Parkinson-White Syndrome
Background & Epidemiology
Pathophysiology
Diagnosis
Management
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)
Background & Epidemiology
Pathophysiology
CPVT Subtypes
Diagnosis
Management
Brugada Syndrome
Background
Epidemiology
Pathophysiology
Diagnosis
Differentiation from the Athlete’s ECG
Management
Idiopathic Ventricular Tachycardia/Ventricular Fibrillation
Background & Epidemiology
Pathophysiology
Diagnosis
Management
Conclusion
References
Chapter 13: Cardiovascular Implantable Electronic Devices in Athletes
Introduction
Pacemakers
Implantable Cardioverter-Defibrillator (ICD) Devices
Recommendations for Athletes with CIEDs for Competitive Sports Participation
Pediatric Athletes
Sideline Management
External Defibrillation in Shock Failure
Unnecessary ICD Shocks
Damage to Pacemakers/ICDs
Syncope During Sports Participation
Quality of Life in Athletes with CIEDs
Team Huddle (Shared Decision Making)
Conclusion
References
Chapter 14: Diagnosis and Management of Coronary Artery Disease in Athletes
Introduction
What Is the Scope of the Problem?
Mechanisms of Exercise-Related SCD due to CAD
Management of CAD in Athletes
Preparticipation Screening
Investigations
Limitations of Exercise Testing in Athletes with CAD
Management of an Athlete with Established CAD
Antiplatelet Therapy
Hypertension and Antihypertensive Therapy
Dyslipidemia and Lipid-Lowering Therapies
Return to Play After a Coronary Event
Coronary Artery Calcification in Endurance Athletes
Summary
References
Chapter 15: Marfan Syndrome and Other Genetic Aortopathies
Introduction
The Normal Aorta
Normal Population vs Athletes
Masters Athlete
Inherited Etiologies of Aortopathy
Bicuspid Aortic Valve (BAV)
Marfan Syndrome
Other Inherited Aortopathies
Management of Aortic Diseases in Athletes
Screening and Monitoring
Medical Management
Surgical Management
Considerations for the Athlete with Aortopathy
Exercise Guidance in the Athlete with Aortopathy
Sport Participation Guidelines
Conclusion
References
Chapter 16: Congenital Heart Disease: Approach to Evaluation, Management, and Physical Activity
Introduction
Common Congenital Defects and Recommendations for Sports Participation
Atrial Septal Defect (ASD)
Anatomy/Physiology
Surgical/Interventional Repair
Exercise Recommendations
Ventricular Septal Defect (VSD)
Anatomy/Physiology
Surgical Repair
Exercise Recommendations
Atrioventricular Septal Defect (AVSD)
Anatomy/Physiology
Surgical Repair
Exercise Recommendations
Tetralogy of Fallot (TOF)
Anatomy/Physiology
Surgical Repair
Exercise Recommendations
D-Transposition of the Great Arteries (D-TGA)
Anatomy/Physiology
Surgical Repair
Exercise Recommendations
Coarctation of the Aorta (CoAo)
Anatomy/Physiology
Surgical/Interventional Repair
Exercise Recommendations
Single Ventricle Spectrum
Anatomy/Physiology
Surgical Repair
Exercise Recommendations
Congenital Coronary Anomalies
Anomalous Origin from the Pulmonary Artery (ARCAPA/ALCAPA)
Anatomy, Pathophysiology, and Clinical Presentation
Surgical Repair
Exercise Recommendations
Anomalous Origin from the Aorta (AAOCA)
Anatomy and Pathophysiology
Clinical Presentation
Evaluation and Management
Exercise Recommendations
Conclusions
References
Chapter 17: Sleep Disorders in Athletes
Introduction
Obstructive Sleep Apnea in Athletes
Insomnia and Insomnia Complaints in Athletes
Circadian Rhythm Disorders in Athletes
Restless Legs Syndrome and Other Miscellaneous Sleep Disorders in Athletes
Conclusions
References
Chapter 18: Chest Pain and Dyspnea
Introduction
Dyspnea
Exercise-Induced Bronchoconstriction
Exercise-Induced Laryngeal Obstruction
Other Causes of Dyspnea
Structural Heart Disease
Anemia
Pulmonary Embolism
Pneumothorax
Chest Wall Abnormalities
Infectious Diseases
Chest Pain
Cardiac
Coronary Disease
Myocarditis
Pericarditis
Aorta Dissection
Palpitations
Gastrointestinal Causes
Chest Wall Pain
Psychiatric
Conclusion
References
Chapter 19: The Evaluation of Palpitations and Dizziness in the Athlete
Palpitations
History
Physical Exam
Evaluation
Prognosis
Dizziness
History
Physical Exam
Noncardiac Dizziness
Cardiac Dizziness
Reflex (Vasovagal) Dizziness and Autonomic Dysfunction
Exertional Cardiac Dizziness
Postexertional Dizziness
Diagnostic Approach to Palpitations and Dizziness in the Athlete
Low-Risk Athletes
High-Risk Athletes
12-Lead ECG
Transthoracic Echocardiography (TTE)
Ambulatory Rhythm Monitoring
Exercise Testing
Additional Diagnostic Testing
Cardiac MRI
EP Studies and Implantable Monitors
Shared Decision Making
Conclusions
References
Chapter 20: The Collapsed Athlete
Introduction
Approach to the Collapsed Athlete
Cardiac Arrest
Exercise-Associated Hyponatremia
Presentation & Diagnosis
Treatment
Prevention
Exertional Heat Stroke
Presentation & Diagnosis
Treatment
Prevention
Hypothermia
Presentation and Diagnosis
Treatment
Prevention
Respiratory Distress (Anaphylaxis, Asthma)
Anaphylaxis
Exercise-induced Bronchoconstriction and Asthma
Exertional Sickling
Presentation & Diagnosis
Treatment & Prevention
Hypoglycemia
Exercise-associated Collapse
Treatment & Prevention
Seizures
Trauma
Emergency Preparedness
Summary
References
Chapter 21: Cardiac Arrest in Athletes
Introduction
Incidence of Sudden Cardiac Death in Athletes
Causes of Sudden Cardiac Death in Athletes
Hypertrophic Cardiomyopathy
Anomalous Aortic Origin of a Coronary Artery
Arrhythmogenic Right Ventricular Cardiomyopathy
Atherosclerotic Coronary Artery Disease
Commotio Cordis
Pre-competition Screening of Athletes to Prevent Sudden Cardiac Death
Management of Sudden Cardiac Arrest in Athletes
Conclusion
References
Chapter 22: Commotio Cordis in Athletes
Introduction
Epidemiology
Proposed Mechanism of Action
Outcome/Resuscitation
Prevention of Commotio Cordis
Conclusion
References
Chapter 23: The Impact of COVID-19 on Sports Cardiology
Background
Cardiac Considerations
Practical Use of Cardiac Testing for COVID-19 Myocarditis
Troponin
Electrocardiography
Echocardiography
Cardiac Magnetic Resonance Imaging
Clinical Experience
Updated Expert Consensus Recommendations
Conclusions
Bibliography
Index
