Summary: Cases For Clinical Exercise Physiology

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• 4 Sudden death in sports

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• Describe in your own words the definition of sudden death

  Death due to any cardiac disease within one hour after the onset of symptoms (out-of-hospital, at the emergency department of death ar arrival at the hospital).

• What are possible explanations of differences in risk and incidence of sudden death between males and females?

  The lower participation and lower training load of females in sport. Also, the different type of sport in which women participate may play a role.

• Consider the funtional advantages of an increased diameter of the left ventricle of increased left ventricle wall thickness

  An increased diameter of the left ventricle will increase stroke volume and hence cardiac output. With a larger cardiac output, you can increase your maximal oxygen uptake. An increased left ventricle wall thickness enables the heart to maintain circulation against the high pressures reached during strength exercise.

• Summarize the cardiovascular alterations for a weight lifter

  A mild increase in LV cavity size, but due to pressure overload in static exercise, a larger increase in LV wall thickness in seen.

• Summarize the cardiovascular alterations for a marathon runner

  Due to the volume overload (increased blood-return skeletal-muscle pump) in endurance exercise an increase in LV cavity size, however a much smaller increase in LV wall thickness is seen.

• Summarize the cardiovascular alterations for a 2000 meter rower

  Due to a combination of static and dynamic exercise as well an increase in LV cavity as in wall thickness is seen.

• What are the advantages and disadvantages of ECG registration as a screening method for cardiovascular abnormalities?

  Advantage: identification of disorders undetectable at physical examination, such as long QT-syndrome. 
  
  Disadvantages: low specificity as a screening test in athletic populations due to the high frequency (40%) of ECG alterations with the normal physiological adaptations of the trained athlete's heart (false-positives). Also, not al disorders produce ECG abnormalities. ECG's have to be made by skilled people and usually judged by physicians. So it takes a lot of time and it costs a lot of money to screen everyone with an ECG.

• What is the single most common cause of sudden death and describe this disorder

  Hypertrophic cardiomyopathy => Hereditary disease, characterized by an asymmetrical LV hypertrophy (especially in the ventricular septum), typically withoud a dilated chamber, withoud obvious cause (such as hypertension or aortic valve abnormalities), and disorganization of cardiac myocytes and myofibrils. First symptoms are dyspnea, pain on the chest and syncopes, however, sudden deaths due occur.

• What is the difference between the American and Italian law system concerning screening?

  In contrast to the US law, the Italian law system of prescreening mandates the required scope of cardiovascular screening and hold physicians criminally negligent for improperly clearing an athlete with an undetected cardiovascular abnormality that ultimately leads to death during sports.

• Compare the Lausanne recommendations with the AHA recommendations on cardiovascular screening

  The IOC recommendations include an ECG and the AHA do not. The physical examination and history show mostly similarities, although the IOC history is more extensive.