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Sudden cardiac death and sports - Coggle Diagram
Sudden cardiac death and sports
Causes sudden deaths
Hypertrophic cardiomyopathy(30%)
Coronary artery abnormalities(15)
Left ventricular hypertrophy(11%)
Arrhythmogenic displasia of the right ventricle(6%)
Myocarditis(5%)
Aorta abnormalities(5%)
Early coronary disease(5%)
Other causes(23%)
Prevention
Priamry
Pre-participation screening
Family and personal history
Physical examination
ECG
12 lead
24-hour Holter-ECG
or MRI
ECG findings
Normal
QRS voltage criteria for right or left ventricular hypertrophy
Incomplete right bundle branch block
Early repolarization
ST elevation followed by R-wave inversion in V1-V4 in black athletes
Inverted T wave in V1-V3 in children under 16 years of age
Bradycardia or sinus arrhythmia
Ectopic atrial or junctional rhythm
1st or 2nd degree AVB (Mobitz I)
Borderline
Right axis deviation
Right atrial growth
Left axis deviation
Left atrial growth
Complete right bundle branch block
Abnormal
Inverted T wave
ST segment depression
Pathological Q waves
Complete left bundle branch block
QRS duration greater than 140 msec
Presence of epsilon wave
Ventricular preexcitation
Prolonged QT interval
Type 1 Brugada syndrome pattern
Severe sinus bradycardia (less than 30 bpm)
PR interval ≥ 400 ms
Second degree AVB (Mobitz II)
3rd degree AVB
≥ 2 Ventricular extrasystoles
Atrial tachyarrhythmias
Ventricular tachyarrhythmias
MRI
Secondary
Medical action plan
Automated external defibrillator
Other diagnostic tests
Stress test or ergometry
24-hour Holter-ECG
Transthoracic echocardiography (TTE)
Cardiac magnetic resonance (CMR)
Transthoracic echocardiography (TTE)
Computed tomography (CT) with athletes
Nuclear cardiac imaging
Pre-participation screening recommended by European society of cardiology
Athlete<35years
Family /personal history : physical examination
Negative
Normal fit
Positive
Second stage of tests(ECG, Ergometry,holter, cardiac,MRI,cardiac tomography, electrophysiology study to check for hypertrophic cardiomyopathy, anomalies in coronary arteries, cardiac arrhythmias.
Abnormal, follow protocol
Negative
Adaptations
HC- hypertrophic cardiomyopathy, AH- Athlete's heart}
Left ventricle end-diastolic diameter <45mm HC: > 54mm AH
LV volume/mass ratio HC-reduced:AH-Normal
LV diastolic function ,HC-reduced,AH-Supranormal
Dialated cardiomyopathy( DC)
LV resting contractile function, DC:Reduced and AH:normal
Increased LV contractile function with exercise DC:decreased, AH:Normal
Non-compacted cardiomyopathy( NCC)
Location of trabeculation NCC:apical,AH:middle
Increased LV contractile function with exercise NCC:Deceased,AH:Supranormal
RV arrhythmogenic cardiomyopathy (RV)
RV dilatation RV: predominant outflow AH:global
Segmental motility alterations RV:yes,AH:No
LV/RV volume ratio RV:>1,AH<1
Increased RV contractile function with exercise RV:Decreased,AH:Normal
Recommendations:
<75% max HR or < 6 Borg:<60%Max HR/<5borg,
(LV, left ventricle; EF, ejection fraction; DD, diastolic diameter; RV, right ventricle; PASP, pulmonary arterial systolic pressure.)
Cardiomyopathies
LV hypertrophyAsymtomatic :symtomatic
PPD 13mm:or >15mm
Lv Function
LVEF 30-50% or <30%
Coronary heart disease
ARVC
Aysmtomatic :Symtomatic
Myocarditis-Pericarditis, contraindicated acute phase
Aortic and Valvular diseases
Aortic or pulmonary stenosis
Flow rate 2.6-4.ms or >4m/s
Mitral stenosis
Mitral or aortic insufficiency
Bicuspid aortic valve. Normally functioning: all sports.
Mitral valve prolapse
assess risk
Dilated aortic root
40-45mm r >45mm
Coarctation of the aorta
20mmHg
Arrhythmias and channelopathies
Atrial fibrillation, atrial flutter. Anticoagulation, no impact sports.
Ventricular arrhythmia
Sinus bradycardia, second degree AVB Mobitz I (Wenckebach)
<30BPM
Second degree (Mobitz II) or third degree AV Block
Preexcitation syndrome or paroxystic supraventricular tachycardia
Radio frequency ablation recommend or indicated.
ICD (implantable cardioverter defibrillator)
Brugada syndrome
Asymtomatic or symtoms
Long or short QT syndrome
Catecholaminergic ventricular tachycardia