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HEADLINE: Fit-to-play hearts; Athlete deaths (4 of 4 DOCS)


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Tim Stewart
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  • HEADLINE: Fit-to-play hearts; Athlete deaths (4 of 4 DOCS)

    4 of 4 DOCUMENTS

    Copyright 2003 Gale Group, Inc.
    Copyright 2003 Cliggott Publishing Co.

    August 1, 2003

    SECTION: No. 9, Vol. 43; Pg. 1069; ISSN: 0010-7069

    IAC-ACC-NO: 107244652

    LENGTH: 773 words

    HEADLINE: Fit-to-play hearts; Consultations & comments: reader reaction and
    timely answers from expert; cardiac disease in high school athletes

    BYLINE: Carek, Peter J.


    What should be included in the optimal cardiovascular evaluation of a high
    school athlete?


    First, ask specific questions about risk factors for and symptoms of
    cardiovascular disease (Box). A positive response to any of these questions
    warrants confirmation and may require further evaluation.

    Physical examination. Auscultate the heart with the patient in both standing
    and supine positions. In addition, auscultate while the patient performs various
    maneuvers (eg, squat-to-stand, deep inspiration, Valsalva maneuver); such
    maneuvers can clarify the classification of a murmur.

    Diagnostic testing. Order diagnostic studies (eg, echocardiography) and/or
    consultation to further evaluate the following:

    * Any systolic murmur grade 3/6 or louder.

    * Any murmur that disrupts normal heart sounds.

    * Any diastolic murmur.

    * Any murmur that intensifies with the maneuvers mentioned above.

    Sinus bradycardia and systolic murmurs are commonly found and usually do not
    warrant further evaluation in an asymptomatic patient. (1) Third and fourth
    heart sounds are also frequently heard in asymptomatic athletes without
    underlying heart disease. (1,2)

    Noninvasive cardiac testing should not be routinely included in the
    screening examination. ECGs, echocardiograms, and exercise stress tests are not
    cost-effective in a population at relatively low risk for cardiac abnormalities;
    moreover, these tests cannot consistently identify persons at actual risky.
    (3-7) For example, a substantial percentage (11%) of participants in a study of
    college athletes had a clinically significant increase in ventricular wall
    thickness that hindered interpretation of echocardiographic findings. (3)

    Furthermore, abnormal findings on noninvasive tests may not affect athletic
    performance. Some patients with hypertrophic cardiomyopathy are able to tolerate
    intense athletic training and competition for many years--and even maintain high
    levels of achievement--without incurring symptoms, disease progression, or
    sudden death. (4)

    However, for patients with an abnormal cardiovascular history or
    examination, echocardiography and stress testing are the most commonly
    recommended diagnostic tests. In conjunction with clinical information,
    echocardiography can be used to distinguish nonobstructive hypertrophic
    cardiomyopathy from the athletic heart syndrome. (8)


    (1.) Huston TP, Puffer JC, Rodney WM. The athletic heart syndrome. N Engl J
    Med. 1985;313:24-32,

    (2.) Crawford MH, O'Rourke RA. The athlete's heart. Adv Intern Med.

    (3.) Lewis JF, Maron BJ, Diggs JA, et al. Preparticipation echocardingraphic
    screening for cardiovascular disease in a large, predominantly black population
    of collegiate athletes. Am J Cardiol. 1989;64:1029-1033.

    (4.) Maron BJ, Klues HG. Surviving competitive, athletes with hypertrophic
    cardiomyopathy. Am J Cardiol. 1994;73:1098-1104.

    (5.) Fuller CM. McNulty CM, Spring DA, et al. Prospective screening of 5,615
    high school athletes for risk of sudden death. Med Sci Sports Exer.

    (6.) Fuller CM. Cost-effectiveness of analysis of high school athletes for
    risks of sudden death. Med Sci Sports Exer. 2000;32:887-890.

    (7.) Pelliccia A, Maron BJ, Culasso F. et al. Clinical significance of
    abnormal electrocardiographic patterns in trained athletes. Circulation.

    (8.) Maron BJ. Pelliccia A, Spirito P. Cardiac disease in young trained
    athletes: insights into methods for distinguishing athlete's heart from
    structural heart disease with particular emphasis on hypertrophic
    cardiomyopathy. Circulation. 1995;91:1596-1601.

    RELATED ARTICLE: Questions to ask high school athletes to assess
    cardiovascular risk.

    * Have you ever passed out during or after exercise?

    * Have you ever been dizzy during or after exercise?

    * Have you ever had chest pain during or after exercise?

    * Do you get tired more quickly than your friends do during exercise?

    * Have you ever had racing of your heart or skipped heartbeats?

    * Have you had high blood pressure or high cholesterol?

    * Have you been told you have a heart murmur?

    * Has any family member or relative died of heart problems or of sudden
    death before age 50?

    * Have you had a severe viral infection (for example, myocarditis or
    mononucleosis) within the last month?

    * Has a physician ever denied or restricted your participation in sports or
    physical activity for any heart problem?

    --Peter J. Carek, MD

    Associate Professor

    Department of Family Medicine

    Medical University of South Carolina


    IAC-CREATE-DATE: September 5, 2003

    LOAD-DATE: September 06, 2003
    Thanks, Tim
    Forum Administrator

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