Page 152 - Athletic Health Handbook
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than age 35 (Maron, Ragosta), while Screening to cardiac conduction cycle. The
primary congenital cardiovascular impact may induce ventricular fibril-
disease is the most common cause The pre-participation physical is the lation if it occurs just before the
affecting individuals younger than 35. recommended method for detecting T-wave in the conduction cycle.
Hypertrophic cardiomyopathy is the cardiac conditions that may be life Athletes may collapse immediately
most common etiology followed by threatening. However, there is contro- after the injury or on a delayed basis
coronary artery anomalies, premature versy over whether widescale screening several minutes later. In the majority
atherosclerotic disease, and dilated is worthwhile since there is no cost of cases CPR is usually ineffective at
cardiomyopathy. In European studies, effective test that is 100 percent sensi- resuscitating patients.
arrhythmogenic right ventricular tive and specific. Even a test with
cardiomyopathy (ARVC) has been 99 percent specificity will lead to The US Commotio Cordis Registry
recognized as a common cause of SCD. numerous false-positives often caus- has cataloged 128 cases as of Septem-
ing healthy individuals to limit their ber 2001. The average age is 13.6
Hypertrophic Cardiomyopathy sports activities. In general any athlete years old with 95 percent of affected
with a personal history of chest pain, athletes being male. The pediatric
Hypertrophic cardiomyopathy exertional syncope, exercise intoler- population may be more susceptible
(HCM) is present in 1 in 500 indi- ance, palpitations, or a family history to commotio cordis because of a
viduals. Heterogeneity and variable of sudden death should be referred thinner layer of soft tissue to the
presentation of the disease are the for further evaluation. Athletes with chest wall, increased compliance
reason for the discrepancy between murmurs that are grade III or greater of the immature rib cage, and slower
incidence of disease and reported in intensity, continuous, holosystolic, protective reflexes. The condition
death (Hosey). Athletes with HCM diastolic, or unclear should be referred occurred in the following distribu-
are typically asymptomatic prior to to a cardiologist for an echocardio- tion: 41 percent baseball, 11 percent
their demise, but may have prodromal gram. Participation guidelines for softball, 7.8 percent hockey puck,
symptoms such as chest pain or different conditions are summarized and 3.9 percent lacrosse. The major-
syncope with or without exercise. Half in Table 1. ity of injuries in baseball and softball
of all HCM cases are familial and are occur to a batter struck by a pitched
caused by specific genetic mutations. Commotio Cordis ball. The true number of deaths is
A systolic murmur may be appreciated unknown due to underreporting
on auscultation, and usually increases Commotio Cordis is defined as and misclassification.
in the standing position or with a sudden death as a result of low impact
Valsalva maneuver. The mechanism of blunt trauma to the precordial region Preventive measures for commo-
death is usually a malignant arrhythmia of the chest wall in subjects with no tio cordis in baseball have focused
generated by abnormal conduction preexisting cardiovascular disease. on chest protectors and softer core
through the thickened heart muscle. The key factor for this event appears baseballs. Unfortunately neither has
to be the timing of the blow related been shown to reduce the risk of

Figure 1: Guidelines on Restriction of Exercise for Cardiovascular Disease

Contraindications to Acute myocarditis Require close monitoring
vigorous exercise and possible restriction
Dilated cardiomyopathy Uncontrolled hypertension
Hypertrophic cardiomyopathy Uncontrolled atrial arrhythmias
Congestive heart failure Hemodynamic significant valvular
Idiopathic concentric left heart disease (aortic insufficiency,
ventricular hypertrophy Congenital anomalies of the mitral stenosis, mitral regurgitation)
coronary arteries
Marfan’s syndrome Adapted from 26th Bethesda Conference.
Cyanotic congenital heart disease Recommendations for determining eligibility
Coronary heart disease for competition in athletes with cardiovascular
Pulmonary hypertension abnormalities. J Am Coll Cardiol 1994;
Uncontrolled ventricular 24:845-899
arrhythmia’s Right ventricular cardiomyopathy

Severe valvular heart disease (espe- Ebstein’s anomaly of the
cially aortic stenosis tricuspid valve
and pulmonic stenosis)
Idiopathic long Q-T syndrome
Coarctation of the aorta

SUDDEN CARDIAC DEATH AND AUTOMATIC EXTERNAL DEFIBRILLATORS 152
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