Sports Cardiology Casebook (eBook)

Sports Cardiology Casebook 2
Foreword 5
Contents 7
Contributors 10
Introduction 14
References 16
1 A 27-Year-Old Professional Cyclist with Palpitations on Effort 18
Family and Personal History 18
Physical Examination 18
12-Lead ECG 18
Diagnostic Testing 19
Recommendations and Treatment 22
Clinical Course 22
Discussion 23
References 24
2 Impaired Performance in a Master Long-Distance Runner 26
History 26
Athletic History 26
Family History 26
Medication 26
Physical Examination 27
12-Lead ECG 27
Maximal Exercise Test with Gas Analysis 27
Trans-Thoracic Echocardiography 28
Stress Echocardiography 30
Diagnosis and Recommendations 30
Discussion 30
References 31
3 A 26-Year-Old Cyclist with Syncope on Effort 32
Family and Personal History 32
Medical History 32
Physical Examination 32
12-Lead ECG 32
Echocardiography 33
Exercise Electrocardiography 34
Clinical Course 34
Discussion 35
Recommendations for Sports Participation in Patients with ARVC 37
References 37
4 A 32-Year-Old Female Soccer Player with Unexplained Syncope 39
Previous Medical History 39
Physical Examination and Diagnostic Testing 39
Clinical Course 39
Family History 41
Type and Level of Sports Activity Performed 41
Physical Examination 41
12-Lead ECG 41
Diagnostic Testing 42
ECG Holter-Monitoring (48h) 42
Blood Pressure (BP)-Monitoring 43
Late Potentials (HV)-ECG 43
Exercise -- Testing 43
Echocardiography 44
Ajmalin -- Testing 44
Sleep Apnea Monitoring 45
Cardiac CT Scan 45
Cardiac Magnetic Resonance 45
Tilt Table Testing 45
Neurologist Consultation 46
Cerebral Doppler 47
Cerebral MRI 48
Ophthalmologist Examination 48
Laboratory Results 48
Final Diagnosis and Recommendations 48
Discussion 48
References 49
5 A 23-Year-Old Top-Level Soccer Player Suffering Syncope on Effort 50
Medical History 50
Physical Examination 50
12-Lead ECG 50
Echocardiography 50
Exercise Electrocardiography 50
Holter Monitoring 51
Other Diagnostic Testing 52
Clinical Course 52
Other Diagnostic Testing 53
Treatment 53
Subsequent Clinical Course 53
Discussion 54
References 55
6 A 21-Year-Old Female Beach Volleyball Player with Palpitations and Pre-syncope on Effort 56
Medical History 56
Physical Examination 56
12-Lead ECG 56
Diagnostic Testing 56
Clinical Course and Recommendations 57
Subsequent Follow-Up 58
Discussion 60
Summary of the Recommendations for Sports Participation in Athletes with AVNRT [ 3 , 5 ] 60
References 61
7 A 49-Year-Old Male Marathon Runner with Exercise Induced Prolonged Palpitations 62
Family and Personal History 62
Medical History 62
12-Lead ECG 62
Echocardiography 62
Exercise Electrocardiography 63
ECG Holter Monitoring 64
Diagnosis and Treatment 64
2nd Cardiovascular Evaluation 65
Physical Examination 65
12-Lead ECG 65
Other Testing 65
Treatment 65
Clinical Course 66
Discussion 67
Suggested Recommendations for Sports Participation in Adult and Senior Athletes with Atrial Fibrillation (AF) 68
References 69
8 A Female Cyclist with Prolonged Palpitations on Effort 71
Medical History 71
Physical Examination 71
Electrocardiogram 71
Echocardiography 71
ECG Holter Monitoring 71
Electrophysiological Study 72
Second Clinical Evaluation 73
Diagnosis and Recommendation 73
Discussion 75
References 76
9 The Girl with Systolic Murmur on the Left Sternal Border 77
Family and Personal History 77
Physical Examination 77
12-Lead ECG 77
Diagnostic Course 77
Cardiology Consultation 78
12-Lead ECG 78
Echocardiography 78
Diagnosis 80
What is the Risk for Our Patient of Continuing her Sport? 80
Recommendations 80
Discussion 80
References 81
10 Elite Tennis Player with a Complete Atrio-Ventricular Block 82
Medical History 82
Physical Examination 82
12-lead electrocardiogram 82
M-mode Echocardiogram 82
Electrophysiologic Study 83
Diagnosis and Recommendation 83
Clinical Course 84
24-Hour ECG Monitoring 84
Exercise Testing 84
Clinical Outcome 84
Medical History 85
12-Lead ECG 85
24-Hour Holter ECG Monitoring 85
Doppler-Echocardiography 85
Discussion 86
References 88
11 A Young Canoeist with an Abnormal Electrocardiogram 89
Family and Personal History 89
Physical Examination 89
12-Lead ECG 89
Echocardiography 89
Exercise Electrocardiography 90
ECG Holter Monitoring 90
Additional Diagnostic Testing 91
Clinical Course 92
Discussion 93
References 96
12 ECG Repolarization Abnormalities in an African Descent Athlete: Pathologic or Physiologic Finding? 97
Medical History 97
Physical Examination 97
12-Lead ECG 97
Echocardiography 97
Cardiac Magnetic Resonance (CMR) 99
Diagnosis and Recommendations 99
Discussion 100
References 102
13 A 16-Year-Old Female Runner with Prolonged QT Interval 104
Medical History 104
Physical Examination 104
12-Lead ECG 104
Other Diagnostic Testing 104
Diagnosis and Recommendations 106
Discussion 107
Pitfalls in the Measurements of QT Interval in Athletes 107
Diagnosis of LQTS in Asymptomatic Athletes 108
Management 109
References 109
14 Athlete with Variable QTc Interval and Abnormal T Wave Pattern 111
Family and Personal History 111
Physical Examination 111
12-Lead ECG 111
Echocardiography 111
Exercise Electrocardiography 112
ECG Holter Monitoring 113
Family Screening 114
Cardiac Magnetic Resonance 115
Diagnosis and Recommendations 115
Clinical Course 116
Genetic Analysis 117
Follow-Up 117
Discussion 117
References 119
15 Young Triathlete with Unusual ST-Segment Elevation in Precordial Leads 120
Family and Personal History 120
Physical Examination 120
12-Lead ECG 120
Exercise Electrocardiography 121
Flecainide Testing 121
Echocardiography 122
Diagnosis 123
Discussion 123
Recommendations for Sports Participation in Brugada Patients 124
Early Repolarization Pattern in Athletes 125
References 126
16 A 17-Year-Old Competitive Soccer Player with Pre-excitation Pattern on 12-Lead ECG 127
Family and Personal History 127
Physical Examination 127
12-Lead ECG 127
Diagnostic Course 127
Recommendations 128
Discussion 128
References 129
17 A Symptomatic Judoka with Wolff-Parkinson-White Pattern 131
Athletic History 131
Family History 131
Personal History 131
Physical Examination 131
12-Lead ECG 131
Echocardiography 132
Electrophysiologic Study and Ablation Procedure 132
Clinical Course and Recommendations 133
Discussion 133
References 135
18 A 35-Year-Old Competitive Cyclist with Frequent Premature Ventricular Beats 136
Athletes History 136
Previous Diagnostic Testing 136
Medical History 136
Physical Examination 137
12-Lead ECG 137
New Diagnostic Testing 137
Recommendations and Treatment 141
Clinical Course 141
Discussion 141
References 143
19 An Athlete with Ischemic Pattern on Exercise ECG 144
Family and Personal History 144
Physical Examination 144
12-Lead ECG 144
Exercise Electrocardiography 144
Echocardiography 145
ECG Holter Monitoring 146
Other Tests 146
Ventriculo-Coronary Angiography 147
Cardiac Magnetic Resonance 147
Diagnosis and Recommendations 148
Discussion 148
References 149
20 A 17-Year-Old National Cyclist with Exercise-Induced Ventricular Tachycardia 150
Family and Personal History 150
Medical History 150
Physical Examination 150
12-Lead ECG 151
Echocardiography 151
Blood Analysis 151
Exercise Test: Race Simulation 152
Holter ECG Monitoring During Bicycle Race 152
Recommendations 154
Additional Diagnostic Tests 154
Electrophysiologic Study 154
Subsequent Clinical Course 154
Continued Follow-Up 154
Final Recommendations 155
Discussion 155
References 156
21 A 53-Year-Old Recreational Jogger with Atrial Fibrillation 157
Family and Personal History 157
Physical Examination 157
12-Lead ECG 157
Echocardiography 158
Diagnosis and Treatment 158
Clinical Course 158
Discussion 159
References 161
22 Paroxysmal Atrial Fibrillation in a Professional Cyclist 162
Family and Personal History 162
Athletic History 162
Physical Examination 162
12-Lead ECG 162
Echocardiography 163
Maximal Exercise Testing with Gas Analysis 163
Follow-Up and Other Testing 164
Treatment and Recommendations 166
Subsequent Follow-Up 166
Discussion 166
References 167
23 A Female Soccer Player with Unusual Fatigability and Ventricular Arrhythmia 168
Medical History 168
Diagnostic Testing 168
Clinical Course 170
Recommendations and Treatment 170
Subsequent Clinical Course 170
Recommendations and Treatment 171
Discussion 171
References 172
24 A 38-Year-Old Marathon Runner with Tricuspid Valve Regurgitation 173
Personal Medical History 173
Family History 173
Type and Level of Sports Activity Performed 173
Physical Examination 173
Diagnostic Testing 174
12-Lead ECG 174
Echocardiography 174
Treadmill - Exercise - Testing 175
Cardiac Magnetic Resonance (CMR) 175
ECG Holter Monitoring 176
Laboratory Results 177
Diagnosis and Recommendations 177
Discussion 177
Reference 177
25 A Young Rower with an Unusual Left Ventricular Hypertrophy 178
Family and Personal History 178
Physical Examination 178
12-Lead ECG 178
Echocardiography 178
Exercise Testing 179
Detraining 180
Clinical Course 181
Additional Diagnostic Testing 181
Diagnosis and Recommendations 182
Discussion 184
References 185
26 An Elite Athlete with Controversial Left Ventricular Hypertrophy 186
Medical History 186
Physical Examination 186
12-Lead ECG 186
Echocardiography 186
Clinical Course 187
Diagnosis and Recommendations 190
Discussion 191
References 192
27 A Non-compaction Cardiomyopathy or Innocent LV Trabeculation? 194
Medical History 194
Family and Personal History 194
Physical Examination 194
12-Lead ECG 194
Exercise Testing 195
24-h ECG Holter Monitoring 195
Signal Averaging ECG 195
Echocardiography 196
Cardiac Magnetic Resonance (CMR) 197
Diagnosis and Recommendations 197
Discussion 198
References 199
28 A 31-Year-Old Male, Recreational Soccer Player with 0Low Risk0 Hypertrophic Cardiomyopathy 202
Medical History 202
Physical Examination 202
12-Lead ECG 202
Echocardiography 202
Exercise Testing 203
ECG Holter Monitoring 203
Diagnosis and Recommendations 203
Clinical Course 204
Autopsy Findings 204
Discussion 205
References 206
29 Competitive Cyclist Suffering from Myocardial Infarction, Willing to Resume Competitive Sport 207
Family and Personal History 207
Athletic History 207
Medical History 207
Reason for Cardiovascular Evaluation 209
Physical Examination 209
12-Lead ECG 209
Evaluation and Risk Stratification 209
Diagnostic Testing 209
Recommendations 211
Discussion 211
References 212
30 A 32 Year-Old Male Soccer Player with Chest Trauma 213
Medical History 213
Physical Examination 213
12-Lead ECG 213
Clinical Course 213
Cardiac Evaluation in the CCU 213
Additional Testing 215
Recommendations 215
Discussion 215
References 215
31 Asymptomatic Cyclist with Stenosis of Left Main Coronary Artery 217
Medical History 217
Physical Examination 217
12-Lead ECG 217
Exercise Testing 217
Additional Testing 217
Diagnosis and Recommendations 218
Discussion 220
References 221
Appendices 222
Index 237