Contents

Search

athletics

History: - past medical history: - exertional chest pain/ or chest discomfort - unexplained syncope or near-syncope - excessive exertional dyspnea - heart murmur - elevated systemic blood pressure [7] - family history: - premature death (sudden & unexpected, or otherwise) before age 50 years due to heart disease in one or more relatives - disability from heart disease in a close relative age < 50 years - certain cardiac conditions in family members - hypertrophic cardiomyopathy - dilated cardiomyopathy - long-QT syndrome or other ion channelopathy - Marfan syndrome - clinically significant cardiac arrhythmia Physical examination: - cardiac ascultation for heart murmur or cardiac arrhythmia - femoral pulses to exclude aortic coarctation - physical stigmata of Marfan syndrome - brachial artery blood pressure (sitting position) Complications: - long-term endurance exercise may increase risk of atrial fibrillation (2-10 fold risk) due to left ventricular hypertrophy -> left atrial enlargement [11] - iron-deficiency anemia in female vegetarian distance runners not uncommon [14] Management: Screening: 1) history of exertional symptoms: chest discomfort, breathless, or palpitations 2) presence of cardiac murmurs 3) regularity of cardiac rhythm 4) Marfan's phenotype 5) family history of sudden death or premature heart disease 6) no additional testing if history & physical normal [1] 7) mandatory cardiac screening - conditions associated with sudden cardiac death in 0.4% of teen athletes [12] - several cardiomyopathies that led to death were missed by screening programs [12] Avoid competition with: 1) significant flu-like symptoms 2) use of excess caffeine 3) illicit drugs & alcohol 4) anabolic steroids 5) proprietary cold medication athletes with pacemakers & ICD may be considered for high- intensity sports; risk for sudden death may be low [8] athletes with long-QT syndrome may be considered for competitive sports; risk for sudden death may be low [8] Head trauma: 1) no evidence that soccer ball heading causes retinal hemorrhage [2] 2) death from neurodegenerative disease more likely among former professional soccer players than matched controls (goalkeepers excepted) [13] 2) also see cerebral concussion Hyponatremia in marathon runners related to fluid consumption, especially weight gain during the race. Sport drinks vs water not significantly different. running barefoot or in minimalist footwear does not result in greater physiologic efficiency or injury prevention [6]. female vegetarian athletes with low normal ferritin, normal blood hemoglobin, upper normal MCV should be treated with standard elemental iron supplement, 100 mg of elemental iron/day according to [14] - see iron deficiency

Related

athlete's heart sports injury sudden death in competitive sports

Specific

football wrestling

General

activity

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18. American College of Physicians, Philadelphia 1998, 2015, 2018.
  2. Journal Watch 22(10):80, 2002
  3. Journal Watch 25(10):84, 2005 Almond CS, Shin AY, Fortescue EB, Mannix RC, Wypij D, Binstadt BA, Duncan CN, Olson DP, Salerno AE, Newburger JW, Greenes DS. Hyponatremia among runners in the Boston Marathon. N Engl J Med. 2005 Apr 14;352(15):1550-6. PMID: 15829535
  4. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006, 296:1593 PMID: 17018804 http://jama.ama-assn.org/cgi/content/full/296/13/1593 - Thompson PD & Levine BD Protecting athletes from sudden cardiac death JAMA 2006, 296:1648 PMID: 17018808 http://jama.ama-assn.org/cgi/content/full/296/13/1593
  5. Maron BJ and Zipes DP Introduction: Eligibility recommendations for competitive athletes with cardiovascular abnormalities--general considerations. J Am Coll Cardiol. 2005;45(8):1318-1321 PMID: 15837280 Free full text http://content.onlinejacc.org/article.aspx?articleid=1136511
  6. Gruber AH et al Economy and rate of carbohydrate oxidation during running with rearfoot and forefoot strike patterns. J Appl Physiol jap.01437.2012. May 16, 2013 PMID: 23681915 http://jap.physiology.org/content/early/2013/05/13/japplphysiol.01437.2012.abstract
  7. Mahmood S, Lim L, Akram Y, Alford-Morales S, Sherin K, ACPM Prevention Practice Committee. Screening for sudden cardiac death before participation in high school and collegiate sports: American College of Preventive Medicine position statement on preventive practice. Am J Prev Med. 2013 Jul;45(1):130-3 PMID: 23790999
  8. Maron BJ, Zipes DP, Kovacs RJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015 Oct 27. pii: S0735-1097(15)06548-1 PMID: 26542655 - Maron BJ, Zipes DP, Kovacs RJ Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations. A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015 Oct 27. pii: S0735-1097(15)06548-1 PMID: 26542655 http://circ.ahajournals.org/content/early/2015/11/02/CIR.0000000000000236
  9. Hainline B et al Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes. J Am Coll Cardiol. 2016 PMID: 27090220 http://content.onlinejacc.org/article.aspx?articleID=2513587#tab1
  10. Maron BJ, Thompson PD, Ackerman MJ et al Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation. 2007 Mar 27;115(12):1643-455. PMID: 17353433 Free Article
  11. Mont L et al Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter Europace 2009 11(1):11-17 PMID: 18988654
  12. Malhotra A, Dhutia H, Finocchiaro G et al. Outcomes of cardiac screening in adolescent soccer players. N Engl J Med 2018 Aug 9; 379:524 PMID: 30089062 https://www.nejm.org/doi/10.1056/NEJMoa1714719
  13. Mackay DF, Russell ER, Stewart K et al Neurodegenerative Disease Mortality among Former Professional Soccer Players. N Engl J Med. Oct 21, 2019 PMID: 31633894 https://www.nejm.org/doi/full/10.1056/NEJMoa1908483 - Stern RA Soccer and Mortality - Good News and Bad News. N Engl J Med. Oct 21, 2019 PMID: 31633893 https://www.nejm.org/doi/full/10.1056/NEJMe1912071 - Russell ER, Mackay DF, Stewart K et al Association of Field Position and Career Length With Risk of Neurodegenerative Disease in Male Former Professional Soccer Players. JAMA Neurol. Published online August 2, 2021 PMID: 34338724 PMCID: PMC8329793 Free PMC article https://jamanetwork.com/journals/jamaneurology/fullarticle/2782750
  14. NEJM Knowledge+ Hematology
  15. Mirabelli MH, Devine MJ, Singh J, et al. The preparticipation sports evaluation. Am Fam Physician. 2015;92:371-6. PMID: 26371570