Cardiac Pathology in Cardiac Pathology in AthletesAthletes

Sudden DeathSudden Death

About 25 young patients die each About 25 young patients die each year nationally in sudden-initially year nationally in sudden-initially unexplained deaths on the field in all unexplained deaths on the field in all sports ~ usually heart related.sports ~ usually heart related.

Usually hypertropic cardiomyopathy Usually hypertropic cardiomyopathy or congenital abnormalitiesor congenital abnormalities

10:1 ratio male to female10:1 ratio male to female Football & Basketball see the highest Football & Basketball see the highest

incidents.incidents.

DefinitionDefinition

Sudden Death:Sudden Death:

90% collapse during or after activity90% collapse during or after activity 62% High School Age 62% High School Age

Heart Anatomy ReviewHeart Anatomy Review

Causes of Sudden DeathCauses of Sudden Death

Hypertrophic Cardiomyopathy (HCM)Hypertrophic Cardiomyopathy (HCM)

Aortic StenosisAortic Stenosis

Congenital Coronary Artery AnomaliesCongenital Coronary Artery Anomalies

Marfan SyndromeMarfan Syndrome

Mitral Valve ProlapseMitral Valve Prolapse

Hypertrophic Hypertrophic CardiomyopathyCardiomyopathy

DefinitionDefinition

Can occur c or s obstructionCan occur c or s obstruction

What happens then?What happens then?

Hypertrophic Cardiomyopathy Hypertrophic Cardiomyopathy cont.cont.

Clinical Presentation:Clinical Presentation:– HistoryHistory

– Physical ExamPhysical Exam

– The first clinical presentation of this The first clinical presentation of this condition may be sudden cardiac death!condition may be sudden cardiac death!

Hypertrophic Cardiomyopathy Hypertrophic Cardiomyopathy cont.cont.

Diagnostic tests:Diagnostic tests:

Bethesda Guidelines – HCMBethesda Guidelines – HCM– Patients with unequivocal diagnosis of Patients with unequivocal diagnosis of

HCM should not participate in most HCM should not participate in most competitive sports with possible competitive sports with possible exception of low intensity sports (i.e. exception of low intensity sports (i.e. BOWLING)BOWLING)

Coronary Artery Coronary Artery AbnormalitiesAbnormalities

Presentation:Presentation:

The 1The 1stst clinical presentation of this clinical presentation of this condition may sudden cardiac death!condition may sudden cardiac death!

Diagnostic Tests:Diagnostic Tests:

Marfan SyndromeMarfan Syndrome

5% of death due to rupture of aortic 5% of death due to rupture of aortic valvevalve

Abe LincolnAbe Lincoln Clinical physical signs:Clinical physical signs:

Bethesda Guidelines – Marfan’sBethesda Guidelines – Marfan’s– Patients s a family hx of sudden death & s Patients s a family hx of sudden death & s

aortic root dilitation ca participate in low & aortic root dilitation ca participate in low & moderate intensity sportsmoderate intensity sports

Rare causes of Sudden Rare causes of Sudden DeathDeath

Long QT SyndromeLong QT Syndrome: electrical : electrical abnormalityabnormality

Bethesda Guideline: QTBethesda Guideline: QT– Restrict from ALL competitive sportsRestrict from ALL competitive sports

Mitral Valve ProlapseMitral Valve Prolapse

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

YOU NEED A CARDIAC YOU NEED A CARDIAC EVALUATION!EVALUATION!

When do you need to refer a When do you need to refer a patientpatient

Referrals/Common Cardiac Referrals/Common Cardiac S/SS/S

Syncope Syncope Chest painChest pain Decreased exercise toleranceDecreased exercise tolerance Tachycardia or palpitations c exerciseTachycardia or palpitations c exercise New or loud murmurNew or loud murmur HypertensionHypertension Finding of Marfan syndromeFinding of Marfan syndrome Family HxFamily Hx

Referrals/Common Cardiac Referrals/Common Cardiac S/SS/S

DyspneaDyspnea

FatigueFatigue

ClaudicationClaudication

Skin Color, Temp and AprearanceSkin Color, Temp and Aprearance

Generalized EdemaGeneralized Edema

Cardiac ExaminationCardiac Examination

Inspection:Inspection:

Palpation:Palpation:

Blood Pressure:Blood Pressure:

Pulse:Pulse: Auscultations:Auscultations:

AuscultationsAuscultations

A: (UR)A: (UR)

P: (UL)P: (UL)

T: (LL)T: (LL)

M: (Apex)M: (Apex)

Diagnostic TestingDiagnostic Testing

EKGEKG CXRCXR ECHOECHO Stress ECHOStress ECHO Transesophageal ECHOTransesophageal ECHO Thallium ScanThallium Scan Cardiac CatheterCardiac Catheter

You need a cardiac Work-Up You need a cardiac Work-Up if:if:

Pathological Murmur during DiastolePathological Murmur during Diastole If S1 or S2 not heard clearlyIf S1 or S2 not heard clearly Murmur in UL or UR (pulmonary/aortic)Murmur in UL or UR (pulmonary/aortic) Any murmur > IIAny murmur > II

– Scale: Scale: I= only cardiologist will hearI= only cardiologist will hearII= Softest of SoftestII= Softest of SoftestIII= SoftIII= SoftIV= Stethoscope flatIV= Stethoscope flatV= Stethoscope tiltedV= Stethoscope tiltedVI= Stethoscope nearly touchingVI= Stethoscope nearly touching

Commotio CordisCommotio Cordis

Blunt chest trauma resulting in Blunt chest trauma resulting in severe cardiac contusionsevere cardiac contusion

Immediate LOC, hypotension, rhythm Immediate LOC, hypotension, rhythm disturbancedisturbance

Tx: Precordial chest thumpTx: Precordial chest thump AED & Early CPRAED & Early CPR

SummarySummary

Sudden Death is a rare eventSudden Death is a rare event

Work-up depends on (+) Hx, as PE is Work-up depends on (+) Hx, as PE is subtle or often normalsubtle or often normal

The first presentation of sudden The first presentation of sudden death may be the event itselfdeath may be the event itself