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146050056400700014605008754110Morphological changes to heart due to training; benign; will reverse with stopping trainingEpidemiology: males > females; 40% incidence in elite athletesAssessment: bradycardia, large pulse volume, sinus arrhythmia, displaced apex, S3+4, large stroke volume ( systolic ejection murmur)ECG: 1st degree heart block (33%; 50x more common than non-athletes), Mobitz I (10%); early repolarisation (ST elevation; ST depression with biphasic/inverted T waves); incomplete RBBB; LVH voltage criteriaCXR: ? cardiothoracic ratio; prominent pulmonary vasculature (? cardiac output)Echo: normal systolic and diastolic function; uniform hypertrophy00Morphological changes to heart due to training; benign; will reverse with stopping trainingEpidemiology: males > females; 40% incidence in elite athletesAssessment: bradycardia, large pulse volume, sinus arrhythmia, displaced apex, S3+4, large stroke volume ( systolic ejection murmur)ECG: 1st degree heart block (33%; 50x more common than non-athletes), Mobitz I (10%); early repolarisation (ST elevation; ST depression with biphasic/inverted T waves); incomplete RBBB; LVH voltage criteriaCXR: ? cardiothoracic ratio; prominent pulmonary vasculature (? cardiac output)Echo: normal systolic and diastolic function; uniform hypertrophy2019305628640Athlete’s Heart Syndrome00Athlete’s Heart Syndrome2019304392295Assessment00Assessment14605004392295History: performance enhancing substances (eg. Stimulants, steroids, dietary supplements); precordial blow ( VF)Examination: ? T, altered LOC, CV examInvestigation: do if: FH HOCM/sudden death, HTN, signs of valve disease / cardiac failure, systolic murmur increases with valsalva, Mobitz II, 3rd degree heart block, prolonged QTc, LAD + LAH + LVH00History: performance enhancing substances (eg. Stimulants, steroids, dietary supplements); precordial blow ( VF)Examination: ? T, altered LOC, CV examInvestigation: do if: FH HOCM/sudden death, HTN, signs of valve disease / cardiac failure, systolic murmur increases with valsalva, Mobitz II, 3rd degree heart block, prolonged QTc, LAD + LAH + LVH2019303362325Patho-physiology following endurance events00Patho-physiology following endurance events14605003362326ECG: non-specific ST/T wave changesBloods: ? CK, ? glu, ?/? Na, ? Ur (rhabdo), metabolic acidosis with respiratory compensation, ? WBC (stress response), ? lactate, ? Hb and platelets (dehydration)Urine: myoglobinuria (peroxidase +ive, RBC –ive), ketosis, ? specific gravity00ECG: non-specific ST/T wave changesBloods: ? CK, ? glu, ?/? Na, ? Ur (rhabdo), metabolic acidosis with respiratory compensation, ? WBC (stress response), ? lactate, ? Hb and platelets (dehydration)Urine: myoglobinuria (peroxidase +ive, RBC –ive), ketosis, ? specific gravity2019302168525Causes of Sudden Death00Causes of Sudden Death14605002168525Usually cardiovascular (see below; others: congenital coronary artery abnormalities, valvular heart disease, arrhythmias (eg. Long QT, Brugada, WPW), commotio cordis); heat stroke, head/spinal trauma, asthma<35yrs: IHD, acute myocarditis, HOCM, arrhythmogenic RV cardiomyopathy>35yrs: IHD (85%)00Usually cardiovascular (see below; others: congenital coronary artery abnormalities, valvular heart disease, arrhythmias (eg. Long QT, Brugada, WPW), commotio cordis); heat stroke, head/spinal trauma, asthma<35yrs: IHD, acute myocarditis, HOCM, arrhythmogenic RV cardiomyopathy>35yrs: IHD (85%)1460500963930Exercise associated collapse: collapse immediately on stopping exertion due to ? venous return / cardiac output from loss of muscle pumpHeat: exhaustion / strokeCardiovascular: MI, AS, arrhythmiaMetabolic: hypoglycaemia, electrolyteIntracranial: seizure, intracerebral haemorrhage00Exercise associated collapse: collapse immediately on stopping exertion due to ? venous return / cardiac output from loss of muscle pumpHeat: exhaustion / strokeCardiovascular: MI, AS, arrhythmiaMetabolic: hypoglycaemia, electrolyteIntracranial: seizure, intracerebral haemorrhage201930964566Causes of Collapse00Causes of Collapse201930330200Exercise-Induced Illness00Exercise-Induced Illness ................
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