Sports Cardiology: Care of the Athletic Heart from the Clinic to the Sidelines

Description

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 interpret​at​ion 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. 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