scholarly journals Sudden Cardiac Death Risk in Downhill Skiers and Mountain Hikers and Specific Prevention Strategies

2021 ◽  
Vol 18 (4) ◽  
pp. 1621
Author(s):  
Josef Niebauer ◽  
Martin Burtscher
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Sudden Cardiac Death ◽  
High Intensity ◽  
Cardiac Death ◽  
High Intensity Exercise ◽  
Systemic Hypertension ◽  
Physical Strain ◽  
Mountainous Regions ◽  
Downhill Skiing

Sudden cardiac death (SCD) still represents an unanticipated and catastrophic event eliciting from cardiac causes. SCD is the leading cause of non-traumatic deaths during downhill skiing and mountain hiking, related to the fact that these sports are very popular among elderly people. Annually, more than 40 million downhill skiers and mountain hikers/climbers visit mountainous regions of the Alps, including an increasing number of individuals with pre-existing chronic diseases. Data sets from two previously published case-control studies have been used to draw comparisons between the SCD risk of skiers and hikers. Data of interest included demographic variables, cardiovascular risk factors, medical history, physical activity, and additional symptoms and circumstances of sudden death for cases. To establish a potential connection between the SCD risk and sport-specific physical strain, data on cardiorespiratory responses to downhill skiing and mountain hiking, assessed in middle-aged men and women, have been included. It was demonstrated that previous myocardial infarction (MI) (odds ratio; 95% CI: 92.8; 22.8–379.1; p < 0.001) and systemic hypertension (9.0; 4.0–20.6; p < 0.001) were predominant risk factors for SCD in skiers, but previous MI (10.9; 3.8–30.9; p < 0.001) and metabolic disorders like hypercholesterolemia (3.4; 2.2–5.2; p < 0.001) and diabetes (7.4; 1.6–34.3; p < 0.001) in hikers. More weekly high-intensity exercise was protective in skiers (0.17; 0.04–0.74; p = 0.02), while larger amounts of mountain sports activities per year were protective in hikers (0.23; 0.1–0.4; <0.001). In conclusion, previous MI history represents the most important risk factor for SCD in recreational skiers and hikers as well, and adaptation to high-intensity exercise is especially important to prevent SCD in skiers. Moreover, the presented differences in risk factor patterns for SCDs and discussed requirements for physical fitness in skiers and hikers will help physicians to provide specifically targeted advice.

Abstract 14760: Myocardial Scarring by Magnetic Resonance Predicts Sudden Cardiac Death in Pediatric Patients With Hypertrophic Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lars Grosse-Wortmann ◽  
Laurine van der Wal ◽  
Aswathy Vaikom House ◽  
Lee Benson ◽  
Raymond Chan
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Pediatric Patients ◽  
Risk Markers ◽  
C Statistic ◽  
Increased Risk ◽  
Traditional Risk Factors

Introduction: Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) has been shown to be an independent predictor of sudden cardiac death (SCD) in adults with hypertrophic cardiomyopathy (HCM). The clinical significance of LGE in pediatric HCM patients is unknown. Hypothesis: LGE improves the SCD risk prediction in children with HCM. Methods: We retrospectively analyzed the CMR images and reviewed the outcomes pediatric HCM patients. Results: Amongst the 720 patients from 30 centers, 73% were male, with a mean age of 14.2±4.8 years. During a mean follow up of 2.6±2.7 years (range 0-14.8 years), 34 experienced an episode of SCD or equivalent. LGE (Figure 1A) was present in 34%, with a mean burden of 14±21g, or 2.5±8.2g/m2 (6.2±7.7% of LV myocardium). The presence of ≥1 adult traditional risk factor (family history of SCD, syncope, LV thickness >30mm, non-sustained ventricular tachycardia on Holter) was associated with an increased risk of SCD (HR=4.6, p<0.0001). The HCM Risk-Kids score predicted SCD (p=0.002). The presence of LGE was strongly associated with an increased risk (HR=3.8, p=0.0003), even after adjusting for traditional risk factors (HR adj =3.2, p=0.003) or the HCM Risk-Kids score (HR adj =3.5, p=0.003). Furthermore, the burden of LGE was associated with increased risk (HR=2.1/10% LGE, p<0.0001). LGE burden remained independently associated with an increased risk for SCD after adjusting for traditional risk factors (HRadj=1.5/10% LGE, p=0.04) or HCM Risk-Kids (HRadj=1.9/10% LGE, p=0.0018, Figure 1B). The addition of LGE burden improved the predictive model using traditional risk markers (C statistic 0.67 vs 0.77, p=0.003) and HCM Risk-Kids (C statistic 0.68 vs 0.74, p=0.045). Conclusions: Quantitative LGE is an independent risk factor for SCD in pediatric patients with HCM and improves the performance of traditional risk markers and the HCM Risk-Kids Score for SCD risk stratification in this population.

Abstract 11447: Low Incidence of Appropriate Therapy Following Defibrillator Implantation for Primary Prevention of Sudden Cardiac Death in Hypertrophic Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Amalie C Thavikulwat ◽  
Todd T Tomson ◽  
Bradley P Knight ◽  
Robert O Bonow ◽  
Lubna Choudhury
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hypertrophic Cardiomyopathy ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Cardiac Death ◽  
Icd Implantation ◽  
Icd Therapy ◽  
Appropriate Therapy

Introduction: Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death (SCD) in young adults. Implantable cardioverter defibrillators (ICD) effectively terminate ventricular tachycardia (VT) and fibrillation (VF) that cause SCD, but the reported prevalence of and patient characteristics leading to appropriate ICD therapy in HCM have been variable. Hypothesis: We hypothesized that some risk factors may be more prevalent than others in patients with HCM who receive appropriate ICD therapy and that the overall incidence of appropriate therapy may be lower than that reported previously. Methods: We retrospectively studied all patients with HCM who were treated with ICDs at our referral center from 2000-2013 to determine the rates of appropriate and inappropriate ICD therapies. Results: Of 1136 patients with HCM, we identified 135 who underwent ICD implantation (125 for primary and 10 for secondary prevention), aged 18-81 years (mean 48±17) at the time of implantation. The mean follow-up time was 5.2±4.5 years. Appropriate ICD intervention occurred in 20 of 135 patients (2.8%/year) by providing a shock or antitachycardia pacing in response to VT or VF. The annual rate of appropriate ICD therapy was 2.4%/year for primary and 7.2%/year for secondary prevention devices. Commonly used risk factors were equally prevalent among patients who received appropriate therapy and those who did not; furthermore, the likelihood of receiving appropriate therapy in the presence of each risk factor was similar (Figure). Inappropriate ICD therapy occurred in 27 patients (3.8%/year). Conclusions: ICDs provide clear benefit to patients who experience life-threatening arrhythmias, particularly those being treated for secondary prevention. However, the appropriate therapy rate for primary prevention was lower than previously reported, and no single risk factor appeared to have stronger association with appropriate ICD therapy than others.

Sudden cardiac death during mountain sports activities

2020 ◽  
Vol 71 (11-12) ◽  
pp. 286-292
Author(s):  
M Burtscher ◽  
D Niederseer
Keyword(s):  
Risk Factors ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Physical Exertion ◽  
Pharmacological Therapy ◽  
Downhill Skiing ◽  
Cross Country Skiing ◽  
Artery Disease ◽  
Sports Activities

Sudden cardiac death (SCD) is an unanticipated and dramatic event resulting from cardiac causes. First reports on SCDs during mountain sports activities date back to the 1970s and 1980s of the last century. Relatively large datasets have been collected in Austria from 1985 onwards initiating systematic recordings and analyses of risk factors and triggers of SCDs during mountain sports activities. The results presented in this publication are derived from a literature search on reported SCDs that occurred during selected mountaineering activities with particular regard to study findings based on data collected in Austria. We found a relatively low SCD risk during mountaineering activities, amounting to about 1 SCD per 1 million activity days when hiking, trekking or ski touring, which is even lower during downhill skiing but higher in competitive cross-country skiing. The risk is much higher in men than in women and increases sharply above the age of 34. Main risk factors include prior myocardial infarction, coronary artery disease, arterial hypertension, hypercholesterolaemia and diabetes mellitus type 2, but regular and sport-specific activities turned out to be important protective factors. Unaccustomed physical exertion, in particular on the first days in the mountains (altitude), prolonged activities without rest and insufficient energy and fluid intake represent important SCD triggers. Besides considering these potential triggers during mountaineering activities, sports medical examination, appropriate pharmacological therapy of risk factors and physical preparation represent preventive key elements. Key Words: Exercise, Mountains, Cardiovascular, Risk, Triggers, Prevention

scholarly journals Functional high-intensity exercise training ameliorates insulin resistance and cardiometabolic risk factors in type 2 diabetes

2018 ◽  
Vol 103 (7) ◽  
pp. 985-994 ◽  
Author(s):  
Ciarán E. Fealy ◽  
Stephan Nieuwoudt ◽  
Julie A. Foucher ◽  
Amanda R. Scelsi ◽  
Steven K. Malin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Exercise Training ◽  
High Intensity ◽  
Cardiometabolic Risk ◽  
High Intensity Exercise ◽  
Cardiometabolic Risk Factors

scholarly journals Vital exhaustion and sudden cardiac death in the Atherosclerosis Risk in Communities Study

Heart ◽  
2017 ◽  
Vol 104 (5) ◽  
pp. 423-429 ◽  
Author(s):  
Brittany M Bogle ◽  
Nona Sotoodehnia ◽  
Anna M Kucharska-Newton ◽  
Wayne D Rosamond
Keyword(s):  
Risk Factors ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Disease Risk ◽  
Ventricular Tachyarrhythmia ◽  
Atherosclerosis Risk In Communities ◽  
Vital Exhaustion ◽  
Increased Risk ◽  
Atherosclerosis Risk ◽  
Aric Study

ObjectiveVital exhaustion (VE), a construct defined as lack of energy, increased fatigue and irritability, and feelings of demoralisation, has been associated with cardiovascular events. We sought to examine the relation between VE and sudden cardiac death (SCD) in the Atherosclerosis Risk in Communities (ARIC) Study.MethodsThe ARIC Study is a predominately biracial cohort of men and women, aged 45–64 at baseline, initiated in 1987 through random sampling in four US communities. VE was measured using the Maastricht questionnaire between 1990 and 1992 among 13 923 individuals. Cox proportional hazards models were used to examine the hazard of out-of-hospital SCD across tertiles of VE scores.ResultsThrough 2012, 457 SCD cases, defined as a sudden pulseless condition presumed due to a ventricular tachyarrhythmia in a previously stable individual, were identified in ARIC by physician record review. Adjusting for age, sex and race/centre, participants in the highest VE tertile had an increased risk of SCD (HR 1.48, 95% CI 1.17 to 1.87), but these findings did not remain significant after adjustment for established cardiovascular disease risk factors (HR 0.94, 95% CI 0.73 to 1.20).ConclusionsAmong participants of the ARIC study, VE was not associated with an increased risk for SCD after adjustment for cardiovascular risk factors.

Prevention of atrial fibrillation – non-modifiable and modifiable risk factors for AF

2020 ◽  
Vol 2 (55) ◽  
pp. 14-19
Author(s):  
Agnieszka Wojdyła-Hordyńska ◽  
Grzegorz Hordyński
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Combined Treatment ◽  
Lifestyle Changes ◽  
Modifiable Risk Factors

Atrial fibrillation is one of the most common arrhythmias, with a significant increase in incidence in recent years. AF is a major cause of stroke, heart failure, sudden cardiac death, and cardiovascular disease. Timely intervention and modification of risk factors increase chance to stop the disease. Aggressive, multilevel prevention tactics are a component of combined treatment, including – in addition to lifestyle changes, anticoagulant therapy, pharmacotherapy and invasive anti-arrhythmic treatment – prevention of cardiovascular diseases, hypertension, ischemia, valvular disease and heart failure.

Exercise heart rate reserve and recovery as risk factors for sudden cardiac death

2021 ◽  
Author(s):  
Sudhir Kurl ◽  
Sae Young Jae ◽  
Ari Voutilainen ◽  
Magnus Hagnäs ◽  
Jari A. Laukkanen
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Exercise Heart Rate ◽  
Heart Rate Reserve

Abstract 14964: Sudden Cardiac Death in Current vs. Former Smokers

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kyndaron Reinier ◽  
Carmen Teodorescu ◽  
Audrey Uy-Evanado ◽  
Karen Gunson ◽  
Jonathan Jui ◽  
...  
Keyword(s):  
Risk Factor ◽  
Sudden Cardiac Death ◽  
Medical Records ◽  
Cardiac Death ◽  
Smoking Prevalence ◽  
Smoking History ◽  
Common Finding ◽  
Behavioral Risk ◽  
Community Based ◽  
Former Smokers

Introduction: Smoking is a well-established risk factor for cardiovascular disease, but its role in sudden cardiac death (SCD) specifically has not been as well investigated. We sought to describe smoking prevalence among cases that suffered SCD in the general population. Hypothesis: We hypothesized that smoking prevalence would be high among SCD cases. Methods: Cases of SCD from an ongoing multiple-source community-based study of SCD in the northwest US (pop. approx. 1 million) were included if they were age ≥18 with smoking history available from medical records. We describe the prevalence of smoking in the SCD population, as well as characteristics of smokers vs. non-smokers. Results: From 2002 -2012, 1833 (76%) of 2402 SCD cases had pre-SCD medical records available, and smoking history was available for 1241 (68%) of these. While 2007-8 community data (Behavioral Risk Factor Surveillance Study) indicated that 16% of Oregonian adults were current smokers, among the SCD cases, 40% were current smokers, 31% former smokers, and 29% non-smokers. Men were more likely than women to be current smokers (42% vs. 37%) or former smokers (35% vs. 23%); 40% of women and 24% of men were non-smokers (p<0.0001). Among SCD cases, current smokers were significantly younger at the time of their SCD (57.8 ± 13.2 yrs) than former smokers (70.0 ± 12.9 yrs) or non-smokers (66.6 ± 17.9 yrs; p<0.0001), despite a similar number of years smoked among the current and former smokers (33 vs 29 years, p=0.22). Former smokers were more likely to have a history of myocardial infarction and documented CAD than current smokers (p<0.0001). Conclusions: In this community-based study of SCD, current and former smoking was a common finding; current smokers suffered SCD at a younger age than former smokers, despite less documented CAD and MI at the time of their arrest.

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