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Epilogue
Published in John W. Dickinson, James H. Hull, Complete Guide to Respiratory Care in Athletes, 2020
John W. Dickinson, Jon Greenwell, James H. Hull
Some form of medical screening for athletes is now fairly commonplace and widely undertaken across most sports, especially in an elite context (e.g. professional football and cycling). Screening can be employed in various guises, but is advocated with the overall purpose and mandate of detecting reversible medical problems, with the ultimate aim that it is undertaken with the purpose of optimising health. Frequently cited examples of athlete screening programmes include cardiac screening to detect and prevent sudden cardiac death in athletes and musculoskeletal screening to try and reduce risk of injury. Indeed, several sports now mandate cardiac screening programmes (e.g. UEFA for young elite footballers). Currently, screening for respiratory problems is however not widely undertaken, despite the substantial evidence that previously undiagnosed EIB is common in high level athletes.
Premature ventricular beats in the athlete: management considerations
Published in Expert Review of Cardiovascular Therapy, 2018
Tamanna K. Singh, Aaron L. Baggish
PVB morphology, etiology, and complexity continue to be redefined as greater understanding of their patterns and associations with idiopathic benign tachyarrhythmias and structural heart disease are further delineated. Maintaining a primary goal of reducing the risk of sudden cardiac death in athletes will continue to propel future investigations into reclassifying ventricular ectopy and lead to further optimization of competitive sport participation guidelines. Radiofrequency catheter ablation for athletes with symptomatic ventricular ectopy may become first-line therapy due to its curative potential and low procedural risk compared to significant medication side effects. While the AHA/ACC currently recommend against ICD implantation as a means to return to competitive sports participation, it has yet to be shown whether the protective benefits of implanted defibrillators outweigh device-associated risks in athletes with implanted ICDs who wish to participate in competitive sports.
Pharmacological and non-pharmacological treatment of obstructive hypertrophic cardiomyopathy
Published in Expert Review of Cardiovascular Therapy, 2018
Luis F. Hidalgo, Srihari S. Naidu, Wilbert S. Aronow
Hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in athletes in the United States. (b) Accordingly, the main non-pharmacological intervention is the exclusion of people with the disease from intense competitive sports [7]. Other non-pharmacologic interventions include managing diet and obesity. In addition to maintaining peripheral skeletal muscle health such that cardiovascular function is optimized despite cardiac dysfunction, managing obesity has the added benefit of improving the dynamic changes in preload that occur with respiration in these patients, or upon postural changes, which often stimulate obstructive physiology and pre-syncope more commonly than in nonobese patients. Accordingly, maintaining an ideal body weight can delay the need for other therapies to relieve obstruction. When these lifestyle modifications fail, or do not improve symptoms sufficiently despite pharmacologic treatments, invasive septal reduction therapy should be pursued.