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Athletes and Arrhythmias

, MD, FACC, FHRS1, , MD, FACC, FACP, FASNC1

Cardiovascular Innovations and Applications

Compuscript

10.15212/CVIA.2015.0020

athletes, cardiac remodeling, arrhythmias, sudden cardiac death

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Abstract

Sudden cardiac death related to athletic competition is a rare but tragic event. The victims are typically young with no previous cardiovascular symptoms or limitations. The majority of sudden cardiac death events in athletes are due to ventricular arrhythmias as a result of underlying molecular and/or structural level pathologic substrate. In this article, we will review the physiologic cardiac adaptations to exercise along with arrhythmias seen in athletes with a focus on those commonly associated with sudden cardiac death.

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Most cited references 53

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Hypertrophic cardiomyopathy: a systematic review.

Throughout the past 40 years, a vast and sometimes contradictory literature has accumulated regarding hypertrophic cardiomyopathy (HCM), a genetic cardiac disease caused by a variety of mutations in genes encoding sarcomeric proteins and characterized by a broad and expanding clinical spectrum. To clarify and summarize the relevant clinical issues and to profile rapidly evolving concepts regarding HCM. Systematic analysis of the relevant HCM literature, accessed through MEDLINE (1966-2000), bibliographies, and interactions with investigators. Diverse information was assimilated into a rigorous and objective contemporary description of HCM, affording greatest weight to prospective, controlled, and evidence-based studies. Hypertrophic cardiomyopathy is a relatively common genetic cardiac disease (1:500 in the general population) that is heterogeneous with respect to disease-causing mutations, presentation, prognosis, and treatment strategies. Visibility attached to HCM relates largely to its recognition as the most common cause of sudden death in the young (including competitive athletes). Clinical diagnosis is by 2-dimensional echocardiographic identification of otherwise unexplained left ventricular wall thickening in the presence of a nondilated cavity. Overall, HCM confers an annual mortality rate of about 1% and in most patients is compatible with little or no disability and normal life expectancy. Subsets with higher mortality or morbidity are linked to the complications of sudden death, progressive heart failure, and atrial fibrillation with embolic stroke. Treatment strategies depend on appropriate patient selection, including drug treatment for exertional dyspnea (beta-blockers, verapamil, disopyramide) and the septal myotomy-myectomy operation, which is the standard of care for severe refractory symptoms associated with marked outflow obstruction; alcohol septal ablation and pacing are alternatives to surgery for selected patients. High-risk patients may be treated effectively for sudden death prevention with the implantable cardioverter-defibrillator. Substantial understanding has evolved regarding the epidemiology and clinical course of HCM, as well as novel treatment strategies that may alter its natural history. An appreciation that HCM, although an important cause of death and disability at all ages, does not invariably convey ominous prognosis and is compatible with normal longevity should dictate a large measure of reassurance for many patients.
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The paradox of exercise.

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Sudden cardiac death in young athletes

Author and article information

Affiliations
1University of Florida, Gainesville, FL, USA
Author notes
Correspondence: Michael J. Jansen, MD, FACC, FHRS and Floyd W. Burke, MD, FACC, FACP, FASNC, 4037 NW 86th Terrace, Gainesville, FL 32606, USA, Tel.: +1-352-5941748, Fax: +1-352-5941777, E-mail: michael.jansen@123456medicine.ufl.edu; and floyd.burke@123456medicine.ufl.edu
Journal
CVIA
Cardiovascular Innovations and Applications
CVIA
Compuscript (Ireland)
2009-8618
2009-8618
February 2016
February 2016
: 1
: 2
: 211-219
Copyright © 2016 Cardiovascular Innovations and Applications

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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