summary Cardiac conditions are the most common cause of sudden death in young athletic patients and comprise of hypertrophic cardiomyopathy (most common), coronary artery disease, and commotio cordis. Diagnosis requires a thorough history and physical exam to identify history of chest pain, palpitations, syncope during exercise and evaluation for murmurs. An EKG or echocardiogram should be performed when there is high suspicion for hypertrophic cardiomyopathy. Treatment is focused on prevention with avoidance of vigorous exercise when hypertrophic cardiomyopathy is diagnosed. If commotio cordis develops, prompt treatment with cardiac defibrillation is required for survival. Etiology Common conditions include syncope hypertrophic cardiomyopathy CAD commotio cordis long QT syndrome Presentation Symptoms history and physical exam is the best screening tool to identify cardiovascular problems in high school athletes chest pain palpitations syncope Physical exam pre-participation physicals diastolic murmur warrants further workup II/VI systolic murmur Evaluation EKG normal EKG findings in endurance athletes ventricular hypertrophy primary AV block nonspecific STT wave changes in the lateral leads on ECG resting sinus bradycardia at 40 beats per minute Syncope Overview a syncopal episode in a young athlete is a red flag for a serious cardiac condition. Treatment medical evaluation requires a medical evaluation prior to returning to athletic activity Hypertrophic Cardiomyopathy Overview most common cause of cardiac sudden death in young athletic patients Presentation symptoms dyspnea on exertion chest pain positive family history physical exam II/VI systolic murmur a murmur that increases with standing or Valsalva maneuver should raise concern for hypertrophic cardiomyopathy increase in murmur caused by dynamic obstruction of blood outflow caused by enlarged ventricle Evaluation echocardiogram study of choice to make diagnosis will show nondilated, thickened left ventricular wall thickness compared to normal individuals of the same age. Treatment avoid vigorous exercise considered an absolute contraindication to vigorous exercise and sports Coronary Artery Disease and Abnormalities Epidemiology 2nd most common cause of sudden cardiac death most common in older patients Pathophysiology coronary artery disease (CAD) usually seen in older patients risk factors hypertension family history left main coronary artery with abnormal origin is a risk because the artery can become compressed and lead to ischemia Presentation symptoms mostly asymptomatic but when symptoms present they are commonly chest pain palpitations syncope Imaging coronary angiography and MR angiography are gold standards Treatment lifestyle changes healthy eating, stress reduction, quit smoking, lose weight medications b-blocker, aspirin, ACE inhibitors, nitroglycerin, calcium channel blockers surgery angioplasty and stenting coronary artery bypass grafting Commotio Cordis A rare but catastrophic condition that is caused by blunt chest trauma it results in cardiac ventricular fibrillation and is universally fatal unless immediate defibrillation is performed Epidemiology most common in children and adolescents due to high number of athletes Treatment CPR vs.cardiac defibrillation best method of treatment is cardiac defibrillation Prevention chest protectors in baseball and hockey have not yielded the protective results desired Long QT Syndrome An abnormality of ventricular repolarization that can lead to ventricular tachycardia torsades de pointes sudden cardiac death if not recognized and treated Symptoms syncope or near-syncope with exercise often times asymptomatic Diagnosis ECG is gold standard Treatment sports return to play determination of play by genetic makeup, presentation, and need for pacemaker
QUESTIONS 1 of 12 1 2 3 4 5 6 7 8 9 10 11 12 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ09.196) A high school basketball player dies suddenly on the basketball court. An autopsy is most likely to find which of the following conditions to be the cause of death? QID: 3009 Type & Select Correct Answer 1 Hypertrophic obstructive cardiomyopathy 95% (3189/3343) 2 Dilated cardiomyopathy 2% (83/3343) 3 Mitral valve prolapse 0% (11/3343) 4 Aortic root rupture 1% (40/3343) 5 Ventricular dysplasia 0% (7/3343) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ07SM.27) A 15-year-old asymptomatic male presents for a pre-participation high school physical for basketball. He has no personal or family history of asthma. He had two relatives who died while playing sports due to a medical problem that runs in his family. Which of the following tests would be most helpful in obtaining his diagnosis and preventing possible sudden death? QID: 1412 Type & Select Correct Answer 1 Renal ultrasound 0% (8/2727) 2 Pulmonary function test 0% (9/2727) 3 Echocardiogram 87% (2378/2727) 4 EKG 11% (305/2727) 5 Cervical MRI 1% (21/2727) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (SBQ07SM.11) An otherwise healthy 14-year-old male baseball pitcher goes into cardiac arrest after being struck in the chest by a batted ball. Commotio cordis is suspected. What is the most appropriate treatment? QID: 1396 Type & Select Correct Answer 1 IV epinephrine 2% (33/1525) 2 Placement of a large gauge needle into the pericardial sac 8% (119/1525) 3 Immediate Cardiac defibrillation 87% (1328/1525) 4 Rescue breathing 2% (34/1525) 5 Fluid bolus 0% (5/1525) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ05.199) What is the most common cause of sudden cardiac death in otherwise healthy 20-30 year-old athletes? QID: 1085 Type & Select Correct Answer 1 Coronary artery disease 1% (18/3014) 2 Hypertrophic cardiomyopathy 96% (2888/3014) 3 Commotio cordis 2% (75/3014) 4 Ruptured aortic aneurysm 1% (22/3014) 5 Rheumatic fever 0% (2/3014) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ05.56) The use of EKG for routine pre-participation screening of youth athletes is not presently standard of care in the United States. With respect to this observation, all of the following statements are correct EXCEPT: QID: 942 Type & Select Correct Answer 1 Echocardiography is used to confirm hypertrophic subaortic cardiomyopathy 6% (64/1019) 2 History and physical examination are considered more cost-effective than EKG for screening 8% (81/1019) 3 Athletes with a family history of sudden cardiac death should receive additional testing 4% (42/1019) 4 Electrocardiography will result in a large number of false-positive results 20% (199/1019) 5 Electrocardiography cannot detect potential causes for sudden cardiac death 62% (628/1019) L 3 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (1) Podcasts (1) Login to View Community Videos Login to View Community Videos Sport Medicine Board Prep Video Collection Series Cardiac Issues in Sports Medicine - Dr. Scott Rand Scott Rand Knee & Sports - Cardiac Conditions B 9/29/2013 547 views 4.6 (7) Knee & Sports | Cardiac Conditions Knee & Sports - Cardiac Conditions Listen Now 16:13 min 2/25/2020 126 plays 5.0 (1)