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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