• Newsletter
  • Search
  • Contacto
  • Home (next newsletter)
  • Home
  • News # 80 | Jun. 2018
  • News # 81 | Jul. 2018
  • News # 82 | Set. 2018
  • News # 83 | Oct. 2018
  • News # 84 | Nov. 2018
  • News # 85 | Dec. 2018
  • News # 86 | Jan. 2019
  • News # 87 | Feb. 2019
  • News # 88 | Mar. 2019
  • News # 89 | Apr. 2019
  • News # 90 | May. 2019
  • News # 91 | Jun. 2019
  • News # 92 | Jul. 2019
  • News # 93 | sep. 2019
  • Newsletters
    • 2008 – 2009
      • News # 1 | nov. 2008
      • News # 10 | nov/dez. 2009
      • News # 2 | dec. 2008
      • News # 3 | jan/fev. 2009
      • News # 4 | mar. 2009
      • News # 5 | abr. 2009
      • News # 6 | mai/jun. 2009
      • News # 7 | jul. 2009
      • News # 8 | ago/set. 2009
      • News # 9 | out. 2009
    • 2010 – 2011
      • News # 11 | jan/fev. 2010
      • News # 12 | mar. 2010
      • News # 13 | abr. 2010
      • News # 14 | mai. 2010
      • News # 15 | jun/jul. 2010
      • News # 16 | ago/set. 2010
      • News # 17 | out/nov. 2010
      • News # 18 | dez. 2010
      • News # 19 | jan/fev. 2011
      • News # 20 | mar/abr. 2011
      • News # 21 | mai/jun. 2011
      • News # 22 | jul/ago. 2011
      • News # 23 | set/out. 2011
      • News # 24 | nov/dez. 2011
    • 2012 – 2013
      • News # 25 | jan. 2012
      • News # 26 | fev/mar. 2012
      • News # 27 | jun. 2012
      • News # 28 | ago. 2012
      • News # 29 | set/out. 2012
      • News # 30 | nov/dez. 2012
      • News # 31 | jan. 2013
      • News # 32 | mar. 2013
      • News # 33 | abr. 2013
      • News # 34 | mai. 2013
      • News # 35 | jun. 2013
      • News # 36 | set. 2013
      •  News # 37 | out. 2013
      • News # 38 | nov/dez. 2013
    • 2014 – 2015
      • News # 39 | jan/fev. 2014
      • News # 40 | mar. 2014
      • News # 41 | abr/mai. 2014
      • News # 42 | jun/jul. 2014
      • News # 43 | set. 2014
      • News # 44 | out/nov. 2014
      • News # 45 | dez. 2014
      • News # 46 | jan. 2015
      • News # 47 | fev. 2015
      • News # 48 | abr. 2015
      • News # 49 | mai. 2015
      • News # 50 | jun. 2015
      • News # 51 | set. 2015
      • News # 52 | out. 2015
      • News # 53 | dez. 2015
    • 2016 – 2017
      • News # 54 | jan. 2016
      • News # 55 | fev. 2016
      • News # 56 | mar. 2016
      • News # 57 | abr. 2016
      • News nº 58 | may 2016
      • News # 59 | jun. 2016
      • News # 60 | jul. 2016
      • News # 61 | set. 2016
      • News # 62 | out. 2016
      • News # 63 | nov/dez. 2016
      • News # 64 | jan. 2017
      • News # 65 | fev. 2017
      • News # 66 | mar. 2017
      • News # 67 | apr. 2017
      • News # 68 | may 2017
      • News # 69 | jun. 2017
      • News # 70 | jul. 2017
      • News # 71 | set. 2017
      • News # 72 | out. 2017
      • News # 73 | nov. 2017
      • News # 74 | dez. 2017
    • 2018
      • News # 75 | jan. 2018
      • News # 76 | fev. 2018
      • News # 77 | mar. 2018
      • News # 78 | abr. 2018
      • News #79 | May 2018
  • Subscribe Newsletter
My Company
  • Home
  • Newsletters
    • 2018 – 2019
      • News nº 92 | jul. 2019
      • News nº 91 | jun. 2019
      • News nº 90 | Mai. 2019
      • News nº 89 | Abr. 2019
      • News nº 88 | Mar. 2019
      • News nº 87 | Fev. 2019
      • News nº 86 | Jan. 2019
      • News nº 85 | Dez. 2018
      • News nº 84 | Nov. 2018
      • News nº 83 | Out. 2018
      • News nº 82 | Set. 2018
      • News nº 81 | Jul. 2018
      • News nº 80 | Jun. 2018
      • News Nº 79 | Mai. 2018
      • News nº 78 | abr. 2018
      • News nº 77 | mar. 2018
      • News nº 76 | fev. 2018
      • News nº 75 | jan. 2018
    • 2016 – 2017
      • News nº 74 | dez. 2017
      • News # 73 | nov. 2017
      • News # 72 | out. 2017
      • News # 70 | set. 2017
      • News nº 70 | jul. 2017
      • News nº 69 | jun. 2017
      • News nº 68 | mai. 2017
      • News nº 67 | abr. 2017
      • News nº 66 | mar. 2017
      • News nº 65 | fev. 2017
      • News nº 64 | jan. 2017
      • News nº 63 | nov/dez. 2016
      • News nº 62 | out. 2016
      • News nº 61 | set. 2016
      • News nº 60 | jul. 2016
      • News nº 59 | jun. 2016
      • News nº 58 | mai. 2016
      • News nº 57 | abr. 2016
      • News nº 56 | mar. 2016
      • News nº 55 | fev. 2016
      • News nº 54 | jan. 2016
    • 2014 – 2015
      • News nº 53 | dez. 2015
      • News nº 52 | out. 2015
      • News nº 51 | set. 2015
      • News nº 50 | jun. 2015
      • News nº 49 | mai. 2015
      • News nº 48 | abr. 2015
      • News nº 47 | fev. 2015
      • News nº 46 | jan. 2015
      • News nº 45 | dez. 2014
      • News nº 44 | out/nov. 2014
      • News nº 43 | set. 2014
      • News nº 42 | jun/jul. 2014
      • News nº 41 | abr/mai. 2014
      • News nº 40 | mar. 2014
      • News nº 39 | jan/fev. 2014
    • 2012 – 2013
      • News nº 38 | nov/dez. 2013
      • News nº 37 | out. 2013
      • News nº 36 | set. 2013
      • News nº 35 | jun. 2013
      • News nº 34 | mai. 2013
      • News nº 33 | abr. 2013
      • News nº 32 | mar. 2013
      • News nº 31 | jan. 2013
      • News nº 30 | nov/dez. 2012
      • News nº 29 | set/out. 2012
      • News nº 28 | ago. 2012
      • News nº 27 | jun. 2012
      • News nº 26 | fev/mar. 2012
      • News nº 25 | jan. 2012
    • 2010 – 2011
      • News nº 24 | nov/dez. 2011
      • News nº 23 | set/out. 2011
      • News nº 22 | jul/ago. 2011
      • News nº 21 | mai/jun. 2011
      • News nº 20 | mar/abr. 2011
      • News nº 19 | jan/fev. 2011
      • News nº 18 | dez. 2010
      • News nº 17 | out/nov. 2010
      • News nº 16 | ago/set. 2010
      • News nº 15 | jun/jul. 2010
      • News nº 14 | mai. 2010
      • News nº 13 | abr. 2010
      • News nº 12 | mar. 2010
      • News nº 11 | jan/fev. 2010
    • 2008 – 2009
      • News nº 10 | nov/dez. 2009
      • News nº 9 | out. 2009
      • News nº 8 | ago/set. 2009
      • News nº 7 | jul. 2009
      • News nº 6 | mai/jun. 2009
      • News nº 5 | abr. 2009
      • News nº 4 | mar. 2009
      • News nº 3 | jan/fev. 2009
      • News nº 2 | dez. 2008
      • News nº 1 | nov. 2008
  • Subscrever Newsletter
  • Contacto
Main Menu
  • Home
  • Newsletters
    • 2018 – 2019
      • News nº 92 | jul. 2019
      • News nº 91 | jun. 2019
      • News nº 90 | Mai. 2019
      • News nº 89 | Abr. 2019
      • News nº 88 | Mar. 2019
      • News nº 87 | Fev. 2019
      • News nº 86 | Jan. 2019
      • News nº 85 | Dez. 2018
      • News nº 84 | Nov. 2018
      • News nº 83 | Out. 2018
      • News nº 82 | Set. 2018
      • News nº 81 | Jul. 2018
      • News nº 80 | Jun. 2018
      • News Nº 79 | Mai. 2018
      • News nº 78 | abr. 2018
      • News nº 77 | mar. 2018
      • News nº 76 | fev. 2018
      • News nº 75 | jan. 2018
    • 2016 – 2017
      • News nº 74 | dez. 2017
      • News # 73 | nov. 2017
      • News # 72 | out. 2017
      • News # 70 | set. 2017
      • News nº 70 | jul. 2017
      • News nº 69 | jun. 2017
      • News nº 68 | mai. 2017
      • News nº 67 | abr. 2017
      • News nº 66 | mar. 2017
      • News nº 65 | fev. 2017
      • News nº 64 | jan. 2017
      • News nº 63 | nov/dez. 2016
      • News nº 62 | out. 2016
      • News nº 61 | set. 2016
      • News nº 60 | jul. 2016
      • News nº 59 | jun. 2016
      • News nº 58 | mai. 2016
      • News nº 57 | abr. 2016
      • News nº 56 | mar. 2016
      • News nº 55 | fev. 2016
      • News nº 54 | jan. 2016
    • 2014 – 2015
      • News nº 53 | dez. 2015
      • News nº 52 | out. 2015
      • News nº 51 | set. 2015
      • News nº 50 | jun. 2015
      • News nº 49 | mai. 2015
      • News nº 48 | abr. 2015
      • News nº 47 | fev. 2015
      • News nº 46 | jan. 2015
      • News nº 45 | dez. 2014
      • News nº 44 | out/nov. 2014
      • News nº 43 | set. 2014
      • News nº 42 | jun/jul. 2014
      • News nº 41 | abr/mai. 2014
      • News nº 40 | mar. 2014
      • News nº 39 | jan/fev. 2014
    • 2012 – 2013
      • News nº 38 | nov/dez. 2013
      • News nº 37 | out. 2013
      • News nº 36 | set. 2013
      • News nº 35 | jun. 2013
      • News nº 34 | mai. 2013
      • News nº 33 | abr. 2013
      • News nº 32 | mar. 2013
      • News nº 31 | jan. 2013
      • News nº 30 | nov/dez. 2012
      • News nº 29 | set/out. 2012
      • News nº 28 | ago. 2012
      • News nº 27 | jun. 2012
      • News nº 26 | fev/mar. 2012
      • News nº 25 | jan. 2012
    • 2010 – 2011
      • News nº 24 | nov/dez. 2011
      • News nº 23 | set/out. 2011
      • News nº 22 | jul/ago. 2011
      • News nº 21 | mai/jun. 2011
      • News nº 20 | mar/abr. 2011
      • News nº 19 | jan/fev. 2011
      • News nº 18 | dez. 2010
      • News nº 17 | out/nov. 2010
      • News nº 16 | ago/set. 2010
      • News nº 15 | jun/jul. 2010
      • News nº 14 | mai. 2010
      • News nº 13 | abr. 2010
      • News nº 12 | mar. 2010
      • News nº 11 | jan/fev. 2010
    • 2008 – 2009
      • News nº 10 | nov/dez. 2009
      • News nº 9 | out. 2009
      • News nº 8 | ago/set. 2009
      • News nº 7 | jul. 2009
      • News nº 6 | mai/jun. 2009
      • News nº 5 | abr. 2009
      • News nº 4 | mar. 2009
      • News nº 3 | jan/fev. 2009
      • News nº 2 | dez. 2008
      • News nº 1 | nov. 2008
  • Subscrever Newsletter
  • Contacto

Cardiocirculatory Repercussion of Physical Training. From the Athlete’s Heart to Sudden Death

By etavares On 31 May, 2010 Open Space | 2010 Comments Off on Cardiocirculatory Repercussion of Physical Training. From the Athlete’s Heart to Sudden Death No tags

Physical Exercise and the Athlete’s Heart 
Regular physical exercise reduces cardiac morbility and mortality, preventing atherosclerosis. In contrast, sudden death may occur in competition athletes, as a consequence of ventricular tachy-dysrhythmias in association with different cardiovascular situations, whether congenital or acquired. Particularly over the last decade, research has systematically dealt with the identification of the limits of the criteria of the athlete’s heart in order to allow the systematic outlining of the risk cardiovascular illnesses underlying sudden death (MS).

The cardiocirculatory modifications associated to the practice of exercise in aerobiosis are secondary to the increase of the consumption of oxygen by the muscular tissue, and are generally expressed by an increase in cardiac debit arising from the raising of the heart rate and of the systolic volume. In a more specific manner, among other factors, the type of sport is of crucial influence. Dynamic or isotonic exercise is associated to the reduction of peripheral resistances, to the increase in arterial pressure and to a circulatory pattern of volume overload. Yet static or isometric exercise accompanies an increase of peripheral resistance and of systodiastolic arterial pressure, setting up a pattern of pressure overload. Although the long distance race is close to the dynamic model and weight-lifting is paradigmatic of static exercise, most sports have mixed components, of differing importance.

The activity of regular exercise or sport is accompanied by electrophysiological alterations and modifications in ventricular remodelling which contribute towards maintaining the cardiac debit high and the parietal stress low. Thus, as a response to overload, one observes the increase in parietal thickness and of the left ventricular mass, which is most remarkable and has no ventricular dilation in isometric sports (concentric hypertrophy), while there is an increase in the dimensions of the cardiac chambers in the activities of the dynamic kind (eccentric hypertrophy) . (Studies with magnetic resonance have made it possible to state that physiological dilation is balanced out for both left and right ventricles . It should be stressed that in the process of conditioning the ventricular systolic function remains normal while the pattern of diastolic function, assessed by transmitral Doppler tissue flow, is normal or “supra-normal”. Recent studies have shown alterations in the myocardic deformation associated to sports of the static type, but their meaning has not been made clear. Adaptation by the autonomous nervous system to athletic conditioning is also a part of the physiological response to regular exercise, with a raising of the vagal tonus vagal and sympathetic inhibition, expressed as sinusal bradycardia and alterations in the auricular-ventricular conduction on the nodal level . The degree and nature of the response also depend on the sex, nature and degree of training and on genetic and ethnic factors .

The modifications described form the pattern of athlete’s heart, as a physiological response to continued physical training. In extreme situations the cardiac modifications may be close to those described for some myocardiopathies that are associated to risk of sudden death and are a counter-indication to competitive sport, with the differential diagnosis often being complex.

Sudden Death in the Athlete 
Sudden death in an athlete is a rare but terrifying event, with values that vary according to the series, higher with age and in the male sex. A very well characterised series from the region of Veneto, in Italy, indicates an incidence of 2.1/100,000 athletes per year . Death appears in 80% of the cases during sports and in 20% after exercise, suggesting that this is the precipitating factor . In the older age group sudden death is more frequently associated to coronary atherosclerotic disease, through intense exercise and due to myocardial stroke or ischemic ventricular arrhythmia. In fact, if exercise has a preventive role for atherosclerosis in the incipient phase, it may have a deleterial effect if it is not efficiently controlled in the pre-clinical established disease. In the young athlete (=35 years old) an important number of cardiovascular studies is the substratum for cardiac sudden death by ventricular tachycardia/fibrillation.

Hypertrophic myocardiopathy, with a genetic base and which is characterised by hypertrophy, fibrosis and structural disarrangement of the ventricular myofibrillas forms over one third of the sudden death situations in the United States (Fig. 1). This situation may be confused with athlete’s heart, particularly when the thickness of the ventricular wall reaches 15-16 mm, a criterion that forms a grey zone . Arrhythmogenic myocardiopathy of the right ventricle, also a genetic disease that is expressed as dilation, dysfunction and fibrolipidic infiltration of the right ventricle (Fig. 2), was indicated as the substratum for sudden death in one quarter of the cases in the region of Veneto. Its diagnosis uses clinical criteria, ECG, genetics, imagiology (ecocardiography/magnetic resonance) . Other situations underlying sudden death include congenital coronary diseases, premature coronary disease, myocarditis, dilated myocardiopathy, conduction disturbances, Wolff-Parkinson-White or the canalopathies, of difficult diagnosis (congenital Short QT and Long QT syndromes, Brugada and catecolaminergical ventricular polymorphic tachycardia). The dissection of the aorta or non-cardiac etiologies may rarely form an etiological situation.

Prevention of Sudden Death by Pre-Participation Screening
Medical evaluation of the athletes allows identification of asymptomatic individuals with a risk of sudden death. The protocol is not universally established. In the United States only the clinical history is assessed, with a special emphasis on family history. Analysis of the efficiency of this screening shows it is not very sensitive and specific . In Italy the screening process is obligatory for all those who practice competitive sport. Besides a full clinical history, taken by sports doctors, it includes ECG as the single examination. In the cases of suspicion of cardiopathy other diagnostic methods are carried out ranging from ecocardiography to Holter monitoring, to ergometry or to magnetic resonance, to electrophysiological study and others, following a diagnostic algorhythm . This strategy has been efficient in reducing the incidence of sudden deaths from 3.6/100,000 in 1980 to 0.4/100,000 patients/year in 2004. Despite the economic impact of the screening strategies, their benefit is widely demonstrated in the results in Italy, the only country where preventive attitudes are legislated and are compulsory. However, the guidelines of the European Society of cardiology now recommend this strategy of assessing athletes.

Fig. 1. Hypertrophic myocardiopathy. Picture of the left ventricle obtained by magnetic showing septal hypertrophy with fibrosis
(in white, arrow).seta).

Fig. 2. Arrhythmogenic myocardiopathy of the left ventricle. Picture of dilation and aneurism (arrow) of the left ventricle, obtained by magnetic resonance.seta).

Ana G. Almeida
Associate Professor of Cardiology
University Clinic of Cardiology
Faculty of Medicine of the University of Lisbon
anagalmeida@gmail.com

REFERENCES
Fagard RH. Impact of different sports and training on cardiac structure and function. Cardiology Clinics 1997;15:397–412
Pelliccia A, Maron BJ, Culasso F, et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 2000;102:278–84
Karjalainen J, Kujala HM, Stolt A, et al. Angiotensinogen gene M235T polymorphism predicts left ventricular hypertrophy in endurance athletes. J Am Coll Cardiol 1999;34:494: 9
Corrado D, Basso C, Rizzoli G, et al. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 2003;42:1959–63
Corrado D, Maron BJ, Basso C, Pelliccia A, et al. Sudden cardiac death in athletes. In Gussac I, Antzelevitch C (eds.) Electrical diseases of the heart, 2008. London: Springer-Verlag, pp.911–23
Maron BJ. Distinguishing hypertrophic cardiomyopathy from athlete’s heart: a clinical problem of increasing magnitude and significance. Heart 2005;91;1380-1382.
Marcus F, MD, McKenna, WJ, Sherrill D et al. Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. Circulation. 2010;121:1533-1541
Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes. Clinical, demographics,and pathological profiles. JAMA 1996;276:199–204
Corrado D, Pelliccia A, Bjørnstad H et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death. Eur Heart J. 2005;26:516-2

Share

Search

Index - News # 14 | mai. 2010
 May 2010 – Month of the Heart at a Time of Crisis
 IMM Researcher wins grant from the Harvard Medical School Portugal Program
 Image in Science and Art
 Interview with the Director of the University Clinic of Cardiology, Professor Mário G. Lopes
 Studying Medicine at the FMUL – Candidate’s Day 2010
 Professor Francisco Pulido Valente Teaching Prize 2010
 PhD Education in Biomedicine and Health Sciences in Europe
 Meeting “Purines – 80 years and very much alive”
 Book Biochemistry in Medicine
 Students’ Association of the Faculty of Medicine of the University of Lisbon Medical Checks
 Campanha – PENSE AMARELO
 Food Bank Against Hunger: FMUL’s participation
 Book of the Month
 FMUL Students on Research Projects in the Field of Cardiology
 Academic Examinations at the Faculty Of Medicine of The University Of Lisbon
 Publications FMUL/HSM/IMM
 Implications of Physical Exercise on the Patient
 Cardiocirculatory Repercussion of Physical Training. From the Athlete’s Heart to Sudden Death
 Effort Echocardiography
 Beyond Genetics: the New Challenges of Male Infertility
 100 Years of Medicine: a Historical Perspective [1910-2010] Part II
 Unsuspecting Collaborators in Research in Medicine
 On that which is called a blessing, or, as Jim Morrison would say, ‘This is the end, my friend’
 Researching Science and Health
 Indicators of the University Clinic of Cardiology
 Presentation of the book Dormir é bom, Dormir faz bem- 1st June
 Scientific Cooperation Agreement between Portugal and Poland – 2nd June
 Communicating Science in Medicine – Systematic Revisions (…) 2nd and 9th June
 12th European Conference of Medical and Health Science Libraries – 16th to 18th June
 3rd Forum of the Obesity – 18th and 19th June
 Homage to Prof. Arsénio Cordeiro – 21st June
 Amadeus Dias Foundation/University of Lisbon Grants (2010/2011)
 Communicating Science in Medicine – Clinical Cases Preparation for Publication – July 24th
 Scientific Research Grants 2010/2011
 Casa da América Latina/Santander Totta Scientific Prize
My Company

100 AnosPropriedade e Edição: Faculdade de Medicina da Universidade de Lisboa NIPC: 502662875  Periodicidade: Mensal  Diretor: Prof. Doutor Fausto J. Pinto Conselho Editorial: Prof. Doutor Fausto J. Pinto, Profª. Doutora Ana Sebastião, Prof. Doutor Mamede de Carvalho, Prof. Doutor António Vaz Carneiro, Prof. Doutor Miguel Castanho, Dr. Luís Pereira  Equipa Editorial:  Ana Raquel Moreira, Cristina Bastos, Isabel Varela, Joana Sousa, Maria de Lurdes Barata, Rui Gomes, Sónia Teixeira  Colaboração:  Gabinete de Relações Públicas, Internacionais e Comunicação  Versão Inglesa: AP|PORTUGAL- Language Services  Conceção: Metatexto, Lda. e-mail: news@medicina.ulisboa.pt  Sede do Editor e Sede da Redação: Avenida Prof. Egas Moniz, 1649-028 Lisboa Estatuto Editorial Anotado na ERC 

  • Increase Font
  • Decrease Font
  • Black & White
  • Inverse Colors
  • Highlight Links
  • Regular Font
  • Reset
Real Accessability