Tim Stewart
09-08-2003, 08:57 AM
4 of 4 DOCUMENTS
Copyright 2003 Gale Group, Inc.
ASAP
Copyright 2003 Cliggott Publishing Co.
Consultant
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.
BODY:
What should be included in the optimal cardiovascular evaluation of a high
school athlete?
--MD
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)
REFERENCES:
(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.
1979;24:311-329.
(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.
1997;29:1131-1138.
(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.
2000;102:278-284.
(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
Charleston
IAC-CREATE-DATE: September 5, 2003
LOAD-DATE: September 06, 2003
Copyright 2003 Gale Group, Inc.
ASAP
Copyright 2003 Cliggott Publishing Co.
Consultant
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.
BODY:
What should be included in the optimal cardiovascular evaluation of a high
school athlete?
--MD
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)
REFERENCES:
(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.
1979;24:311-329.
(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.
1997;29:1131-1138.
(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.
2000;102:278-284.
(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
Charleston
IAC-CREATE-DATE: September 5, 2003
LOAD-DATE: September 06, 2003