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 Screening for Sudden Cardiac Death in Athletes and Low-Risk Patients  Screening for Sudden Cardiac Death in Athletes and Low-Risk Patients

Screening for Sudden Cardiac Death in Athletes and Low-Risk Patients - PowerPoint Presentation

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Screening for Sudden Cardiac Death in Athletes and Low-Risk Patients - PPT Presentation

Cameron Smith Epidemiology The exact incidence of SCD in athletes remains unclear Overall incidence is between 150000 and 1100000 per year in young athletes 1 A total of 1866 athletes who died suddenly or survived cardiac arrest 196 years of age were identified throughout the Unit ID: 776397

cardiac athletes cardiomyopathy death cardiac athletes cardiomyopathy death hypertrophic syncope scd sudden symptoms patients screening murmur heart apr cardiovascular

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Slide1

Screening for Sudden Cardiac Death in Athletes and Low-Risk Patients

Cameron Smith

Slide2

Epidemiology

The exact incidence of SCD in athletes remains unclear.

Overall incidence is between 1:50,000 and 1:100,000 per year in young athletes

1

A total of 1866 athletes who died suddenly (or survived cardiac arrest), 19+/-6 years of age, were identified throughout the United States from 1980 to 2006 in 38 diverse sports

2

Slide3

Epidemiology

NCAA Data 2015

Slide4

Most common cause of athlete death

The majority of SCD events in athletes are due to malignant arrhythmias, usually sustained VT or VF.

The most common cardiac causes were hypertrophic cardiomyopathy (36%) and congenital coronary artery anomalies (17%).

2

Other major causes include arrhythmogenic right ventricular cardiomyopathy (ARVC) especially in international populations.

3

Slide5

Other causes of Cardiac death

Recommendations and Considerations Related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update, Volume: 115, Issue: 12, Pages: 1643-1655, DOI: (10.1161/CIRCULATIONAHA.107.181423)

Slide6

Other causes of Cardiac death

2003-2013 NCAA

6

Slide7

The most common anomaly associated with SCD is a coronary that courses between the aorta and pulmonary artery

Other causes of Cardiac death

Slide8

Other causes of Cardiac death

Slide9

Who should you screen with EKG?

The USPSTF recommends against screening with resting or exercise ECG to prevent cardiovascular disease events in asymptomatic adults at low risk

Slide10

Screening Algorithm

Slide11

Who should you suspect?

History of heart murmur

4

Exertional symptoms

4

Symptoms of

Marfan

Syndrome

Family History of SCD

Syncope

Further evaluation should be considered for persons with heart or lung disease, bleeding disorders, musculoskeletal problems, history of concussion, or other neurologic disorders.

Slide12

Who should you suspect?

Upwards of approximately 30% of athletes with SCD have been reported to have had symptoms such as chest pain, shortness of breath, performance decline, palpitations, pre-syncope, or syncope leading up to the event

Slide13

Slide14

Hypertrophic Cardiomyopathy

Autosomal Dominant

Mutation in the Cardiac Sarcomere –

β

-Myosin Heavy Chain

Prevalence is 1:500 in adults

Histology shows disorganized pattern of hypertrophied myocytes in disarray with replacement fibrosis

Slide15

Slide16

Hypertrophic Cardiomyopathy

Commonly asymptomatic

Patients may report symptoms of DOE, SOB, orthopnea, PND, chest pain, palpitations, pre-syncope/syncope, fatigue, or edema

Physical Exam

Crescendo-Decrescendo Systolic Murmur best heart at apex and LLSB

Murmur intensifies with

Valsalva

and standing

Murmur decreases with handgrip, leg-lift, and squatting

Slide17

Hypertrophic Cardiomyopathy

ECG Findings

90% will have abnormal findings

No pathognomonic signs

Most often will show prominent abnormal Q waves, P wave abnormalities, left axis deviation, and deeply inverted T waves

Echo Findings

Increased LV wall thickness in the absence of another cause

LVH (particularly asymmetrical LVH)

Increased LVOT gradient

Systolic anterior motion of the mitral valve leaflets

Slide18

ECG is reproduced from Hansen & Merchant (2007). 

Slide19

Slide20

Hypertrophic Cardiomyopathy

Diagnosis

Using Echo/CMR – LV wall thickening >15mm anywhere in the LV without any other identifiable cause (HTN, AS, Athlete’s Heart)

Suggest doing cardiovascular magnetic resonance in all patients with suspected or diagnosed HCM to most reliably assess LV morphology, including maximal LV wall thickness

Slide21

Hypertrophic Cardiomyopathy

Treatment and Prognosis

Patients with symptoms of HF should be treated with

Beta Blockers

Non-dihydropyridine CCB (Verapamil/Diltiazem)

Disopyramide

Avoid vasodilators or diuretics, which may worsen LVOT obstruction

Asymptomatic patients generally do not need Rx

Slide22

Slide23

References

1. Landry CH, Allan KS, Connelly KA, et al. Sudden Cardiac Arrest during Participation in Competitive Sports. N

Engl

J Med 2017; 377:1943.

2.

Maron BJ,

Doerer

JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation. 2009 Mar 3;119(8):1085–92.

3.

Wasfy

MM,

Hutter

AM, Weiner RB. Sudden Cardiac Death in Athletes.

Methodist

Debakey

Cardiovasc J

. 2016 Apr-Jun;12(2):76-80.

doi

: 10.14797/mdcj-12-2-76.

4.https://www.aafp.org/afp/2015/0901/p371.html

5.https://www.aafp.org/afp/2018/0915/od1.html

6.

Maron

BJ, Douglas PS, Graham TP, Nishimura RA, Thompson PD. Task Force 1:

preparticipation

screening and diagnosis of cardiovascular disease in athletes. J Am

Coll

Cardiol

. 2005 Apr 19;45(8):1322–6

7.

Marijon

E,

Uy-Evanado

A,

Reinier

K,

Teodorescu

C,

Narayanan

K,

Jouven

X,

Gunson

K,

Jui

J,

Chugh

SS

Circulation

. 2015

Apr

21; 131(16):1384-91.

8

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Harmon KG,

Asif

IM,

Maleszewski

JJ et al. Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review. Circulation. 2015 Jul 7;132(1):10–9.

9. http://www.msdlatinamerica.com/ebooks/RadiologyReviewManual/sid990079.html

10. Maron M. Hypertrophic cardiomyopathy: Clinical manifestations, diagnosis, and evaluation. Up to Date. 2019 May 08.

11. Robinson A, Kramer C. Imaging in Hypertrophic Cardiomyopathy. American College of Cardiology. 2018 Apr 24.

12. http://www.msdlatinamerica.com/ebooks/RadiologyReviewManual/sid990079.html