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 –Επικοινωνία: τηλ & κιν

EXERCISE IS GOOD FOR YOU ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 2

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

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 4

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 5

Who are we talking about, what are the numbers and what are we talking about ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 6

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 7

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 8

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 9

THE YOUNG ATHLETE A SAMPLING OF THE CAUSES ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 10

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

THE YOUNG ATHLETE ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 12

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 ….

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

MECHANISM OF SUDDEN DEATH Ventricular Tachycardia and Ventricular Fibrillation Normal EKG Ventricular Tachycardia Polymorphic Ventricular Tachycardia Ventricular Fibrillation ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 15

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 16

THE YOUNG ATHLETE SOME SPECIFIC EXAMPLES ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 17

HYPERTROPHIC CARDIOMYOPATHY ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 18

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 19 HANK GATHERS

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 20

The IMPLANTIBLE CARDIAC DEFIBRILLATOR (ICD) ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 21

DISQUALIFIED? The 36 th Bethesda Conference ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 22

THE 36 TH BETHESDA CONFERENCE ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 23 maximal voluntary contraction

ANOMALOUS ORIGIN OF THE CORONARY ARTERIES ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 24

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 25

ARRYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 26

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 27

MYOCARDITIS / CARDIOMYOPATHY ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 28

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 29

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

MARFAN SYNDROME ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 31

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 & 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.

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

WHAT IS A CHANNEL? ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 34

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

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 36

THE CHANNELOPATHIES THE LONG QT SYNDROME ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 37

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 38

ACQUIRED LONG QT Medications:.( 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 & PSYRROPOULOS DIMITRIOS, MD, PhD 39

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 40

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 41

THE CHANNELOPATHIES CATECHOLAMINERGIC POLYMORPHIC VT ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 42

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 43

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 44

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 45

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 46

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 47

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 48 Question

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 49 automated external defibrillators (AED) Cardiopulmonary resuscitation (CPR)

LOWERING RISK IN THE YOUNG ATHLETE ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 50

SCREENING RELATIVES “BACKWARD AND FORWARD” Can both include exclude disease ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 51

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 52 Only ?

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 53

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

Metabolic Equivalent - MET 1.Sitting……………………………………………… Walking at 2.5 m/h……………………………2.9 3.Biking at 10 m/h……………………………… Elliptical……………………………………………5.5 5.Jogging…………………………………………… Swimming (moderate)…………………… Swimming (hard)…………………………… Running 8 min mile……………………… Bike Racing (not drafting) > 20m/h… ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 55

RISK LEVEL LOW MODERATE HIGH HIGH MOD LOW INTENSITY WHO NEEDS PRE-EXERCISE TESTING ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 56

Study in Athlete's Heart PSYRROPOULOS DIMITRIOS, MD, PhD ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ &

Echocardiography PSYRROPOULOS DIMITRIOS, MD, PhD ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ &

A Young Athlete With Hypertrophic Cardiomyopathy Echocardiography & CMR PSYRROPOULOS DIMITRIOS, MD, PhD ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ &

Separating Athlete's Heart From Cardiac Pathology PSYRROPOULOS DIMITRIOS, MD, PhD ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & 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?

Match your type, intensity and duration of exercise to your goal ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ & PSYRROPOULOS DIMITRIOS, MD, PhD 61

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 62

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 & PSYRROPOULOS DIMITRIOS, MD, PhD 63

Χαμογελάμε...! PSYRROPOULOS DIMITRIOS, MD, PhD ΨΥΡΡΟΠΟΥΛΟΣ ΔΗΜΗΤΡΗΣ - ΚΑΡΔΙΟΛΟΓΟΣ &