Η ΚΑΡΔΙΑ ΤΟΥ ΑΘΛΗΤΗ ______________________________________________________________ THE HEART OF THE ATHLETE Sources: J Am Coll Cardiol & W. B. Baker, MD,

Παρουσίαση με θέμα: "Η ΚΑΡΔΙΑ ΤΟΥ ΑΘΛΗΤΗ ______________________________________________________________ THE HEART OF THE ATHLETE Sources: J Am Coll Cardiol & W. B. Baker, MD,"— Μεταγράφημα παρουσίασης:

1 Η ΚΑΡΔΙΑ ΤΟΥ ΑΘΛΗΤΗ ______________________________________________________________ THE HEART OF THE ATHLETE Sources: J Am Coll Cardiol & W. B. Baker, MD, FACC Δρ Δημήτρης Ψυρρόπουλος, Ειδικός Καρδιολόγος, MD, PhD Συντονιστής Διευθυντής Καρδιολογίας ex, Καρδιολογική Κλινική Γ.Ν.Θ. «Γ. Γεννηματάς & Άγιος Δημήτριος» ΠΡΟΤΥΠΗ ΚΑΡΔΙΟΛΟΓΙΚΗ ΔΙΑΓΝΩΣΗ ΕΝΗΛΙΚΩΝ & ΠΑΙΔΩΝ – ProCardia 1 Κλεάνθους 16 (γωνία Κ. Καραμανλή), Ιπποκράτειο, Θεσσαλονίκη, ΤΚ 54642 –Επικοινωνία: τηλ 2310 913 880 & κιν 6944 372 956 e-mail: dps.kardiologos@gmail.com www.kardiologos-1.net& www.kardiologika.blogspot.gr

2 EXERCISE IS GOOD FOR YOU ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 2

3 BENEFITS OF EXERCISE DISEASE PREVENTION Cardiovascular Diabetes Osteoporosis, joint health FITNESS WEIGHT CONTROL ENJOYMENT Personal Goals Competition ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 3

4 DEFINITIONS FOR THIS TALK EXERCISE: Any form of physical activity, done on a regular basis, with the purpose of achieving a specific goal Low level to vigorous Recreational (including “play”) to competitive ATHLETE: Anyone who is exercising YOUNG ATHLETE: Less than 35 years old ADULT ATHLETE: Greater than 35 years old ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 4

5 COULD YOUR “WORKOUT” CAUSE YOU CARDIOVASCULAR HARM? ANSWER: YES THE RISK IS SMALL THE CONSEQUENCES ARE SIGNIFICANT WHAT THE RISK IS AND WHAT CONDITIONS ARE RESPONSIBLE FOR THE RISK VARY BY AGE ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 5

6 Who are we talking about, what are the numbers and what are we talking about ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 6

7 THE YOUNG ATHLETE AND THE RISK (US numbers) All deaths related to exercise: 120/year (excluding trauma) Deaths caused by CVD: < 100/year Approximately 1 CVD death/100,000/year CVD death in affected athletes is not limited to exercise times At least 2-3 X more likely during exercise All the “conditions” that might harm athletes are just as prevalent in non-athletes. Athletes are at higher risk. ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 7

8 THE YOUNG ATHLETE HOW MANY ARE AT RISK? 44 Million youths participate in “sports programs” 3.5 Million high school athletes 500,000 college athletes in the US 10,000 “pro-athletes” in the US IF A CONDITION THAT CAN HARM AN ATHLETE AFFECTS 1 IN 500 YOUTHS, HOW MANY ARE AT RISK? ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 8

9 THE YOUNG ATHLETE A SAMPLING OF THE CAUSES Structural Heart Disease Hypertrophic Cardiomyopathy Anomalous Origin of the Coronary Arteries Arrhythmogenic Right Ventricular Cardiomyopathy Myocarditis/Cardiomyopathy Valvular Disease The “Channelopathies” - (Δίαυλοι ιόντων) Marfan Syndrome, etc. ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 9

10 THE YOUNG ATHLETE A SAMPLING OF THE CAUSES ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 10

11 Why do they die? Maron et al, Cardiology Clinics 1996 ; 14 : 196 Maron says:-

12 THE YOUNG ATHLETE ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 12

13 SUDDEN CARDIAC DEATH IN ATHLETES Remember: - Pheidippides (490 BC) 40 - Jim Fixx (1984) 52 MI - Flo Hyman (1986) 32 AoDis Voll - Pete Maravich (1988) 40 CAAn - Hank Gathers (1990) 23 VT/Cm - Reggie Lewis (1993) 27 FHxHOCM - Sergei Grinkov (1995) 29 MI and others ….

14 THE YOUNG ATHLETE and SUDDEN CARDIAC DEATH Rare events Without warning Devastating Occur in healthy individuals Attract attention ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 14

15 MECHANISM OF SUDDEN DEATH Ventricular Tachycardia and Ventricular Fibrillation Normal EKG Ventricular Tachycardia Polymorphic Ventricular Tachycardia Ventricular Fibrillation ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 15

16 THE YOUNG ATHLETE and SUDDEN CARDIAC DEATH The “Underlying Substrate”: Many of these conditions predispose to lethal arrhythmia There can be changes in the athlete’s heart that may increase the risk Hypertrophy (the “muscular heart”) LV and RV dilation (the “enlarged heart”) Increased demand and “adrenalin” ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 16

17 THE YOUNG ATHLETE SOME SPECIFIC EXAMPLES ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 17

18 HYPERTROPHIC CARDIOMYOPATHY ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 18

19 HYPERTROPHIC CARDIOMYOPATHY Affects 1 in 500 individuals Genetically determined Sporadic or inherited At least 11 genes, 1400 mutations Accounts for 35 – 40% of athletic deaths Can be symptomatic/detectable before SCA Increased risk with age Ventricular arrhythmia is primary cause of death ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 19 HANK GATHERS 1967 - 1990

20 HYPERTROPHIC CARDIOMYOPATHY Treatment: Medical Treatment: Implantable Defibrillator “Disqualified” from participation in all but low effort sports (bowling, curling) regardless of symptoms, phenotype, treatment. ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 20

21 The IMPLANTIBLE CARDIAC DEFIBRILLATOR (ICD) ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 21

22 DISQUALIFIED? The 36 th Bethesda Conference ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 22

23 THE 36 TH BETHESDA CONFERENCE - 2005 ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 23 maximal voluntary contraction

24 ANOMALOUS ORIGIN OF THE CORONARY ARTERIES ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 24

25 ANOMALOUS ORIGIN OF THE CORONARY ARTERIES Accounts for 15 – 20% of sudden death in young athletes Can be symptomatic (< 50%) Chest discomfort Shortness of breath Palpitations Fainting Treatment: Medical or Surgical May be “cleared” to participate if corrected ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 25

26 ARRYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 26

27 ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY Prevalence: 1/1000 – 2000 Genetic, 30% inherited. Accounts for 5% of sudden death in young athletes Can be symptomatic: palpitations, fainting Treatment: medical, ICD Disqualified from competitive sports ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 27

28 MYOCARDITIS / CARDIOMYOPATHY ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 28

29 MYOCARDITIS / CARDIOMYOPATHY Accounts for 5 -10% of sudden cardiac arrests in young athletes Causes: “viral”, inherited/genetic, idiopathic Can be symptomatic: shortness of breath, palpitations, fatigue/weakness, fainting, chest discomfort Treatment: Medical, time, ICD, transplant Disqualified from most competitive sports. May return if recover. ICD = no contact sports ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 29

30 MARFAN SYNDROME Connective tissue disorder Genetic 25% sporadic Autosomal Dominant 1/3000 – 5000 ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 30

31 MARFAN SYNDROME ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 31

32 COMMOTIO CORDIS – ΔΙΑΣΕΙΣΗ ΚΑΡΔΙΑΣ Vulnerable moment High force, specific area Baseball, hockey, karate, etc. Kids more vulnerable 20% survival Boys > girls Prevention key (Training to avoid impact & vests ?) ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 32 Human adult thorax, showing the outline of the heart (in red). The sensitive zone for mechanical induction of heart rhythm disturbances lies between the 2nd and the 4th ribs, to the left of the sternum. From 1996 to spring 2007, the USA National Commotio Cordis Registry had 188 cases recorded, with about half occurring during organized sports. Almost all (96%) of the victims were male, the mean age of the victims during that period was 14.7 years.

33 INHERITED ARRHYTHMIA and SUDDEN CARDIAC ARREST The “Channelopathies” (Δίαυλοι ιόντων) ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 33

34 WHAT IS A CHANNEL? ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 34

35 THE CHANNELOPATHIES AND SUDDEN CARDIAC ARREST (A SAMPLING) Long QT Syndrome Brugada Syndrome Catecholaminergic Polymorphic Ventricular Tachycardia Short QT ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 35

36 THE CHANNELOPATHIES AND SUDDEN CARDIAC ARREST Inherited/genetic conditions Lead to Ventricular Tachycardia and Ventricular Fibrillation Evident (variably/intermittently) on EKG Cause of Sudden Cardiac Arrest in both athletes and non-athletes. Exercise does increase the risk in many of these conditions. ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 36

37 THE CHANNELOPATHIES THE LONG QT SYNDROME ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 37

38 THE CHANNELOPATHIES THE LONG QT SYNDROME Not rare: 3000 – 4000 deaths/y in children/adolescents Inherited/genetic 12 types/genes, hundreds of different mutations Variable “lethality” AR associated with deafness Variable expression Acquired form Medications/drugs Electrolyte changes Increased risk of SCA with exercise, risk variable based on type SCA in athletes: not rare, numbers not clear EKG +, gene +, symptom + : Disqualified from competitive sports ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 38

39 ACQUIRED LONG QT Medications:.(www.qtdrugs.org) Antiarrhythmics Antibiotics: Levaquin, Zithromax (Z pack), erythromycin Antidepressants: Tricyclics, Prozac, Celexa Tamoxifen diuretics 140 other drugs Methadone Combinations of drugs Electrolytes: Low K+, Mg++, Ca++ Genetic + Drugs, ? Unmasked congenital form Reversible ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 39

40 ACQUIRED LONG QT AND EXERCISE ? Drug + exercise interaction ? Electrolyte changes with exercise Dehydration Excessive “free water” intake Losses with sweating Diuretics ? Greater risk with endurance events The Perfect Storm: Congenital substrate + drugs + exercise ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 40

41 THE CANNELOPATHIES BRUGADA SYNDROME Genetic Genetic testing variable Na+ channel EKG variable Provocative testing Multiple types Male > Female Avg age at DX: 41 Fever/hyperthermia trigger Night time trigger Treatment: ICD, limited medications Caution advised for competitive sports with no history of events With history of events or ICD low level sports only ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 41

42 THE CHANNELOPATHIES CATECHOLAMINERGIC POLYMORPHIC VT ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 42

43 THE CHANNELOPATHIES CATECHOLAMINERGIC POLYMORPHIC VT Genetic, at least 2 gene mutations Inherited Emotional and physical triggers. Symptoms: dizziness and syncope Usually presents in childhood and adolescence Treatment: Medical therapy, ICD + medical, Sympathectomy, Medical therapy for gene + asymptomatic. Generally recommend against competitive sports, ICD precludes contact sports ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 43

44 OTHER ARRHYTHMIA WOLFF PARKINSON WHITE 1/400 Often Incidental finding Can present with symptoms Often first diagnosed in adulthood Risk of V-fibrillation Risk stratify asymptomatic Pts Ablation OK to participate in competitive sports once treated ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 44

45 SCREENING YOUNG ATHLETES Recommendations vary widely internationally Recommendations vary widely based on level of participation Not clear if definitely reduces risk Findings variable with time Variable age of onset These are relatively rare diseases Needs to be done regularly until adult age ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 45

46 SCREENING GOAL To identify those at risk Prevent injury and lethal events TO ASSIST YOUNG ATHLETES AND THEIR FAMILIES IN MAKING RATIONAL DECISIONS REGARDING THE RISK OF ATHLETIC PARTICIPATION ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 46

47 THE PREPARTICIPATION EXAM Review for symptoms Dizziness or fainting, shortness of breath, palpitations, chest discomfort, can’t keep up Family History Premature death “Death under unusual circumstances” Physical exam Murmurs, build, pulses ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 47

48 WHAT ABOUT EKGs Not recommended routinely in some countries (e.g. US) Required in all Europe Controversial Not clear it helps Athletes often have EKG changes that are “normal” False negatives, False positives Cost of EKGs, Cost of additional testing, Cost of disqualifying athletes Estimated $80,000 to find one case (US) ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 48 Question

49 LOWERING RISK IN THE YOUNG ATHLETE Pre-participation Exam Parental involvement in children and adolescents Coaches/trainer/athlete awareness Symptom awareness Workout/practice design Hydration/electrolyte replacement AEDs in close proximity when feasible and AED training CPR training of coaches/trainers/athletes ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 49 automated external defibrillators (AED) Cardiopulmonary resuscitation (CPR)

50 LOWERING RISK IN THE YOUNG ATHLETE ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 50

51 SCREENING RELATIVES “BACKWARD AND FORWARD” Can both include exclude disease ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 51

52 WHO NEEDS SCREENING Everyone over 20 years old should know their risk factors for CVD and periodically re-evaluate them Everyone should discuss with their physician their exercise routine (Physicians rarely ask) A “baseline” history and exam is indicated as part of the risk evaluation for exercise It is reasonable for adults to have at least one baseline EKG ???? ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 52 Only ?

53 RISK LEVEL Low Risk: man < 45, woman < 55, no CVD risk factors, no symptoms, no worrisome history Moderate Risk: man > 45, woman > 55, 1 or 2 CVD risk factors (not DM) High Risk: History or Symptoms of CVD, DM, age > 65, > 2 CVD risk factors ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 53

54 MEASURING INTENSITY The Metabolic Equivalent or MET 3.5 ml O2/kg/min ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 54

55 Metabolic Equivalent - MET 1.Sitting……………………………………………….1.0 2.Walking at 2.5 m/h……………………………2.9 3.Biking at 10 m/h……………………………….4.0 4.Elliptical……………………………………………5.5 5.Jogging……………………………………………. 7.0 6.Swimming (moderate)…………………….. 8.0 7.Swimming (hard)…………………………….12.0 8.Running 8 min mile……………………… 12.5 9.Bike Racing (not drafting) > 20m/h…. 16.0 ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 55

56 RISK LEVEL LOW MODERATE HIGH HIGH MOD LOW INTENSITY WHO NEEDS PRE-EXERCISE TESTING ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 56

57 Study in Athlete's Heart PSYRROPOULOS DIMITRIOS, MD, PhD ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 57

58 Echocardiography PSYRROPOULOS DIMITRIOS, MD, PhD ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 58

59 A Young Athlete With Hypertrophic Cardiomyopathy Echocardiography & CMR PSYRROPOULOS DIMITRIOS, MD, PhD ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 59

60 Separating Athlete's Heart From Cardiac Pathology PSYRROPOULOS DIMITRIOS, MD, PhD ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 60 Clinical scenario 1: The power athlete with LV hypertrophy: is it hypertrophic cardiomyopathy? Clinical scenario 2: The endurance athlete with cardiac enlargement and low ejection fraction: is it a dilated cardiomyopathy? Clinical scenario 3: The endurance athlete with palpitations and cardiac enlargement: is it arrhythmogenic right ventricular cardiomyopathy? Can extreme exercise result in myocardial injury?

61 Match your type, intensity and duration of exercise to your goal ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 61

62 IF YOU ARE EXERCISING DON’T IGNORE SYMPTOMS WHETHER WITH EXERCISE OR NOT Decreased performance Chest discomfort Shortness of breath Irregular heart beats / palpitations Dizziness or fainting ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 62

63 CONCLUSIONS EXERCISE IS GOOD FOR YOU EVERYBODY SHOULD EXERCISE EXERCISE CARRIES A SMALL RISK OF A CARDIAC EVENT THAT IS “AGE” SPECIFIC GET APPROPRIATE “SCREENING” DON’T IGNORE SYMPTOMS. THERE IS NO LIFETIME WARRANTY FROM A SINGLE SCREENING ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 PSYRROPOULOS DIMITRIOS, MD, PhD 63

64 Χαμογελάμε...! PSYRROPOULOS DIMITRIOS, MD, PhD ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ 6944 372 956 & 2310 913 880 64