The electrocardiogram in the athlete

2019 ◽  
pp. 57-68
Author(s):  
Zorzi Alessandro ◽  
Domenico Corrado
Keyword(s):  
Cardiovascular Disease ◽  
Exercise Training ◽  
Cardiac Disease ◽  
Increased Risk ◽  
Exercise Ecg ◽  
Related Group ◽  
Group 2 ◽  
Electrocardiogram Ecg ◽  
Ecg Abnormalities ◽  
And Training

Interpretation of the athlete’s 12-lead electrocardiogram (ECG) should be based on specific criteria because changes that would be considered abnormal in the untrained population may develop in trained athletes as a physiological and benign consequence of the heart’s adaptation to exercise. ECG abnormalities in athletes are classified into two groups—‘common and training-related’ (Group 1) and ‘uncommon and training-unrelated’ (Group 2)—based on their prevalence, relation to exercise training, association with an increased risk of cardiovascular disease, and need for further investigations. The present chapter reviews the abnormalities that may be found in an athlete ECG and proposes criteria for interpretation of such changes as normal variants or abnormal findings that need further assessment to exclude an underlying cardiac disease.

Clinical assessment of the athlete’s heart: normal and abnormal ECGs in athletes

ESC CardioMed ◽  
2018 ◽  
pp. 2916-2920
Author(s):  
Alessandro Zorzi ◽  
Domenico Corrado
Keyword(s):  
Cardiovascular Disease ◽  
Athlete’S Heart ◽  
Physiological Adaptation ◽  
Ecg Changes ◽  
Increased Risk ◽  
Electrocardiogram Ecg ◽  
Ecg Abnormalities ◽  
Work Up ◽  
And Training ◽  
Athlete's Heart

The electrocardiogram (ECG) of trained athletes may show changes that represent the consequence of the heart’s adaptation to physical exercise (‘athlete’s heart’) such as enlarged cardiac chamber size and increased vagal tone. Physiological ECG changes must be differentiated from the ECG abnormalities secondary to an underlying cardiovascular disease that may be responsible for sudden cardiac death during exercise. The ECG changes of athletes are classified according to their prevalence, relation to exercise training, association with an increased risk of cardiovascular disease, and the need for further investigations: common ECG changes should be considered as a benign sign of physiological adaptation to exercise and do not require additional evaluation; on the other hand, in case of uncommon and training-unrelated abnormalities, which may be associated with an underlying cardiovascular disease, further work-up should be performed. This chapter reviews the abnormalities that may be found in an athlete’s ECG and proposes criteria for interpretation of such changes as normal or abnormal findings.

scholarly journals Heart Rate Variability: An Old Metric with New Meaning in the Era of Using mHealth technologies for Health and Exercise Training Guidance. Part Two: Prognosis and Training

2018 ◽  
Vol 7 (4) ◽  
pp. 1 ◽  
Author(s):  
Nikhil Singh ◽  
Kegan James Moneghetti ◽  
Jeffrey Wilcox Christle ◽  
David Hadley ◽  
Victor Froelicher ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Exercise Training ◽  
Risk Stratification ◽  
Current Evidence ◽  
Health Technologies ◽  
Exercise Ecg ◽  
Prospective Cohorts ◽  
Available Technology ◽  
And Training

It has been demonstrated that heart rate variability (HRV) is predictive of all-cause and cardiovascular mortality using clinical ECG recordings. This is true for rest, exercise and ambulatory HRV clinical ECG device recordings in prospective cohorts. Recently, there has been a rapid increase in the use of mobile health technologies (mHealth) and commercial wearable fitness devices. Most of these devices use ECG or photo-based plethysmography and both are validated for providing accurate heart rate measurements. This offers the opportunity to make risk information from HRV more widely available. The physiology of HRV and the available technology by which it can be assessed has been summarised in Part 1 of this review. In Part 2 the association between HRV and risk stratification is addressed by reviewing the current evidence from data acquired by resting ECG, exercise ECG and medical ambulatory devices. This is followed by a discussion of the use of HRV to guide the training of athletes and as a part of fitness programmes.

Brugada Syndrome and Exercise Practice: Current Knowledge, Shortcomings and Open Questions

2017 ◽  
Vol 38 (08) ◽  
pp. 573-581 ◽  
Author(s):  
Giuseppe Mascia ◽  
Elena Arbelo ◽  
James Hernandez-Ojeda ◽  
Francesco Solimene ◽  
Ramon Brugada ◽  
...  
Keyword(s):  
Brugada Syndrome ◽  
Current Knowledge ◽  
Recovery Period ◽  
Hereditary Disease ◽  
Cardiac Events ◽  
Open Questions ◽  
Increased Risk ◽  
Exercise Effect ◽  
Electrocardiogram Ecg ◽  
Ecg Abnormalities

AbstractSince its recognition as a clinical entity in 1992, the Brugada Syndrome (BrS), a hereditary disease characterized by a typical electrocardiogram (ECG) pattern potentially predisposing to sudden cardiac death (SCD), has attracted the attention of many physicians for its circadian pattern of ventricular arrhythmias (VA), mostly occurring at rest. Exercise may potentially worsen the ECG abnormalities in BrS patients, resulting in higher peak J-point amplitudes during the vasovagal reaction of the recovery period, possibly leading to an increased risk of cardiac events. Moreover, the enhanced vagal tone in athletes could be both a BrS risk factor and an exercise effect. Therefore, the true risk of a BrS patient during exercise is still unclear. This review summarizes current knowledge, shortcomings and open questions on BrS and exercise. The paper, in particular, underlines specific considerations including BrS diagnostic criteria and differential diagnosis in athletes, the genetic basis, the autonomic imbalance during exercise practice and the recommendations for athletic participation in this patient group.

scholarly journals The Association of Body Composition Parameters and Simultaneously Measured Inter-Arm Systolic Blood Pressure Differences

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 384
Author(s):  
Serkan Yüksel ◽  
Metin Çoksevim ◽  
Murat Meriç ◽  
Mahmut Şahin
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Body Composition ◽  
Systolic Blood Pressure ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Bioelectrical Impedance ◽  
The Body ◽  
Increased Risk ◽  
Group 2

Background and Objectives: An inter-arm systolic blood pressure difference (IASBPD) is defined as a blood pressure (BP) disparity of ≥10 mmHg between arms. IASBPDs are associated with an increased risk of cardiovascular disease (CVD). Similarly, visceral fat accumulation (VFA) is clinically important because it is associated with higher cardiovascular disease risk. Accordingly, this study compared the body composition parameters of IASBPD individuals with individuals who did not express an IASBPD. Materials and Methods: The analysis included 104 patients. The blood pressures of all participants were measured simultaneously in both arms using automated oscillometric devices. Then patients were divided into two groups according to their IASBPD status: Group 1 (IASBPD- (<10 mmHg)); Group 2 (IASPPD+ (≥10 mmHg)). Body composition parameters were measured using bioelectrical impedance analysis. Results: In 42 (40%) patients, the simultaneously measured IASBPD was equal to or higher than 10 mmHg. The right brachial SBP was higher in 63% of patients. There were no differences between the groups in terms of demographic and clinical characteristics. Regarding the two groups’ body composition parameter differences, VFA was significantly higher in group 2 (p = 0.014). Conclusions: The IASBPD is known to be associated with an increased risk of cardiovascular events. Although the body mass indexes (BMIs) of the two groups were similar, VFA levels in those with a greater than 10 mmHg IASBPD were found to be significantly higher. This finding may explain the increased cardiovascular risk in this group.

scholarly journals Interpretation of electrocardiogram in an ultra-marathon athlete: a case report

2019 ◽  
Vol 13 (1) ◽  
pp. 64-67
Author(s):  
Antonio Villa ◽  
Pietro Vandoni ◽  
Isabella Riva ◽  
Claudio Moro ◽  
Luisa Chiappa ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Final Diagnosis ◽  
St Segment Elevation ◽  
Cardiology Department ◽  
St Segment ◽  
Ecg Alterations ◽  
Electrocardiogram Ecg ◽  
Ecg Abnormalities ◽  
Repolarization Abnormalities ◽  
Rule Out

The electrocardiogram (ECG) of athletes, especially in those that are endurance-trained, frequently shows some alterations; however, abnormalities of athlete’s ECG may be an expression of an underlying heart disease, which carries a risk of sudden death during sport. It is important that ECG abnormalities are correctly distinguished. We report a case of an ultramarathon athlete who arrived in Emergency Department, after a 100-kilometer race, showing ECG alterations that required further investigations to rule out a cardiac disease. ECG trace showed anterior repolarization abnormalities with ST-segment elevation in V1 to V3 leads. He was admitted to the Cardiology Department and underwent a coronary study that was normal. A cardiac magnetic resonance was also performed. The final diagnosis was athlete’s heart.

scholarly journals Cancer and Heart Failure: Understanding the Intersection

2017 ◽  
Vol 03 (01) ◽  
Author(s):  
Carine E Hamo ◽  
Michelle W Bloom ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Cardiac Disease ◽  
Cardiac Toxicity ◽  
Treatment Strategies ◽  
Cancer Therapies ◽  
Life Saving ◽  
Increased Risk ◽  
The Us ◽  
Prevention And Treatment

Cancer and cardiovascular disease account for nearly half of all deaths in the US. The majority of cancer therapies are known to cause potential cardiac toxicity in some form. Patients with underlying cardiac disease are at a particularly increased risk for worse outcomes following cancer therapy. Most alarming is the potential for heart failure as a result of cancer treatment, which may lead to early disruption or withdrawal of life-saving cancer therapies and can potentially increase cardiovascular mortality. A multi-disciplinary cardio-oncology approach can improve outcomes through early surveillance, prevention and treatment strategies.

Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study

2020 ◽  
Author(s):  
Firas Ajam ◽  
Arda Akoluk ◽  
Anas Alrefaee ◽  
Natasha Campbell ◽  
Avais Masud ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiac Conduction ◽  
Future Research ◽  
Dialysis Patients ◽  
Bundle Branch Block ◽  
Conduction Abnormality ◽  
Ckd Stage ◽  
Stage 1 ◽  
Electrocardiogram Ecg ◽  
Ecg Abnormalities

ABSTRACT Background: The electrocardiogram (ECG) can aid in identification of chronic kidney disease (CKD) patients at high risk for cardiovascular diseases. Cohort studies describe ECG abnormalities in patients on hemodialysis (HD), but we did not find data comparing ECG abnormalities among patients with normal kidney function or peritoneal dialysis (PD) to those on hemodialysis. We hypothesized that ECG conduction abnormalities would be more common, and cardiac conduction interval times longer, among patients on hemodialysis vs. those on peritoneal dialysis and CKD 1 or 2. Methods: Retrospective review of adult inpatients’ charts, comparing those with billing codes for “Hemodialysis” vs. inpatients without those charges, and an outpatient peritoneal dialysis cohort. Patients with CKD 3 or 4 were excluded. Results: One hundred and sixty-seven charts were reviewed. ECG conduction intervals were consistently and statistically longer among hemodialysis patients (n=88) vs. peritoneal dialysis (n=22) and CKD stage 1 and 2 (n=57): PR (175±35 vs 160±44 vs 157±22 msec) (p=0.009), QRS (115±32 vs. 111±31 vs 91±18 msec) (p=0.001), QT (411±71 vs. 403±46 vs 374±55 msec) (p=0.006), QTc (487±49 vs. 464±38 vs 452±52 msec) (p=0.0001). The only significantly different conduction abnormality was prevalence of left bundle branch block: 13.6% among HD patients, 5% in PD, and 2% in CKD 1 and 2 (p=0.03). Conclusion: To our knowledge, this is the first study to report that ECG conduction intervals are significantly longer as one progresses from CKD Stage 1 and 2, to PD, to HD. These and other data support the need for future research to utilize ECG conduction times to identify dialysis patients who could potentially benefit from proactive cardiac evaluations and risk reduction.

Circulating Stem/Progenitor Cells as Prognostic Biomarkers in Macro- and Microvascular Disease: A Narrative Review of Prospective Observational Studies

2018 ◽  
Vol 25 (35) ◽  
pp. 4507-4517 ◽  
Author(s):  
Mauro Rigato ◽  
Gian Paolo Fadini
Keyword(s):  
Cardiovascular Disease ◽  
Progenitor Cells ◽  
Cardiovascular Events ◽  
Observational Studies ◽  
English Language ◽  
Microvascular Disease ◽  
Patient Characteristics ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Cell Phenotypes

Background: Circulating progenitor cells (CPCs) and endothelial progenitor cells (EPCs) are immature cells involved in vascular repair and related to many aspects of macro and microvascular disease. <p> Objective: We aimed to review studies reporting the prognostic role of CPCs/EPCs measurement on development of cardiovascular disease and microangiopathy. <p> Methods and Results: We reviewed the English language literature for prospective observational studies reporting the future development of cardiovascular disease or microangiopathy in patients having a baseline determination of CPCs/EPCs. We retrieved 34 studied reporting on cardiovascular outcomes and 2 studies reporting on microvascular outcomes. Overall, a reduced baseline level of CPCs/EPCs was associated with a significant increased risk of cardiovascular events, all-cause death, and onset/progression of microangiopathy. The most predictive phenotypes were CD34+ and CD34+CD133+. The main limitation was related to the high heterogeneity among studies in terms of patient characteristics and cell phenotypes. <p> Conclusion: The present review shows that a reduced level of circulating progenitor cells is a risk factor for the development of future cardiovascular events and death. In addition, low CPCs/EPCs levels predict the onset or worsening of microalbuminuria and retinopathy in diabetic patients.

Subclinical Thyroid Dysfunction and the Risk of Cardiovascular Disease

2020 ◽  
Vol 26 (43) ◽  
pp. 5617-5627
Author(s):  
Mirjana Stojković ◽  
Miloš Žarković
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Cardiac Electrophysiology ◽  
Vascular System ◽  
Density Lipoprotein ◽  
Thyroid Stimulating Hormone ◽  
Normal Limits ◽  
Developing Heart ◽  
Treatment Indications ◽  
Increased Risk

The prevalence of subclinical hypothyroidism (SH) is 3-10%. The prevalence of subclinical hyperthyroidism (SHr) is 0.7-9.7%. Thyroid hormones affect cardiac electrophysiology, contractility, and vasculature. SH is associated with an increased risk of coronary heart disease (CHD), especially in subjects under 65. SHr seems to be associated with a slightly increased risk of CHD and an increase in CHD-related mortality. Both SH and SHr carry an increased risk of developing heart failure (HF), especially in those under 65. Both SH and SHr are associated with worse prognoses in patients with existing HF. SH is probably not associated with atrial fibrillation (AF). SHr, low normal thyroid-stimulating hormone (TSH) and high normal free thyroxine (FT4) are all associated with the increased risk of AF. An association between endothelial dysfunction and SH seems to exist. Data regarding the influence of SHr on the peripheral vascular system are conflicting. SH is a risk factor for stroke in subjects under 65. SHr does not increase the risk of stroke. Both SH and SHr have an unfavourable effect on cardiovascular disease (CVD) and all-cause mortality. There is a U-shaped curve of mortality in relation to TSH concentrations. A major factor that modifies the relation between subclinical thyroid disease (SCTD) and mortality is age. SH increases blood pressure (BP). SHr has no significant effect on BP. Lipids are increased in patients with SH. In SHr, high-density lipoprotein cholesterol and lipoprotein( a) are increased. SCTD should be treated when TSH is over 10 mU/l or under 0.1 mU/l. Treatment indications are less clear when TSH is between normal limits and 0.1 or 10 mU/L. The current state of knowledge supports the understanding of SCTD’s role as a risk factor for CVD development. Age is a significant confounding factor, probably due to age-associated changes in the TSH reference levels.

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