Sports Cardiology: Core Curriculum for Providing Cardiovascular Care to Competitive Athletes and Highly Active People.

The last few decades have seen substantial growth in the populations of competitive athletes and highly active people (CAHAP). Although vigorous physical exercise is an effective way to reduce the risk of cardiovascular (CV) disease, CAHAP remain susceptible to inherited and acquired CV disease, and may be most at risk for adverse CV outcomes during intense physical activity. Traditionally, multidisciplinary teams comprising athletic trainers, physical therapists, primary care sports medicine physicians, and orthopedic surgeons have provided clinical care for CAHAP. However, there is increasing recognition that a care team including qualified CV specialists optimizes care delivery for CAHAP. In recognition of the increasing demand for CV specialists competent in the care of CAHAP, the American College of Cardiology has recently established a Sports and Exercise Council. An important primary objective of this council is to define the essential skills necessary to practice effective sports cardiology.

Cardiovascular Considerations in the Female Athlete.

Over several decades, much has been learned about the diverse physical impacts of exercise. Those who excel, such as elite athletes, have physiologic differences compared with the general population. There is a growing body of data suggesting that gender may play a role in these adaptations. Further, certain cardiac conditions may exhibit a gender predilection. This article explains the particular cardiac nuances of the female athlete.

Coronary Artery Evaluation by Screening Echocardiogram in Intercollegiate Athletes.

INTRODUCTION: Coronary artery anomalies are the second most common congenital cause of sudden cardiac death in young athletes. Some centers have advocated for limited transthoracic echocardiogram (TTE) protocols in the screening of college athletes, which may miss important causes of sudden cardiac death. PURPOSE: The purpose of this study was to evaluate the ability of screening TTE to determine the origin and proximal course of the coronary arteries in intercollegiate athletes. METHODS: An institutional review board-approved retrospective review of all incoming National Collegiate Athletic Association Division-I athletes at a single institution for the 2013-2014 academic year was performed. Two pediatric cardiologists independently reviewed all TTE studies for right coronary artery (RCA) and left coronary artery (LCA) ostia, proximal course, and measurable course. Proximal course was defined as a measurable course >1 cm for the RCA and a measurable course >1 cm or observation of the bifurcation for the LCA. Measurable course was defined as the maximum continuously observable distance of coronary artery from a clearly delineable ostium. Results were compared among athlete characteristics, and interobserver reliability was evaluated. RESULTS: Chart review identified 146 athletes, representing 22 sports and 6 ethnicities. No coronary anomalies were found. The average measurable course was 2.1 cm for the RCA and 1.5 cm for the LCA. Both readers observed the RCA ostium in 143 athletes (98%), LCA ostium in 143 athletes (98%), RCA proximal course in 119 athletes (82%), and LCA proximal course in 118 athletes (81%). Statistical analysis showed good interobserver reliability for observation of the ostia and proximal course. CONCLUSIONS: The origin and proximal course of the coronary arteries were readily and reliably observed in the majority of athletes, suggesting coronary artery evaluation should be included in athlete screening TTE protocols.

Congenital Heart Disease and the Athlete: What We Know and What We Do Not Know.

Since outcomes for patients with congenital heart disease (CHD) have greatly improved, most patients with CHD are surviving into adulthood and creating dilemmas for practitioners with regard to competitive sports participation. Much time, effort, and expertise have gone into developing the new American Heart Association/American College of Cardiology's guidelines and the European Society of Cardiology's guidelines. Practitioners should consult the guidelines but also be aware of gaps in the literature and should individualize recommendations for each patient. Both participation and restriction decisions should be made thoughtfully and collaboratively with athletes as either decision carries important consequences."

Endurance Training on Congenital Valvular Regurgitation: An Athlete Case Series.

BACKGROUND: Both intense endurance training and valvular regurgitation place a volume load on the right and left ventricles, potentially leading to dilation, but their effects in combination are not well-known. PURPOSE: The purpose of this case series is to describe the combined volume load of intense endurance athletic training and regurgitant valvular disease as well as the challenging assessment of each component's cardiovascular effect. METHODS: In this article, the clinical course of three elite endurance athletes with congenital valvular disease were reviewed. RESULTS: A swimmer with aortic regurgitation, a cyclist with aortic regurgitation, and a cyclist with pulmonary regurgitation were found to have severe dilation of the associated ventricles despite continuing to train at an elite level without symptoms. CONCLUSIONS: Because of the cumulative effects of endurance training and valvular regurgitation, each athlete manifested ventricular dilation out of proportion to their valvular disease and symptoms. Although the effects of congenital valvular disease and athletic remodeling on ventricular dilation have been thoroughly studied individually, their cumulative effect is not well understood. This complicates the assessment of athletes with valvular regurgitation and underscores the need for athlete-specific recommendations for valve replacement.

The Impact of Sports Cardiology on the Practice of Primary Care Sports Medicine: Where Were We, Where Are We, Where Are We Headed?

This article is a commentary on the role of sports cardiologists in the athletic arena and the beneficial impact they offer sports medicine in the comprehensive care of competitive athletes. The focus is a dialogue on current recommendations for primary prevention of sudden cardiac arrest (SCA), incorporating elements of the preparticipation evaluation and continuing care of athletes with diagnosed heart disease (HD). The feasibility and potential advantages of implementing well-designed preparticipation cardiovascular screening programs and the role of sports cardiologists to educate primary care team physicians on secondary prevention of SCA and proper treatment of underlying HD are discussed.

Something Old, Something New: Using Family History and Genetic Testing to Diagnose and Manage Athletes with Inherited Cardiovascular Disease.

A primary objective of the preparticipation physical examination is to identify athletes at increased risk for sudden cardiac arrest (SCA). Review of an athlete's family history may identify those at risk for SCA. Genetic testing for inherited cardiovascular disease has emerged as a valuable addition to the repertoire of cardiologists facing the decision of clearing athletes with concerning clinical signs and/or family histories. Genetic testing may lead to various outcomes for an athlete including: reassurance, diagnosis in those with borderline clinical features, finding disease predisposition prior to the onset of clinical signs (ie, genotype-positive/phenotype-negative), or continued uncertainty.

The Historical Perspective of Athletic Sudden Death.

Since antiquity, the athlete has been elevated to a heroic status both within small communities and at the international level. Although numerous population studies have estimated athletic sudden death to be a rare event, the consequences resonate far beyond those directly affected. Sports cardiology has evolved as a result of these tragedies, which highlighted a need for safer play and more programmatic protection of the athlete in play. In this article, athletic sudden death is analyzed from a historical and literary perspective and the development of modern initiatives to protect athletes from sudden death is reviewed.

Edgar Allan Poe: a case description of the Marfan syndrome in an obscure short story.

In the obscure short story "A Tale of the Ragged Mountains," Edgar Allen Poe meticulously described a character with features remarkably consistent with the Marfan syndrome. This description appeared in fiction >50 years before the celebrated index description in the published medical research by Professor Antoine Marfan in Paris in 1896.

Cardiovascular screening and the elite athlete: advances, concepts, controversies, and a view of the future.

This article addresses programmatic cardiovascular screening and evaluation of the elite athlete at the intercollegiate, national team, professional, and Olympic levels. Although much of this content may apply to high-school and recreational sports at large, it is not specifically designed to address athletes participating in all sports activities.