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Updated: Jun 2 2021

Cardiac Conditions

  • 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
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