IOC Manual of Sports Cardiology

Professor Mathew Wilson is Head of Athlete Health and Performance Research and is Lead Performance Physiologist at Aspetar (Qatar Orthopedic Sports Medicine Hospital, Qatar). He has led cardiovascular pre-participation screening programmes both within the United Kingdom and the Middle-East, and has been charged with the screening of over 15,000 high-level athletes at the Olympic Medical Institute (United Kingdom) and Aspetar (Qatar). Professor Jonathan Drezner is past-president of the American Medical Society for Sports Medicine, Director of the Center for Sports Cardiology and a sports medicine physician at the University of Washington, and team physician for the Seattle Seahawks NBA basketball team. Professor Drezner is a leading authority on the role of the automatic external defibrillator in preventing sudden cardiac death. Professor Sanjay Sharma is Medical Director of the Virgin London Marathon, Chair-Elect of the European Society of Cardiology (Sports Cardiology) nucleus group and leads the inherited cardiomyopathies and sports cardiology clinics at St George s Hospital, London.

Contributors, x Foreword, xiii Preface, xiv PART 1 The Cardiovascular System 1 1 Anatomy and Physiology of the Heart 3 Keith P. George and Nathan Riding 2 The Vascular System 13 N. Tim Cable 3 Energy Production Pathways During Exercise 21 Sebastien Racinais and Stephane Perrey 4 Cardiovascular Responses to Exercise 32 Julien D. Periard 5 The Athlete s Heart: Impact of Age, Sex, Ethnicity and Sporting Discipline 43 Tracey Keteepe ]Arachi and Nabeel Sheikh 6 Physical Activity in the Prevention and Management of Atherosclerotic Disease 53 John P. Buckley PART 2 Preventing Sudden Cardiac Death in Athletes 63 7 Incidence and Aetiology of Sudden Cardiac Death in Athletes 65 Kimberly G. Harmon 8 Cardiovascular Screening for the Prevention of Sudden Cardiac Death in Athletes 74 Antonio Pelliccia and Domenico Corrado 9 Comparison of Pre ]participation Evaluations for Assessing Cardiovascular Risk in Athletes 82 Ramy S. Abdelfattah and Mathew G. Wilson 10 Normal Electrocardiographic Findings in Athletes 95 Mathew G. Wilson and Victoria Watt 11 Abnormal Electrocardiographic Findings in Athletes: Recognising Changes Suggestive of Cardiomyopathy 104 Gherardo Finocchiaro and Michael Papadakis 12 Abnormal Electrocardiographic Findings in Athletes: Recognising Changes Suggestive of Primary Electrical Disease 114 Jordan Prutkin 13 Effective Echocardiographic Assessment of the Athlete: Basic Examination to Advanced Imaging Techniques 128 David Oxborough 14 Early Repolarisation in Athletes 147 Greg Mellor and Elijah R. Behr 15 Clinical (Laboratory) Exercise Testing 153 Jonathan Myers and Victor Froelicher 16 The Role of Cardiovascular Magnetic Resonance in the Assessment of Athletes 163 Rory O Hanlon 17 Genetic Testing for Cardiovascular Conditions Predisposing to Sudden Death 175 Colleen Caleshu and Euan Ashley PART 3 Cardiac Conditions Predisposing to Sudden Cardiac Death 187 Section 1: Introduction 189 18 Causes of Sudden Cardiac Death in Sport: The Importance of Autopsy and Specialist Examination of the Heart 191 Mary N. Sheppard Section 2: Inherited and Congenital Cardiovascular Pathologies 203 19 Hypertrophic Cardiomyopathy 205 David S. Owens 20 Arrhythmogenic Right Ventricular Cardiomyopathy 217 Alessandro Zorzi and Domenico Corrado 21 Dilated Cardiomyopathy, Left Ventricular Hypertrabeculation and Noncompaction 231 Sabiha Gati and Sanjay Sharma 22 Marfan Syndrome and Aortopathies 240 Anne H. Child and Bethan Davies 23 Valvular Disease 247 Kathleen E. Kearney and Catherine M. Otto 24 Congenital Heart Disease 263 Guido E. Pieles and A. Graham Stuart 25 Congenital Coronary Artery Anomalies 275 Cristina Basso and Gaetano Thiene Section 3: Ion Channelopathies, Accessory Pathways and Electrical Disease 287 26 Long QT Syndrome 289 David J. Tester and Michael J. Ackerman 27 Brugada Syndrome 303 Elena Arbelo and Josep Brugada 28 Wolff Parkinson White Syndrome 315 Jack C. Salerno 29 Catecholaminergic Polymorphic Ventricular Tachycardia 324 Leonie C.H. Wong and Elijah R. Behr 30 Idiopathic Ventricular Tachycardia/Ventricular Fibrillation 331 Andre La Gerche Section 4: Acquired Disorders 341 31 Commotio Cordis 343 Christopher Madias and Mark S. Link 32 Myocarditis 350 Jeffrey A. Towbin Section 5: Other Causes of Sudden Death 359 33 Alternative Noncardiac Medical Causes of Sudden Death: Sickle ]Cell Trait, Exertional Heatstroke, Exercise Rhabdomyolysis, Asthma and Extreme Environmental Conditions 361 Juan Manuel Alonso and Paul Dijkstra PART 4 Cardiovascular Management 371 34 Guidelines for Sports Practice in Athletes with Cardiovascular Disease 373 Andrew D Silva and Sanjay Sharma 35 Management of the Symptomatic Athlete 385 Meagan M. Wasfy and Aaron L. Baggish 36 Management of Abnormal Physical Examination Findings in Athletes 395 Victoria Watt, Mats Borjesson and Mikael Dellborg 37 Management of Atrial Fibrillation in Athletes 406 Eduard Guasch and Lluis Mont 38 Implantable Cardioverter ]Defibrillators in Athletes 415 Victoria Watt 39 Management of Hypertension in Athletes 427 Maria ]Carmen Adamuz PART 5 Conundrums in Sports Cardiology 439 40 Distinguishing Physiological Left Ventricular Hypertrophy from Hypertrophic Cardiomyopathy in Athletes 441 Aneil Malhotra and Sanjay Sharma 41 Screening for Cardiovascular Disease in the Older Athlete 449 Mats Borjesson 42 Is Ultra ]Endurance Exercise Damaging to the Right Ventricle? 457 Guido Claessen and Hein Heidbuchel 43 Clinical Implications of Performance ]Enhancing Drugs for Cardiovascular Health 468 Peter J. Angell and Yorck O. Schumacher 44 Cardiovascular Concerns in the Paralympic Athlete 475 Cindy J. Chang and Suzy Kim PART 6 Emergency Cardiac Care 483 45 Emergency Cardiac Care in the Athletic Setting: From School Sports to the Olympic Arena 485 Efraim Kramer and Martin Botha PART 7 Sports Cardiology Training 493 46 Recommendations for Sports Cardiology Training for the Sports Medicine Physician 495 Irfan M. Asif and Jonathan A. Drezner Index, 503