Module 4

(Part 3)

CARDIOVASCULAR ISSUES IN SPORTS & CONCUSSION IN SPORTS

 CARDIOVASCULAR ISSUES IN SPORTS

• An integral part of the preparticipation

physical examination for athletes is the
cardiovascular evaluation.
• The goal of this evaluation is to
identify athletes who are at risk for
sudden cardiac death during vigorous
physical activity.
• By applying elements of the personal
history, the family history, and the
physical exam, the most important
signs and symptoms of the most
common cardiac reasons for sudden
death can be obtained.
CARDIOVASCULAR ISSUES IN SPORTS
• An integral part of the preparticipation physical
examination for athletes is the cardiovascular
evaluation.
• The goal of this evaluation is to identify athletes who
are at risk for sudden cardiac death during vigorous
physical activity.
• By applying elements of the personal history, the
family history, and the physical exam, the most
important signs and symptoms of the most common
cardiac reasons for sudden death can be obtained.
• These include hypertrophic cardiomyopathy (HCM),
selected arrhythmias, coronary artery anomalies,
ruptured aortic aneurysm, and commotion cordis.
• In particular, HCM has received much attention in the
press and in the literature as it has taken the lives of
several high profile athletes.
• It is the primary cause of sudden atraumatic death in
athletes, responsible for nearly 35% of those deaths.
Hypertrophic Cardiomyopathy
• HCM is a hereditary condition that occurs as
commonly as 1:500 in the adult population.
• It is most commonly transmitted via an autosomal
dominant pattern in which there is a genetic defect
in the sarcomere contractile proteins.
• This leads to an increased ventricular muscle mass
that is characteristically the hallmark of this
condition.
• It is important to note that there is not an
associated increase in actual ventricular cavity size;
just a hypertrophy of the muscle tissue itself.
• This is important because it can often be difficult to
differentiate HCM from a conditioned athlete’s
heart.
• In HCM, there is a severe net reduction in actual
inner ventricular cavity size because of the much
enlarged and hypertrophied muscle mass.
• In HCM, there is also evidence of reduced
compliance secondary to the inability to
adequately relax the hypertrophied muscle mass
and causes diastolic dysfunction.
• An arrhythmia, or irregular
heartbeat, is a problem with the
rate or rhythm of your heartbeat.
• Your heart may beat too quickly,
too slowly, or with an irregular
rhythm.
• It is normal for your heart rate to
speed up during physical activity
and to slow down while resting or
sleeping.
Coronary artery anomalies
(CAAs) are a group of
congenital conditions
characterized by abnormal
origin or course of any of the
main epicardial coronary
arteries.
• An aortic aneurysm is a bulging or dilation in the
wall of the aorta which is a major blood vessel that
carries blood from the heart to the body.
• The dilating wall of aorta is caused by the
weakness or degeneration that develops in some
portion of the aortic wall.
• Aortic aneurysms include abdominal aortic
aneurysm (in the abdomen) and thoracic aortic
aneurysm (in the chest cavity).
• An aneurysm might enlarge and the wall of the
aorta cannot stretch any further.
• At this point, an aneurysm is at risk of rupturing
and causing potentially fatal conditions.
• If ruptured aortic aneurysm could not be
accurately diagnosed and effectively treated in
time, it can cause life-threatening internal bleeding
which leads to the increased chances of sudden
death.
• Commotion cordis is a condition
in which an abnormal heart
rhythm (ventricular fibrillation)
and cardiac arrest happen
immediately upon an object
(usually something small and hard
like a baseball or hockey puck)
striking the chest directly over the
heart at a very critical time during
a heartbeat.
• Needless to say, an aggressive and focused
preparticipation evaluation must be an essential
part of the armamentarium of the sports
medicine physician.
• He or she must understand the pathophysiology
of the most common causes of sudden cardiac
deaths in athletes, as well as be able to identify
which athletes are at risk for this based on their
preparticipation evaluation.
• The physician/physical therapist must also serve
as an educator to coaches, players, and parents
about the warning signs of dangerous cardiac
scenarios
 CONCUSSION IN SPORTS

• A concussion results from trauma

transmitted either directly or
indirectly to the head, causing
impairment of the brain’s normal
function.
• This impairment may last from
seconds to days.
• At times, dysfunction or post-
concussive symptoms (headache,
dizziness, tinnitus, irritability, memory
impairment, nausea/vomiting,
fatigue, etc.) can last months to years.
• Concussion is a type of brain injury,
which can be classified as minor, mild,
moderate, or severe.
 Concussion
Concussion is defined as a complex pathophysiological process affecting the brain, induced by
traumatic biomechanical forces.
Several common features that incorporate clinical, pathological, and biomechanical injury
constructs that may be used in defining the nature of a concussive head injury include
1. Concussion may be caused by a direct blow to the head, face, neck, or elsewhere on the body,
with an “impulsive” force transmitted to the head.
2. Concussion typically results in the rapid onset of short-lived impairment of neurological
function that resolves spontaneously.
3. Concussion may result in neuropathological changes but the acute clinical symptoms largely
reflect a functional disturbance rather than structural injury.
4. Concussion results in a graded set of clinical syndromes that may or may not involve LOC.
Resolution of the clinical and cognitive symptoms typically follows a sequential course.
5. Concussion is typically associated with grossly normal structural neuroimaging studies.
• The evaluation of the athlete
suspected of a concussion should
include a history of past head and
neck injuries (including orofacial),
severity of impact (magnitude of
force, linear, rotational), prior
structural deficits if the athlete
had a prior injury, and genetic
phenotype if known
(apolipoprotein).
• This should be combined with the
detailed evaluation of the current
episode. Although LOC is an
appropriate concern, it appears
insensitive for most concussions,
and amnesia may be a better
measure of severity.

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