Introduction Epidemiology cardiac pathology is the most common cause of sudden death in young athletic patients 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 11 1 2 3 4 5 6 7 8 9 10 11 Previous Next This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07SM.73) A 20-year-old soccer player who collapsed after a goal kick reports weakness and nausea. He appears slightly confused. Examination reveals that he is not sweating. His skin is warm and dry. The outdoor temperature is 80 degrees F (26.6 degrees C) with a relative humidity of 80%. Management should consist of Review Topic QID: 8735 1 a drink of water. 4% (3/77) 2 a sports drink with electrolytes. 9% (7/77) 3 placement in the reverse Trendelenburg position in a shaded area. 3% (2/77) 4 immersion in a warm water bath. 0% (0/77) 5 transportation to the emergency department. 83% (64/77) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 5 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 (OBQ05.199) What is the most common cause of sudden cardiac death in otherwise healthy 20-30 year-old athletes? Review Topic QID: 1085 1 Coronary artery disease 0% (7/1624) 2 Hypertrophic cardiomyopathy 98% (1587/1624) 3 Commotio cordis 1% (24/1624) 4 Ruptured aortic aneurysm 0% (3/1624) 5 Rheumatic fever 0% (1/1624) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 2 (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: Review Topic QID: 942 1 Echocardiography is used to confirm hypertrophic subaortic cardiomyopathy 6% (27/442) 2 History and physical examination are considered more cost-effective than EKG for screening 5% (21/442) 3 Athletes with a family history of sudden cardiac death should receive additional testing 4% (18/442) 4 Electrocardiography will result in a large number of false-positive results 18% (78/442) 5 Electrocardiography cannot detect potential causes for sudden cardiac death 67% (298/442) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 5 (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? Review Topic QID: 3009 1 Hypertrophic obstructive cardiomyopathy 97% (2307/2388) 2 Dilated cardiomyopathy 2% (47/2388) 3 Mitral valve prolapse 0% (4/2388) 4 Aortic root rupture 1% (20/2388) 5 Ventricular dysplasia 0% (3/2388) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (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? Review Topic QID: 1412 1 Renal ultrasound 0% (6/1943) 2 Pulmonary function test 0% (8/1943) 3 Echocardiogram 89% (1725/1943) 4 EKG 10% (191/1943) 5 Cervical MRI 0% (9/1943) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 3 (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? Review Topic QID: 1396 1 IV epinephrine 2% (17/972) 2 Placement of a large gauge needle into the pericardial sac 7% (69/972) 3 Immediate Cardiac defibrillation 89% (865/972) 4 Rescue breathing 2% (17/972) 5 Fluid bolus 0% (3/972) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 3
Upgrade to View Premium Videos Upgrade to View Premium Videos Sport Medicine Board Prep Video Collection Series Cardiac Issues in Sports Medicine - Dr. Scott Rand Scott Rand Knee & Sports - Cardiac Conditions 9/29/2013 438 views