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- Title
ATHLETIC HEART AND CARDIOMYOPATHIES.
- Authors
Broekhuizen, Lysette; Guettler, Norbert; Bron, Denis; Holdsworth, David; Manen, Olivier; Syburra, Thomas; d'Arcy, Joanna
- Abstract
INTRODUCTION: Differentiating cardiomyopathies (hypertrophic or dilated) from exercise related remodeling can be a challenge for the aeromedical examiner and cardiologist. Cardiac remodeling induced by exercise is an adaptive increase in cardiac chamber size and wall thickness that is promoted by the physiological demands of exercise, often referred to as the 'Athletes heart'. TOPIC: Regular high intensity exercise promotes structural, functional, and electrical changes of the heart, this rarely leads to adverse clinical effects, such as the onset of arrhythmias or sinus node dysfunction. In patients with a genetic predisposition for certain cardiomyopathies (CMP), mainly arrhythmogenic cardiomyopathies or ACM: Arrhythmogenic right ventricular cardiomyopathy (ARVC), arrhythmogenic dilated cardiomyopathy (DCM) and biventricular arrhythmogenic cardiomyopathy, it has been suggested that exercise can promote early development of arrhythmia and pathological alterations, mainly of the RV, and therefore high performance activities usually need to be discouraged. As both entities can look very similar, differentiating the trained athletes heart with 'physiological' remodeling from pathological structural changes associated with inherited and acquired cardiac disorders calls for experience together with good diagnostic techniques. CMR is the gold standard for evaluating left and right ventricular function, giving detailed information on presence of regional wall motion abnormalities, myocardial thinning, and ventricular aneurysms. Additional late gadolinium enhancement (LGE) images detect edema and fibrosis which can be used for prognostic purpose. Holtermonitoring and exercise testing in order to screen for arrhythmias or conduction disorders are pivotal additional diagnostic methods. Prior to medical investigation it is needed to perform a thorough interview asking about symptoms and family history of cardiovascular disease and sudden cardiac death (SCD). If the family history is positive genetic counseling may help to further determine the diagnosis. APPLICATION: However rare, recognizing real CMP from the athletes heart in aircrew is essential as heart muscle disease can lead to acute incapacitation or even SCD, but also to determine treatment goals. On the other hand, misdiagnosing an athletes heart calling it cardiomyopathy can have a serious impact on someone's career and lead to unnecessary restrictions. Learning Objectives 1. To understand why it is usefull to screen aircrew for myocardial disease and know the different types of cardiomyopathy and their complications. 2. To understand that exercise induced remodeling of the heart can mimic cardiomyopathies and learn how to differentiate between 'normal' cardiac adaption to sports and pathology. 3. To learn about diagnostic strategies that can be used to determine cardiovascular risk.
- Subjects
ARRHYTHMOGENIC right ventricular dysplasia; ARRHYTHMIA; CARDIOMYOPATHIES; MYOCARDIUM; MEDICAL examinations of athletes; EXERCISE intensity; DILATED cardiomyopathy; HEART
- Publication
Aerospace Medicine & Human Performance, 2024, Vol 95, Issue 8, p503
- ISSN
2375-6314
- Publication type
Article