BELLARMINE UNIVERSITY, LOUISVILLE, KY

Early Detection of Hypertrophic

CardiomyopathyKatie Wilson, Heather Dixon Lindsey, Aneta Petri, Kaycee

Stone

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Objectives

• Define causes of hypertrophic cardiomyopathy

• Identify signs & symptoms• Discuss differential diagnosis

compared to typical athlete’s heart• Discuss physicals, deconditioning,

EKG, and advanced cardiac imaging

BELLARMINE UNIVERSITY, LOUISVILLE, KY

What is Hypertrophic Cardiomyopathy (HCM)?• Autosomal dominant (Chun et al.,

2010)• Most common genetic heart disease• 11 genetic mutations (Maron, 2009)• Males>Females (Corrado et al., 2005)• Left ventricular hypertrophy (Chun et

al., 2010)• 1/3 of sudden deaths in U.S. (Corrado

et al., 2005)

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Normal Heart vs. HCM

From: Mayo Clinic, http://www.mayoclinic.com/health/medical/IM00586

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Signs and Symptoms

• Chest pain/discomfort• Syncope (Chun et al., 2010)• Irregular heartbeat/palpitations• Shortness of breath/dyspnea• Fatigue out of proportion to exertion• Positive family history (Corrada et al.,

2005)

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Differential Diagnosis of HCM in Athletes:

ChallengesTypical Athletic Heart

• Adaptations to training (Neary et. al, 2011)

• LV remodelling <13 mm (Maron, 2009)

• L atrial enlargement• Bizarre ECG changes

Athletic Heart with HCM

• LV thickness >15 mm (Chun et al., 2010)

• Positive genetic testing/ family history (Maron, 2009)

• Abnormal LV filling• L atrial enlargement• Bizarre ECG changes

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Our Investigation

P: Athletes with family history of HCM or experienced cardiac S/SI: Cardiac ImagingC: Traditional medical sports physicals O: Early detection of HCM

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Traditional Sports Physicals in the U.S.

• Personal history• Family history• Physical examination

– Heart sounds and rhythm– Musculoskeletal features (Marfan

syndrome)– Blood pressure and femoral pulses

(Corrado et al., 2006)

BELLARMINE UNIVERSITY, LOUISVILLE, KY

12-lead EKG

• Mandatory part of European sports physicals (Corrado et al., 2005)

• 26-year Italian study on pre-screening athletes (Corrado et al., 2006)– 89% decrease in incidence of sudden

CV death over period of study

From: Corrado et al., 2005

BELLARMINE UNIVERSITY, LOUISVILLE, KY

T-wave Inversion

From: Neary et al., 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Deconditioning Period

• Forced detraining 8-12 weeks (Printz, 2012)

• Non-invasive diagnostic method• Athletic heart: physiological changes

after• HCM heart: no physiological

changes after

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Advanced Cardiac Imaging

• Exercise echocardiograph stress testing (Printz, 2012)

• Cardiac CT scan• Cardiac MRI (Neary et al.,2011)• Ballistocardiography• Doppler ultrasound (Maron, 2009)

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Conclusions

• Adding 12-lead EKG to sports physicals can detect cardiac abnormalities

• Study: Saved 360 kids before age 21(Anderson et al., 2013)

• Cost limitations of implementing in U.S.

• Advanced cardiac imaging is still needed for diagnosis

BELLARMINE UNIVERSITY, LOUISVILLE, KY

For More Information

• http://www.youtube.com/watch?v=MhxkyUV6NSA&list=PL39C030C007545A9

• Cleveland Clinic: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/hypertrophic-cardiomyopathy/

BELLARMINE UNIVERSITY, LOUISVILLE, KY

References1. Anderson BR, McElligott S, Polsky D, Vetter VL. Electrocardiographic screening for

hypertrophic cardiomyopathy and long QT syndrome: the drivers of cost-effectiveness for the prevention of sudden cardiac death. Pediatr Cardiol. Sept 5 2013[Epub ahead of print].

2. Chun EJ, Choi SI, Jin KN, Kwag HJ, et al. Hypertrophic cardiomyopathy: assessment with MR imaging and multi-detecter CT. RadioGraphics. 2010;30(5):1309-1328.

3. Corrado D, Pelliccia A, Bjornstad HH, et al. Cardiovascular pre-participation screening of young competitive athletes for a prevention of sudden death: proposal for a common European protocol. Eur Heart J. Feb 2005;26(5):516-24.

4. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296(13):1593-1601.

5. Maron BJ. Distinguishing hypertrophic cardiomyopathy from athlete’s heart physiological remondeling: clinical significance, diagnostic strategies and implications for preparticipation screening. Br J Sports Med. 2009;43:649-656.

6. Neary JP, MacQuarrie DS, Jamnik V, Gledhill N, Gledhill S, Busse EFG. Assessment of mechanical cardiac function in elite athletes. Open Sports Med J. 2011;5:26-37.

7. Printz BF. Noninvasive imaging modalities and sudden cardiac arrest in the young: can they help distinguish subjects with a potentially life-threatening abnormality from the normals? Pediatr Cardiol. 2012;33(3):439-51.