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1994-02-22
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L319 237 319 245
L319 245 319 253
L319 253 319 261
L319 261 319 269
L319 269 319 277
L319 277 319 285
L319 285 319 293
L319 293 319 301
L319 301 319 309
L319 309 319 317
L319 317 319 325
L319 325 319 333
L319 333 319 341
L319 341 319 349
L319 349 319 357
L319 357 319 365
L319 365 319 373
L319 373 319 381
L319 381 319 389
L319 389 319 397
L319 397 319 405
L319 405 319 413
L319 413 319 421
L319 421 319 429
XxZ
O9
XxA
L319 15 331 15
L331 15 343 15
L343 15 355 15
L355 15 367 15
L367 15 379 15
L379 15 391 15
L391 15 403 15
L403 15 415 15
L415 15 427 15
L427 15 439 15
L439 15 451 15
L451 15 463 15
L463 15 475 15
L475 15 487 15
L487 15 499 15
L499 15 511 15
L511 15 523 15
L523 15 535 15
L535 15 547 15
L547 15 559 15
L559 15 571 15
L571 15 583 15
L583 15 595 15
L595 15 607 15
L607 15 619 15
L619 15 620 15
L620 15 621 15
L621 15 622 15
L622 15 623 15
L623 15 624 15
L624 15 624 23
L624 23 624 31
L624 31 624 39
L624 39 624 47
L624 47 624 55
L624 55 624 63
L624 63 624 71
L624 71 624 79
L624 79 624 87
L624 87 624 95
L624 95 624 103
L624 103 624 111
L624 111 624 119
L624 119 624 127
L624 127 624 135
L624 135 624 143
L624 143 624 151
L624 151 624 159
L624 159 624 167
L624 167 624 175
L624 175 624 183
L624 183 624 191
L624 191 624 199
L624 199 624 207
L624 207 624 215
L624 215 624 223
L624 223 624 231
L624 231 624 239
L624 239 624 247
L624 247 624 255
L624 255 624 263
L624 263 624 271
L624 271 624 279
L624 279 624 287
L624 287 624 295
L624 295 624 303
L624 303 624 311
L624 311 624 319
L624 319 624 327
L624 327 624 335
L624 335 624 343
L624 343 624 351
L624 351 624 359
L624 359 624 367
L624 367 624 375
L624 375 624 383
L624 383 624 391
L624 391 624 399
L624 399 624 407
L624 407 624 415
L624 415 624 423
L624 423 624 431
L624 431 624 439
L624 439 624 447
L624 447 624 455
L624 455 624 456
L624 456 624 457
L624 457 624 458
L624 458 624 459
L624 459 624 460
L624 460 624 461
L624 461 624 462
L624 462 624 463
L624 463 624 464
L624 464 624 465
L624 465 612 465
L612 465 600 465
L600 465 588 465
L588 465 576 465
L576 465 564 465
L564 465 552 465
L552 465 540 465
L540 465 528 465
L528 465 516 465
L516 465 504 465
L504 465 492 465
L492 465 480 465
L480 465 468 465
L468 465 456 465
L456 465 444 465
L444 465 432 465
L432 465 420 465
L420 465 408 465
L408 465 396 465
L396 465 384 465
L384 465 372 465
L372 465 360 465
L360 465 348 465
L348 465 336 465
L336 465 324 465
L324 465 312 465
L312 465 300 465
L300 465 288 465
L288 465 276 465
L276 465 264 465
L264 465 252 465
L252 465 240 465
L240 465 228 465
L228 465 216 465
L216 465 204 465
L204 465 192 465
L192 465 180 465
L180 465 168 465
L168 465 156 465
L156 465 144 465
L144 465 132 465
L132 465 120 465
L120 465 108 465
L108 465 96 465
L96 465 84 465
L84 465 72 465
L72 465 60 465
L60 465 48 465
L48 465 36 465
L36 465 24 465
L24 465 23 465
L23 465 22 465
L22 465 21 465
L21 465 20 465
L20 465 19 465
L19 465 18 465
L18 465 17 465
L17 465 16 465
L16 465 15 465
L15 465 14 465
L14 465 13 465
L13 465 12 465
L12 465 12 457
L12 457 12 449
L12 449 12 441
L12 441 12 433
L12 433 12 425
L12 425 12 417
L12 417 12 409
L12 409 12 401
L12 401 12 393
L12 393 12 385
L12 385 12 377
L12 377 12 369
L12 369 12 361
L12 361 12 353
L12 353 12 345
L12 345 12 337
L12 337 12 329
L12 329 12 321
L12 321 12 313
L12 313 12 305
L12 305 12 297
L12 297 12 289
L12 289 12 281
L12 281 12 273
L12 273 12 265
L12 265 12 257
L12 257 12 249
L12 249 12 241
L12 241 12 233
L12 233 12 225
L12 225 12 217
L12 217 12 209
L12 209 12 201
L12 201 12 193
L12 193 12 185
L12 185 12 177
L12 177 12 169
L12 169 12 161
L12 161 12 153
L12 153 12 145
L12 145 12 137
L12 137 12 129
L12 129 12 121
L12 121 12 113
L12 113 12 105
L12 105 12 97
L12 97 12 89
L12 89 12 81
L12 81 12 73
L12 73 12 65
L12 65 12 57
L12 57 12 49
L12 49 12 41
L12 41 12 33
L12 33 12 25
L12 25 12 17
L318 15 319 15
L319 15 320 15
L320 15 321 15
L321 15 322 15
L322 15 323 15
L323 15 324 15
L324 15 325 15
L325 15 326 15
L326 15 327 15
L327 15 328 15
L328 15 329 15
L329 15 330 15
L330 15 331 15
L331 15 332 15
L332 15 333 15
L333 15 334 15
L334 15 335 15
L335 15 336 15
L336 15 337 15
L337 15 338 15
L338 15 339 15
L339 15 340 15
L340 15 341 15
L341 15 342 15
L342 15 343 15
L343 15 344 15
L344 15 345 15
L345 15 346 15
L346 15 345 15
L345 15 344 15
L344 15 343 15
L343 15 342 15
L342 15 341 15
L341 15 340 15
L340 15 339 15
L339 15 327 15
L327 15 315 15
L315 15 303 15
L303 15 291 15
L291 15 279 15
L279 15 267 15
L267 15 255 15
L255 15 243 15
L243 15 231 15
L231 15 219 15
L219 15 207 15
L207 15 195 15
L195 15 183 15
L183 15 171 15
L171 15 159 15
L159 15 147 15
L147 15 135 15
L135 15 123 15
L123 15 111 15
L111 15 99 15
L99 15 87 15
L87 15 75 15
L75 15 63 15
L63 15 51 15
L51 15 39 15
L39 15 27 15
L27 15 15 15
L15 15 14 15
L14 15 13 15
L13 15 12 15
L12 21 12 20
L12 20 12 19
L12 19 12 18
L12 18 12 17
L12 17 12 16
XxZ
O9
XxA
O0
ti322 38 SATURN19
ATHLETIC HEART SYNDROME
O9
ti320 36 SATURN19
ATHLETIC HEART SYNDROME
XxZ
O12
XxA
O0
tl21 61 TRADIT13
CLINICAL FINDINGS
O12
tl20 60 TRADIT13
CLINICAL FINDINGS
XxZ
O8
XxA
te25 73 TRADIT13
If the physician is not familiar with clinical and
laboratory findings in the athlete, the
information may be misinterpreted as
compatible with cardiac pathology. However,
on the other hand, the risk of sudden death in
the athlete must be kept in mind. Syncope at
rest or exertion, repetitive chest pain
particularly in a patient with risk factors and
> 35, warrants further evaluation. A
familial history of sudden death, hypertrophic
cardiomyopathy, coronary artery disease or
Marfan's syndrome should also lead to
further testing. Athletes that engage in
endurance training such as swimming,
running and bicycling usually have pulse
rates below 60 in > 50%. This sinus
bradycardia is due to an increase in vagal
tone and a decrease in resting sympathetic
tone. Wandering atrial pacemakers and sinus
arrhythmia are relatively common. If an ECG
shows atrial fibrillation, frequent PVC's or
other abnormal rhythms, further evaluation
is needed. BP in the athlete may be slightly
decreased, and the muscular athlete may
require a large cuff to prevent falsely
elevated BPs. Cardiac auscultation may
reveal systolic murmurs in 30-50% of
endurance trained athletes, which are due to
increased blood flow. These must be
differentiated from the murmurs produced by
~
XxZ
XxA
te325 57 TRADIT13
hypertrophic cardiomyopathy and aortic
stenosis. Valsalva and other maneuvers may
help clarify these murmurs, but
echocardiography is usually needed. An S3
heart sound is commonly heard in 30-100%,
while an S4 is heard in 20-60%. Mitral valve
prolapse, manifested by systolic
click-murmur, in association with a
family history of sudden death resulting from
mitral valve prolapse, a history of syncope,
moderate to marked mitral regurgitation,
evidence of dilatation of the descending aorta
or sustained supraventricular or ventricular
tachycardia, should all be considered reasons
for limiting competitive sports to low intensity
activity.
~
XxZ
O12
XxA
O0
tl333 277 TRADIT13
LABORATORY FINDINGS
O12
tl332 276 TRADIT13
LABORATORY FINDINGS
XxZ
O8
XxA
te325 289 TRADIT13
The ECG may show first degree AV block,
type I second degree Wenckebach AV block
and junctional rhythms secondary to
increased vagal tone, which may disappear
with exercise as vagal tone decreases and
sympathetic tone increases. Prolonged
physical training causes an increase in
myocardial mass which in turn increases the
QRS voltage so that LV hypertrophy criteria
are satisfied. Sometimes, right and left atria
enlargement along with right ventricular
hypertrophy is seen.
~
XxZ
O12
XxA
te325 449 TRADIT13
Continued Next Page
~
XxZ