Tag Archives: athletes

Introduction Physical activity and sports play a pivotal role in maintaining overall health and well-being, and as societies become increasingly sedentary, with an epidemic of obesity1,2 and type 2 diabetes3 in the western world, the medical profession seeks to promote meaningful exercise during daily life to maintain physical and mental health. The World Health Organisation (WHO) recommends that all adults engage in a minimum of 150 minutes of moderate intensity exercise, or 75 minutes of vigorous exercise, per week.4 For many years, the causes of sudden death in young people have been under scrutiny, with those events particularly highlight

Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia with an estimated prevalence in the UK of 3%.1 Epidemiological studies have shown a 12–20% reduction in the risk of AF in individuals who engage in guideline-recommended physical activity levels.2,3 However, the reduction in AF risk appears to diminish with increasing doses of exercise, with contemporary data proposing a paradoxical rise in the risk of AF with the highest doses of exercise; suggesting a U-shaped dose-response relationship (figure 1).4 Figure 1. The extreme exercise hypothesis4 whereby the benefits of exercise are reduced in extreme training volumes

Epidemiology The incidence of sudden cardiac death (SCD) in athletes varies widely between studies, ranging between 0.24 and 6.8 per 100,000 person-years.1,2 This is partially explained by the differences in the populations studied, differences in the definition of an athlete, and the inclusion of sudden cardiac arrest into studies. Age has been shown to be an important determinant of risk, with a nationwide Danish study showing that those aged 12 to 35 years were at a lower risk (0.43 to 2.95 per 100,000 person-years) compared with those aged 36 to 49 years (0.47 to 6.64 per 100,000 person-years).3 Interestingly, this study also showed that

(more…)

Amiodarone for the treatment of stable ventricular tachycardia – has the Resuscitation Council got it wrong? Dear Sirs, Amiodarone has been the UK Resuscitation Council’s recommendation for the treatment of haemodynamically stable ventricular tachycardia (VT) since 2000.1  It is my opinion that the evidence in support of amiodarone in this setting is poor and that superior agents may exist. In the last six years, three retrospective studies have been published showing a dismal success rate when amiodarone is used to treat patients with stable VT. Marill et al reported that eight out of 28 (29%) patients cardioverted using a dose of 150 m

PARTNER: transcatheter valves just as good as surgery for high risk aortic stenosis Transcatheter aortic valve implantation (TAVI) is just as effective at reducing mortality as surgery for severe aortic stenosis in elderly patients whose age and overall health posed high risks for conventional surgery, according to the results of the PARTNER (Placement of AoRTic TraNscathetER Valve trial). However, stroke rates were higher in the trancatheter group. The transcatheter approach involves delivering a bioprosthetic valve to its target location with a catheter using either transfemoral access or trans-apical access (through the ribs) if peripheral

Chest pain – troponin and athletes Dear Sirs. We recently admitted two young men with chest discomfort suggestive of an acute coronary syndrome, who were troponin I positive. One was a 26-year-old Caucasian with left-sided chest heaviness engaging in regular triathlons. While serial resting electrocardiograms were unremarkable, troponin I on admission and one month later were elevated at 0.1 and 0.09 mg/L, respectively (normal range 0-0.04). An echocardiogram was entirely normal. An exercise treadmill stress test (ETT) was performed to 13 minutes (99% target heart rate achieved) of a Bruce protocol without symptoms or changes in the E