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sudden death and exercise

Naokata Sumitomo
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is induced by emotions or exercise in patients without organic heart disease and may be polymorphic or bidirectional in nature. The prognosis of CPVT is not good, and therefore prevention of sudden death is of utmost importance. Genetic variants of CPVT include RyR2, CASQ2, CALM2, TRD, and possibly KCNJ2 and ANK2 gene mutations. Hypotheses that suggest the causes of CPVT include weakened binding of FKBP12.6 and RyR2, a store overload-induced Ca(2+) release (SOICR), unzipping of intramolecular domain interactions in RyR2, and molecular and functional abnormalities caused by mutations in the CASQ2 gene...
October 2016: Journal of Arrhythmia
Carlos M Mery, Keila N Lopez, Silvana Molossi, S Kristen Sexson-Tejtel, Rajesh Krishnamurthy, E Dean McKenzie, Charles D Fraser, Scott B Cantor
OBJECTIVES: The goal of this study was to use decision analysis to evaluate the impact of varying uncertainties on the outcomes of patients with anomalous aortic origin of a coronary artery. METHODS: Two separate decision analysis models were created: one for anomalous left coronary artery (ALCA) and one for anomalous right coronary artery (ARCA). Three strategies were compared: observation, exercise restriction, and surgery. Probabilities and health utilities were estimated on the basis of existing literature...
November 2016: Journal of Thoracic and Cardiovascular Surgery
Freek R van de Schoor, Vincent L Aengevaeren, Maria T E Hopman, David L Oxborough, Keith P George, Paul D Thompson, Thijs M H Eijsvogels
Myocardial fibrosis (MF) is a common phenomenon in the late stages of diverse cardiac diseases and is a predictive factor for sudden cardiac death. Myocardial fibrosis detected by magnetic resonance imaging has also been reported in athletes. Regular exercise improves cardiovascular health, but there may be a limit of benefit in the exercise dose-response relationship. Intense exercise training could induce pathologic cardiac remodeling, ultimately leading to MF, but the clinical implications of MF in athletes are unknown...
October 6, 2016: Mayo Clinic Proceedings
Angira Patel, Gregory Webster, Kendra Ward, John Lantos
: Aim The aim of the present study was to determine general paediatrician knowledge, practices, and attitudes towards electrocardiogram (ECG) screening in school athletes during pre-participation screening exam (PPSE). METHODS: Paediatricians affiliated with a tertiary children's hospital completed a survey about ECGs for PPSE. RESULTS: In total, 205/498 (41%) responded; 92% of the paediatricians did not include an ECG as part of PPSE; 56% were aware of a case in which a student athlete in their own community had died of sudden unexplained death; 4% had an athlete in their practice die...
October 10, 2016: Cardiology in the Young
Waseem Hindieh, Arnon Adler, Adaya Weissler-Snir, Dana Fourey, Sarah Harris, Harry Rakowski
Hypertrophic cardiomyopathy is a common genetic disorder with a prevalence of 1:500 in the general population. Amongst a varied spectrum of clinical presentations, the most feared complication of this cardiac disorder is sudden cardiac death. Although only a minority of patients with hypertrophic cardiomyopathy who suffer sudden cardiac death or resuscitated cardiac arrest do so during exercise, strenuous physical activity is regarded as an important trigger for these tragic outcomes. Furthermore, during exercise, patients with hypertrophic cardiomyopathy may develop augmentation of left ventricular outflow tract obstruction, myocardial ischemia, diastolic dysfunction and/or inappropriate vasodilation in non-exercising vascular beds...
September 20, 2016: Journal of Science and Medicine in Sport
Sara Saberi, Sharlene M Day
Inherited cardiomyopathies have highly variable expression in terms of symptoms, functional limitations, and disease severity. Associated risk of sudden cardiac death is also variable. International guidelines currently recommend restriction of all athletes with cardiomyopathy from participation in competitive sports. While the guidelines are necessarily conservative because predictive risk factors for exercise-triggered SCD have not been clearly identified, the risk is clearly not uniform across all athletes and all sports...
November 2016: Cardiology Clinics
Tee Joo Yeo, Sanjay Sharma
This article summarizes the role of the 12-lead electrocardiogram (ECG) for the clinical care of athletes, with particular reference to the influence of age, gender, ethnicity, and type of sport on the appearance of the ECG, and its role in differentiating physiologic exercise-related changes from pathologic conditions implicated in sudden cardiac death (SCD). The article also explores the potential role of the ECG in detecting athletes at risk of SCD. In addition, the article reviews the evolution of ECG interpretation criteria and emphasizes the limitations of the ECG as well as the potential for future research...
November 2016: Cardiology Clinics
Alan C Sing, Stephen Tsaur, Stephen M Paridon, Julie A Brothers
BACKGROUND: Anomalous aortic origin of a coronary artery is a congenital cardiac condition that can be associated with increased risk of sudden death. To date, quality of life and exercise performance have not been evaluated in patients with this condition who do not undergo surgical repair. METHODS: We carried out a cross-sectional analysis of patients with unoperated anomalous aortic origin of a coronary artery at our institution from 1 January, 2000 to 31 January, 2016...
September 26, 2016: Cardiology in the Young
Parham Parto, James H O'Keefe, Carl J Lavie
BACKGROUND: Debatably, the most commonly prescribed lifestyle modification for cardiovascular health involves daily exercise training (ET) and physical activity. Exercise has numerous known health benefits on blood pressure, lipid profile, weight loss, and glucose metabolism. However, controversy exists regarding the link between excessive endurance ET and harmful cardiac effects. METHODS: We review the current literature and discuss the numerous known adverse effects of endurance ET on cardiac function...
2016: Ochsner Journal
Stephen J Ives, Wesley K Lefferts, Margret Wharton, Patricia C Fehling, Denise L Smith
: Heat stress increases cardiovascular strain and is of particular concern in occupations, such as firefighters, where individuals are required to perform strenuous work while wearing personal protective equipment (PPE). Sudden cardiac events are associated with strenuous activity and are the leading cause of duty-related death among firefighters, accounting for ∼50% of duty-related fatalities/year. Understanding the acute effects of exercise-induced heat stress (EIHS) on vascular endothelial function may provide insight into mechanisms precipitating acute coronary events in firefighters...
September 20, 2016: Experimental Physiology
Christian Steinberg, Gareth J Padfield, Jean Champagne, Shubhayan Sanatani, Paul Angaran, Jason G Andrade, Jason D Roberts, Jeffrey S Healey, Vijay S Chauhan, David H Birnie, Mikyla Janzen, Brenda Gerull, George J Klein, Richard Leather, Christopher S Simpson, Colette Seifer, Mario Talajic, Martin Gardner, Andrew D Krahn
BACKGROUND: Unexplained cardiac arrest (UCA) may be explained by inherited arrhythmia syndromes. The Cardiac Arrest Survivors With Preserved Ejection Fraction Registry prospectively assessed first-degree relatives of UCA or sudden unexplained death victims to screen for cardiac abnormalities. METHODS AND RESULTS: Around 398 first-degree family members (186 UCA, 212 sudden unexplained death victims' relatives; mean age, 44±17 years) underwent extensive cardiac workup, including ECG, signal averaged ECG, exercise testing, cardiac imaging, Holter-monitoring, and selective provocative drug testing with epinephrine or procainamide...
September 2016: Circulation. Arrhythmia and Electrophysiology
Megan L Keen, Kevin C Miller
: Clinical Scenario: Exercise performed in hot and humid environments increases core body temperature (TC). If TC exceeds 40°C for prolonged periods of time, exertional heat stroke (EHS) may occur. EHS is one of the leading causes of sudden death in athletes. Mortality and morbidity increase the longer the patient's TC remains above 40°C; thus, it is imperative to initiate cooling as quickly as possible. "Acceptable" cooling rates in EHS situations are between 0.08°C·min-1 and 0.15°C·min-1 while "ideal" cooling rates are above 0...
August 24, 2016: Journal of Sport Rehabilitation
Francesco Danilo Tiziano, Vincenzo Palmieri, Maurizio Genuardi, Paolo Zeppilli
Although relatively rare, inherited primitive cardiac disorders (IPCDs) in athletes have a deep social impact since they often present as sudden cardiac death (SCD) of young and otherwise healthy persons. The diagnosis of these conditions is likely underestimated due to the lack of shared clinical criteria and to the existence of several borderline clinical pictures. We will focus on the clinical and molecular diagnosis of the most common IPCDs, namely hypertrophic cardiomyopathies, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy, and left ventricular non-compaction...
2016: Frontiers in Cardiovascular Medicine
Magnus J Hagnäs, Timo A Lakka, Sudhir Kurl, Rainer Rauramaa, Timo H Mäkikallio, Kai Savonen, Jari A Laukkanen
OBJECTIVE: The aim of this study was to investigate whether information on both cardiorespiratory fitness (CRF) and exercise-induced ST segment depression improves the prediction of sudden cardiac death (SCD) in men. METHODS: The study was based on a population sample of 2328 men aged 42-60 years, who were followed up for on average 19 years. CRF was assessed with maximal exercise test using respiratory gas analysis, expressed in metabolic equivalents (METs) and dichotomised at eight METs...
September 7, 2016: Heart: Official Journal of the British Cardiac Society
I Sathyamurthy, K Jayanthi
Aortic stenosis (AS) is one of the commonest forms of acquired valvular heart disease. Aortic valve replacement (AVR) is the treatment of choice for symptomatic severe AS. Conservative management is usually advocated for asymptomatic severe AS. But there are data on predictors to identify subsets of asymptomatic AS patients at high risk of cardiac events in whom early surgical intervention is warranted. Non-invasive tests like exercise stress test, exercise echocardiography will help us to identify those who are at high risk of developing early symptoms due to LV dysfunction and also those at high risk of sudden death...
July 2016: Indian Heart Journal
Alejandro Santos-Lozano, Fabian Sanchis-Gomar, Nuria Garatachea, Ángel Arrarás-Flores, Helios Pareja-Galeano, Carmen Fiuza-Luces, Michael J Joyner, Alejandro Lucia
No abstract text is available yet for this article.
November 15, 2016: International Journal of Cardiology
Andrew J Haertel, Joshua A Stern, J Rachel Reader, Abigail Spinner, Jeffrey A Roberts, Kari L Christe
Concentric left ventricular hypertrophy (LVH) is a hallmark finding in hypertrophic cardiomyopathy that leads to diastolic dysfunction and variable cardiac consequences as severe as congestive heart failure and sudden cardiac death. LVH was diagnosed postmortem in a large colony of rhesus macaques (Macaca mulatta), but methods to screen and diagnose LVH in living animals are desired. We hypothesized that targeted echocardiography of macaques with a familial association of LVH would yield antemortem LVH diagnoses...
2016: Comparative Medicine
Fabrizio Drago, Vincenzo Pazzano, Corrado Di Mambro, Mario Salvatore Russo, Rosalinda Palmieri, Massimo Stefano Silvetti, Salvatore Giannico, Benedetta Leonardi, Antonio Amodeo, Vincenzo Maria Di Ciommo
BACKGROUND: The post-surgical history of repaired congenital heart disease (rCHD), in particular tetralogy of Fallot (TOF), is often complicated by sudden death. Electrical myocardial abnormalities could be a substrate for malignant ventricular arrhythmias. METHODS AND RESULTS: 146 patients with TOF or other rCHD involving a subpulmonary right ventricle, considered to be at high arrhythmic risk, underwent right ventricular (RV) electroanatomic voltage mapping (EVM)...
November 1, 2016: International Journal of Cardiology
Meagan M Wasfy, Adolph M Hutter, Rory B Weiner
There are clear health benefits to exercise; even so, patients with cardiac conditions who engage in exercise and athletic competition may on rare occasion experience sudden cardiac death (SCD). This article reviews the epidemiology and common causes of SCD in specific athlete populations. There is ongoing debate about the optimal mechanism for SCD prevention, specifically regarding the inclusion of the ECG and/or cardiac imaging in routine preparticipation sports evaluation. This controversy and contemporary screening recommendations are also reviewed...
April 2016: Methodist DeBakey Cardiovascular Journal
David J Engel, Allan Schwartz, Shunichi Homma
IMPORTANCE: The incidence of sudden cardiac death is higher in US basketball players compared with other athlete groups. However, the recognition of the risk for sudden cardiac death among basketball players is challenging because little is known regarding athletic cardiac remodeling in these athletes or athletes of similarly increased size. OBJECTIVE: To perform a comprehensive cardiac structural analysis of National Basketball Association (NBA) professional athletes...
April 1, 2016: JAMA Cardiology
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