cardiology – SEMS-journal

elite sports RTS sports medicine cardiology cardiology

Acute Perimyocarditis in Elite Athletes: Navigating Diagnosis and Return to Competition

A 23-year-old female elite runner, previously healthy with normal pre-participation screening, developed fatigue and an upper respiratory tract infection with fever for three days. Her symptoms improved but she continued to experience prolonged fatigue, which led her to seek evaluation by a sports and exercise medicine physician.

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Effects of therapeutic exercise on cognition in adults with hypertension: A systematic review

Background: To systematically review the effectiveness of exercise on cognition in patients with arterial hypertension (HTN). Methods: A systematic search was performed in the subsequent databases starting from the oldest records existing till June 2022: MEDLINE (accessed by PubMed), CENTRAL, Scopus, and Web of Science (Web of Science Core Collection). The search was carried out from November 2021 to January 2022. Trials investigating the effects of exercise on cognition in patients with HTN were included in the review. Two authors assessed trial quality using PEDro and National Institute of Health (NIH) tools.

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The Athlete’s ECG

Sudden cardiac death (SCD) is the leading non-traumatic cause of mortality in athletes under 35, most often due to inherited cardiomyopathies or primary electrical disorders that may remain silent until a fatal event. The 12-lead electrocardiogram (ECG) is the most accessible and cost-effective screening tool, yet its early use was hampered by poor specificity and high false-positive rates, mainly due to non-standardized interpretation and limited awareness of physiological adaptations.

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Strong, silent and stigmatized

The global lifetime prevalence rate of all image and performance enhancing drugs (IPED) is unknown, however it is 6.4% in men an 1.6% in women for anabolic androgenic steroids (1). IPED are widely used in the bodybuilding scene and have found a bigger audience through social media platforms.

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Exercise induced Leg Pain due to Vascular Compression Syndrome

Within a sports medicine setting vascular pathologies of the legs represent a rare entity and are often associated with a significant delay of diagnosis and treatment. Nevertheless, timely detection is crucial when it comes to management of athletes.

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Exercise Hypertension – A Review

The actual significance and definition of hypertensive response to exercise (HRE) is still debated. Up to now, there is consensus in defining it as a systolic blood pressure value of either ≥ 210 mmHg in men and ≥ 190 mmHg in women or a diastolic blood pressure ≥ 110 mmHg during maximal exercise stress test. The mechanisms underlying an exaggerated blood pressure response to exercise are poorly understood; however, there are studies suggesting that HRE may represent a preclinical stadium of essential hypertension, which shares several common pathological mechanisms mostly related to an endothelial dysfunction and vascular stiffness.

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Diagnosing and sports counselling of athletes with myocarditis

Myocarditis is defined as an inflammation of the heart muscle and its presentation, especially in athletes, is heterogeneous. Underlying causes include in most of the cases viruses, and less often bacteria, toxins, vasculitic diseases or pharmaceutical agents. Cardiac magnetic resonance (CMR) imaging is the primary imaging tool to diagnose myocarditis following laboratory test, electrocardiogram and echocardiography. In certain cases, endomyocardial biopsy is required, especially in unclear cases with reduced systolic left ventricular ejection fraction.

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Regional differences of sudden cardiac death in sports. Experiences from German and Swiss registries

Sudden death of an athlete is the most devastating medical event in sports. While accidents account for more than 50% of these cases, sudden cardiac deaths (SCD) are less frequent (approx. 15%), but the leading medical cause of deaths. The risk depends on age, sex, ethnicity, type of sport and sport level. There are large variations in the methods of registration of SCD in recreational and competitive sports. This must be taken into account when interpreting reported incidences and causes. High data quality in registries is a prerequisite for meaningful preventive strategies (e.g. ECG screening and safety at sports facilities).

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The International (Seattle) Criteria

Through continuous improvement of diagnostic accuracy of ECG criteria for athletes sensitivity as well as specificity have grown so much that foregoing this screening tool is not feasible anymore. The most updated guidelines, the so-called “International (Seattle) Criteria” globally exhibit the most important reference publication, currently. The criteria were created with the purpose that particularly “non-cardiologists” should be able to use them before clearly pathological findings lead to further follow-up examinations at a specialist. On the other hand, physiologic ECG findings should not prompt expensive further evaluations, as it used to happen quite frequently.

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Recommendations for cardiovascular evaluation in athletes – a viewpoint

Traditionally, cardiovascular screening has been recommended mostly for competitive athletes younger than 35 years. The perception that only young competitive athletes at top level are at increased risk, has changed in the last years. Theoretically, we advocate a voluntary cardiovascular screening for all athletes who exercise vigorously, independent of their competitive status, and age. Although, this should be based on an individual estimation of the athlete’s risk. Physical examination, medical history and an ECG should be the baseline investigations for all athletes.