A 'sensitive heart' in a tennis player.

A 49-year-old man was evaluated because of exertional chest pain of 1 month's duration that began during vigorous tennis. Initially, the pain was substernal and lasted 1 to 2 minutes. Recurrent episodes were always exercise related, though the activity might be mild, and episodes were relieved by several minutes of rest. At times, the pain radiated to the left side of the neck.

Leila Denmark, MD: practicing medicine at age 100.

Leila Denmark, MD, continues to practice medicine at age 100. Her lifestyle and work ethic are an inspiration in the current era of managed care mania.

ECG Variations in College Athletes.

At Georgia Institute of Technology, the sports preparticipation evaluation includes a cardiovascular questionnaire and careful examination of the heart, listening especially for systolic murmurs that intensify with Valsalva's maneuver and/or standing, which could indicate hypertrophic cardiomyopathy (1,2).

Preparticipation physical evaluation: getting to the heart of the matter.

The cardiovascular evaluation is an important component of the preparticipation physical examination of the athlete. The history should be standardized to include questions ranging from those about chest pain and palpitations to ones about syncope. The physical examination should not be a perfunctory one, but rather a careful search for findings that might include a low grade heart murmur that accentuates with Valsalva'a maneuver (suggestive of hypertrophic cardiomyopathy, the leading cause of sudden death in a competitive athlete). The cardiovascular risks to the athlete are known. Fortunately, only a small percentage of athletes who are screened have such abnormalities. The validity of such screening remains to be proven. Recommendations are provided to make the present approach more time efficient and perhaps more cost effective.

Medical care delivery at the 1996 Olympic Games. Centers for Disease Control and Prevention Olympics Surveillance Unit.

CONTEXT: Mass gatherings like the 1996 Olympic Games require medical services for large populations assembled under unusual circumstances. OBJECTIVE: To examine delivery of medical services and to provide data for planning future events. DESIGN: Observational cohort study, with review of medical records at Olympics medical facilities. SETTING: One large multipurpose clinic and 128 medical aid stations operating at Olympics-sponsored sites in the vicinity of Atlanta, Ga. PARTICIPANTS: A total of 10715 patients, including 1804 athletes, 890 officials, 480 Olympic dignitaries, 3280 volunteers, 3482 spectators, and 779 others who received medical care from a physician at an Olympic medical station. MAIN OUTCOME MEASURES: Number of injuries and cases of heat-related illness among participant categories, medical use rates among participants with official Games credentials, and use rates per 10000 persons attending athletic competitions. RESULTS: Injuries, accounting for 35% of all medical visits, were more common among athletes (51.9% of their visits, P < .001) than among other groups. Injuries accounted for 31.4% of all other groups combined. Spectators and volunteers accounted for most (88.9%, P < .001) of the 1059 visits for heat-related illness. The rates for number of medical encounters treated by a physician were highest for athletes (16.2 per 100 persons, P < .001) and lowest for volunteers (2.0 per 100). Overall physician treatment rate was 4.2 per 10000 in attendance (range, 1.6-30.1 per 10000). A total of 432 patients were transferred to hospitals. CONCLUSIONS: Organizers used these data during the Games to monitor the health of participants and to redirect medical and other resources to areas of increased need. These data should be useful for planning medical services for future mass gatherings.

Management of casualties from the bombing at the centennial olympics.

BACKGROUND: The explosion of a bomb 75 to 100 yards away from attendees at a concert who were in the process of being evacuated from Centennial Olympic Park at approximately 1:25 AM on July 27, 1996, resulted in a multiple-casualty event involving primarily four hospitals in proximity to the blast. The purpose of this study was to review triage and care of the victims, emphasizing those with significant injuries. METHODS: Retrospective review of triage and care of injured patients. RESULTS: Ninety-six of the 111 victims of the blast were triaged in the first half hour to four hospitals within 3 miles of the bombing. Only four minor operations were performed in 61 patients evaluated at community hospitals. Ten of 35 patients evaluated at the regional trauma center underwent emergency or urgent operations, and all who were seriously injured did well. CONCLUSIONS: Although overtriage to the regional trauma center occurred, outcome was excellent in all seriously injured victims treated there.

ECG Quiz: Flushing, Paresthesias, and Difficulty Swallowing After a Run.

A 45-year-old veteran runner, while on a summer vacation in Martha's Vineyard, went for his usual 5-mile jog in 80 degrees F weather. Two minutes after completing the run, his vision blurred and he became lightheaded. He had difficulty swallowing and noted tingling in his hands and arms and generalized flushing. He felt no chest pain, but his facial and arm muscles felt "distorted."

Automatic external defibrillators in the sports arena: the right place, the right time.

At first glance, the idea of having automatic external defibrillators (AEDs) at sports events may seem curious, since spectator sports are the domain of young, healthy athletes. Yet athletes are not entirely free of cardiac risk. More important, there are many other people at sports events (officials, coaches, fans) who are at risk for cardiac arrest. In just one example, baseball umpire John McSherry suffered a fatal heart attack before a national TV audience during the Cincinnati Reds' home opener in April 1996.

Acute dyspnea and a new murmur in a team physician.

A 61-year-old physician for a professional sports team experienced transient palpitations and dyspnea while playing in an over-50 basketball scrimmage. He had been physically active for many years, had no known cardiopulmonary disorders, and had never been told of a heart murmur. He had not been febrile, nor had he experienced any chest pain. There was no history of recent dental work.

Imaging quiz: a new cardiac test for an older doctor.

A physically active 69-year-old male physician was seen after he had an electron beam computed tomography (EBCT) scan of his heart. The test was offered free to physicians.

Chest Pain and a 'Normal' Exercise ECG in a 44-Year-Old Runner.

A 44-year-old man was evaluated because of new-onset chest pain. The patient reported that 4 days earlier, at a stressful out-of-town business meeting, he had experienced anterior chest pain while sitting. It improved when he lay on his side. The pain was steady for 1 hour, then intermittent for several hours. The patient went the same day to an ambulatory care clinic, where an electrocardiogram (ECG) and chest x-ray were said to be normal, and an antacid was prescribed. The chest pain recurred the following day while he was running on a treadmill, but did not return during a 30-minute run the morning I initially examined him.

Cardiovascular events in the 1996 Olympic Games.

Cardiovascular events were few during the 1996 Olympic Games. On-site availability of defibrillators and well-trained medical personnel were life-saving in several instances.

Medical and public health services at the 1996 Atlanta Olympic Games: an overview.

Planning for the 2000 Sydney Olympic Games may benefit from the experience of the 1996 Atlanta Olympics. Excellent health promotion and prevention activities before and during the Games resulted in fewer medical and public health problems than anticipated. Despite this, there was room for improvement in the level of communication and cooperation between the many service providers to ensure the most appropriate and efficient responses.

The Polyclinic at the 1996 Atlanta Olympic Village.

The Polyclinic, staffed mainly by volunteers, successfully provided primary health care during 16,519 patient encounters, 64% involving athletes. However, the profile of patient needs held some surprises.

ECG Quiz: Dizziness in a Cardiac Rehabilitation Patient.

A 62-year-old woman entered a cardiac rehabilitation program for help with weight loss and fitness, and also for monitoring of episodic atrial fibrillation, which had begun in 1992. She was able to exercise without triggering atrial fibrillation. Additional past medical problems included glucose intolerance (treated with diet), hyperlipidemia, hypertension, migraine headaches, degenerative disease of the spine, and a duodenal ulcer.