Athletes heart

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HISTORYHeneschen(1890) used physical examination to determine increased cardiac dimensions in elite nordic skiers.Eugene darling in the same year in rowers of harvard university.2/1/20152ATHLETE'S HEART

Paul dudely white(1900) studied radial pulse rate among boston marathon competitors and was the first to report marked resting sinus bradycardia in long distance runners.

2/1/20153ATHLETE'S HEARTEarlier it was thought to be beneficial adaptations to exercise.But later it was postulated as a form of overuse pathology and prolonged participation in sport can lead to premature cardiovascular system collapse.2/1/20154ATHLETE'S HEARTAthletesheart syndrome , a term often applied to athletic patient who present with subjective symptoms or abnormal CVS findings.2/1/20155ATHLETE'S HEARTAerobic /endurance exercises execises requiring primarily an increase in o2 transpot.2/1/20156ATHLETE'S HEART

Resting /strength exercises exercises primarily stressing the skeletal muscle.2/1/20157ATHLETE'S HEART

PHYSIOLOGYPhysical activity acutely increases o2 demand which increases cardiac output (Q) and arteriovenous difference (A-V)O2.1 lit of oxygen consumption (VO2) produces 5-6 lit increase in Q.2/1/20158ATHLETE'S HEARTThe CV response to exercise has both external and internal work rate,External work rate is VO2 required for exercise task and is direct determination of Q.Internal work rate is MO2 required for exercise task and is direct determinant of HR2/1/20159ATHLETE'S HEART92/1/2015ATHLETE'S HEART10 Repetitive excercises to increase exercise capacity

Increases VO2

Increased Q(HR and SV) Increased stroke volume

The increase in SV means that performing the same exercise task which requires the same VO2 can be performed at a slower HR and a lower MO2 or internal work rate.2/1/2015ATHLETE'S HEART11The physiologic mediators of these CV adaptations may be produced by increased resting vagal tone and reduced resting sympathetic tone resulting in resting sinus bradycardia2/1/2015ATHLETE'S HEART12LEFT VENTRICLEStudies revealed LV hypertrophy and showed increased LV end diastolic diameter and small percentage had LV wall thickness more than 13mm.2/1/2015ATHLETE'S HEART13MORGANROTH studies demonstrated concentric LV hypertrophy in strength training and eccentic LV hypertrophy in aerobic training.2/1/2015ATHLETE'S HEART142/1/2015ATHLETE'S HEART15



Figure 3. Impact of different clinical variables on LV end-diastolic cavity dimensions in a large population of male and female elite athletes.

Maron B J , and Pelliccia A Circulation. 2006;114:1633-1644Copyright American Heart Association, Inc. All rights reserved.2/1/201518ATHLETE'S HEARTFigure 3. Impact of different clinical variables on LV end-diastolic cavity dimensions in a large population of male and female elite athletes. The relative impact of the examined variables (body size, gender, age, and type of sport) are shown here as a proportion of overall variability in LV cavity size.On LV systolic function demonstrated preserved LV ejection fraction except for one studyOn LV diastolic function improved LV diastolic function is essential mechanism in preserving stroke volume2/1/2015ATHLETE'S HEART19RIGHT VENTRICLECardiac remodelling is not confined to LVScharhag et al study demonstrated RV enlargement parallels LV enlargement supporting the concept of biventricular enlargement.2/1/2015ATHLETE'S HEART20AORTAExperiences a significant hemodynamic load during exercise.Aerobic exercise- high volume aortic flow with modest systemic hypertensionStrength exercises-normal volume with profound systemic hypertension.2/1/2015ATHLETE'S HEART21Babee et al studies revealed increased aortic dimensions in strength exercise training.Pellica et al studies revealed incresed aortic dimensions in aerobic training exercises.2/1/2015ATHLETE'S HEART22LEFT ATRIUM Studies confirmed high prevalnce of left atrial enlargement in athletesSEX AND RACE2/1/2015ATHLETE'S HEART23PATHOLOGY VS PHYSIOLOGICAL ADAPTATION2/1/2015ATHLETE'S HEART24

A, An electrocardiogram of a 46-year-old male triathlete who presented after long-standing palpitations and a recent episode of syncope.

Baggish A L , and Wood M J Circulation. 2011;123:2723-2735Copyright American Heart Association, Inc. All rights reserved.2/1/201525ATHLETE'S HEARTA, An electrocardiogram of a 46-year-old male triathlete who presented after long-standing palpitations and a recent episode of syncope. The findings of diffuse T-wave inversions prompted an echocardiogram (B), which revealed normal left ventricular (LV) dimensions and function. C, A subsequent magnetic resonance imaging study confirmed the presence of focal asymmetric LV hypertrophy (yellow arrow) consistent with the apical variant form of hypertrophic cardiomyopathy.ARRHYTHMIASBrady arrhythmias such asSinus bradycardiaJunctional bradycardiaAV blockThe reduced AV conduction velocity may take accessory pathway such as WPW syndrome.2/1/2015ATHLETE'S HEART26Increased vagal tone may be responsible for early repolarisation and ST abnormalities.2/1/2015ATHLETE'S HEART272/1/2015ATHLETE'S HEART28

VALVE DISEASE IN ATHLETSAORTIC STENOSISCareful evaluation of symptoms and maximal exercise testingWarm up dyspnea indicates clinically important AS2/1/2015ATHLETE'S HEART29AORTIC REGURGITATIONGenerally tolerate AR,because of increased HR during exercise, decreases diastole and regurgitant.Rarely restrict the patients with AR unless there is ventricular deterioration.2/1/2015ATHLETE'S HEART30AORTIC DISSECTION IN BAVWe do not restrict the patient unless the patient aortic root dimensions are more than 45 mmAnnual screening.2/1/2015ATHLETE'S HEART31SYNCOPEMajority of syncope in athletes is attributed to neurocardiogenic syncope.Manifests in the immediate post exercise testing owing to sudden reduction in venous return, which facilitates transient cerebral hypoperfusion.2/1/2015ATHLETE'S HEART32Syncope during exercise, there is a possibility of malignant arrhythmias, valvular heart disease and myocardial ischemia.2/1/2015ATHLETE'S HEART33DECREASED EXERCISE CAPACITYHyperthyroididmExercise induced asthmaDisease of the skeletal musclesAnemiaAFViral illness2/1/2015ATHLETE'S HEART34ELEVATED CARDIAC ENZYMESIncrease in cTnT occurs in athletes following prolonged exertion.Endurance athletes were documented to have increased concentrations of CK-MB and satellite cells in their leg muscles.2/1/2015ATHLETE'S HEART352/1/2015ATHLETE'S HEART36