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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Cardiac Sports Conditions

- See:
      - pulmonary contussion:
      - cardiac enzymes
      - blunt cardiac trauma

- Discussion:
    - defined as cardiogenic shock, arrhythmias requiring treatment, or structural cardiac abnormalities directly related to the cardiac trauma;

- Commotio Cordis:
     - catastrophic condition (rare) that is caused by blunt chest trauma
     - causes cardiac fibrillation and is fatal unless immediate defibrillation is performed;
     - references:
           - Commotio cordis. Br J Sports Med 2002;36:236-237. 
           - Commotio Cordis. New Engl J Med 2010;362(23):917-927
           - Teen Dies After Being Hit By Baseball

- Hypertrophic Cardiomyopathy (HCM)
    - may result in deadly conduction abnormalities and is an absolute contraindication to vigorous exercise;
    - causes about 30-50% of sudden-death cases occurring in young athletes;
    - HCM phenotype becomes evident by age 13 to 14 years
    - screening
            - history of chest pain or syncope in the athlete
            -  family history of early cardiac death 
    - dectection of heart murmur
            - listen for murmurs in the supine and standing positions to identify murmurs from dynamic left ventricular outflow obstruction (standing intensifies
                    a HCM murmur by decreasing cardiac venous return);
    - cardiac echo:
            - establishes the diagnosis
    - references:
            - Physiologic limits of left ventrical hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete's heart and hypertrophic cardiomyopathy. J Am College Cardiol. 2002;40:1431-1436. 
            - Development and progression of left ventrical hypertrophy in children with hypertrophic cardiomyopathy. N Engl J Med. 1986;315:610-614.
            - Risk of sudden cardiac death in young athletes: which screening strategies are appropriate?

- Long QT Syndrome: (genetic arrhythmia syndrome)
     - characterized by abnormal QT interval on EKG, and can lead to V fib and death;
     - manifests as palpitations (skipped heart beats), presyncope, syncope, and cardiac arrest
     - ref: Long-QT Syndrome

- Questions: that every parent should consider

    - Is there any ? syncope (fainting with exertion) , chest pain, shortness of breath with exercise, elevated blood pressure, heart murmur, family history or severe early heart disease
Outside Links:
    - Sports Medicine Update (2002)
    - The Preparticipation Athletic Evaluation
    - CPR And External Defibrillator Training May Decrease Adolescent Sports-related Deaths


A prospective evaluation of myocardial contusion: correlation of significant arrhythmias and cardiac output with CPK-MB measurements.

Early detection of myocardial contusion and its complications in patients with blunt trauma.

The utility of cardiac evaluation in the hemodynamically stable patient with suspected myocardial contusion.

A plea for sensible management of myocardial contusion.

Cardiac contusion. The effect on operative management of the patient with trauma injuries.

Sternal fractures: associated injuries and management.

Sternal fractures: a retrospective analysis of 272 cases.

Significance of myocardial contusion following blunt chest trauma.

The clinical significance of myocardial contusion.

Clinically Significant Blunt Cardiac Trauma: Role of Serum Troponin Levels Combined with Electrocardiographic Findings.  

Outcomes in Athletes with Marked ECG Repolarization Abnormalities




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, December 19, 2011 4:33 pm