I came across an informative article about sudden cardiac death (SCD) in the online edition of the Halifax Evening Courier. The article focuses on the recent death of Boyzone singer Stephen Gately, but the content relates to the risk of SCD in young athletes as well. The article points to the need for careful screening examinations for cardiovascular disease and this fits in well with my previous post, “Who Needs a Doctor?”
Who Needs a Doctor?
One of the most frequent questions I receive takes the form of:
“Should I see a doctor?”
or
“How often should I see a doctor?”
If you’ve been reading here at the blog, you know that athletes take on special cardiovascular risks just by participating in their sports activities. And for that reason, they should see a doctor before they participate. The hope is that a careful physician can screen for potential underlying cardiovascular problems that might place the athlete at risk. And all of this is on top of the many other benefits that a careful physician might provide.
Here’s what I tell my friends who ask….
Student athletes
For middle school, high school, and college students who participate in athletics, their schools should provide guidelines about pre-participation physical examinations. The American Heart Association has developed guidelines to help physicians carefully screen for underlying cardiovascular conditions. The guidelines are written for medical professionals, so the text may be difficult for others to understand. In short, the AHA recommends that student athletes have a physical examination every 2 years during middle and high school and every year during college. Middle and high school students should have a careful medical history taken EVERY year, even if a physical examination is not performed.
The medical history should ask about:
1. Any chest pain or discomfort
2. Unexplained syncope or near syncope (blacking out or nearly blacking out)
3. Excessive shortness of breath during exertion
4. Previous recognition of a heart murmur
5. Elevated blood pressure
6. Family history of premature death (before 50 years) due to heart disease
7. Family history of disability due to heart disease in a relative younger than 50 years old
8. Family history of specific medical problems: Marfan syndrome, hypertrophic or dilated cardiomyopathy, long Q-T syndrome, or arrhythmias
The physical exam should pay attention to:
1. Heart murmur
2. Femoral pulses (to exclude coarctation of aorta)
3. Physical signs of Marfan syndrome
4. Blood pressure
Any abnormalities uncovered with this checklist should be evaluated further.
Young adult athletes, up to age 35
The AHA guidelines are probably also useful for young adult athletes. I tell my friends in this age group that they should see a physican yearly for a careful medical history and physical examination. The checklist for cardiovascular conditions above is also useful in this age group. This is also the age group where a baseline check on blood cholesterol and lipid levels and routine blood chemistries (glucose, creatinine, etc.) should be made.
Older adult athletes, over age 35
As athletes age, they confront an ever-increasing risk of events due to coronary artery disease (CAD, where plaque builds up in the arteries that supply the heart). A yearly visit to the physician for a medical history and physical examination is increasingly important. This is the age range when it is important, even aside from athletic reasons, that people should establish a long-term relationship with a family or internal medicine physician. In this age group, many female athletes will already see a physician regularly for gynecologic or obstetrical care, but “healthy” men are notoriouis for avoiding the doctor. The physician should continue to screen on a periodic basis for the risk factors for CAD: smoking, high blood pressure, obesity, diabetes or pre-diabetes, elevated blood cholesterol or lipids, and potentially others.
Athletes of any age, with medical problems
My suggestions above apply only to “healthy” athletes….those with NO chronic medical conditions. Athletes with ANY chronic medical condition will need to work with their physician to determine the frequency of visits to monitor those conditions. This will almost certainly require more than a single annual visit to the doctor.
Aortic Stenosis and Bicuspid Aortic Valve
I operated on a young man (in his early 30’s) a couple weeks ago for aortic valve replacement. It reminded me that valvular heart disease is not limited to older folks. This particular patient wasn’t an athlete, but I have a cycling acquaintance here in Jackson who also needed aortic valve replacement in his 30’s.
The aortic valve is the valve that lets blood flow out of the heart, from the left ventricle (the heart’s main pumping chamber) into the aorta (the large blood vessel that carries blood to the rest of the body). Ordinarily, this valve has 3 leaflets that are arranged to produce a pattern much like the Mercedes Benz emblem, if you look at the valve from above. With each heartbeat, the leaflets open nearly completely, allowing for unobstructed blood flow out of the heart.
There are 2 main problems that happen with heart valves….the valve can leak or it can become obstructed. Today, we’re going to focus on narrowing of the aortic valve, that produces obstruction to blood flow, and this is a condition that we call aortic stenosis. We’ll leave the leaking valves to another day.
There are several causes of aortic stenosis, but, by far, the most common cause is age-related calcific degeneration of the valve. That is, over years and years, calcium deposits build up in the valve leaflets, making them immobile. The leaflets eventually become so stiff that they do not open properly….and produce obstruction to blood flow exiting the heart. Aortic stenosis is usually a problem for patients who are in their 60’s, 70’s, or even older. Because the problem develops gradually over many years, patients sometimes don’t notice the effects, but the 3 primary symptoms are: 1) shortness of breath with exertion; 2) chest pain; and 3) syncope (blacking out).
Patients come to medical attention because of one or more of the hallmark symptoms or occasionally because a physician hears a heart murmur. There is a characteristic sound, or murmur, associated with aortic stenosis and your physician can hear this murmur in a very particular location on the chest—just to the right of the sternum, above the level of the nipples. An echocardiogram (ultrasound) is used to make detailed pictures of the heart valves and can be used to quantify the degree of stenosis, or obstruction, as mild, moderate, severe, or critical.
Aortic stenosis is a serious medical problem. Patients with severe or critical aortic stenosis require valve replacement. There is no other treatment (ie, medicines) that can correct the problem. For patients with breathing difficulties because of their aortic stenosis, the average life-expectancy is less than 2 years without valve replacement. Major heart surgery is needed to replace the valve with a mechanical (eg, carbon fiber and metal) or tissue (eg, the aortic valve “borrowed” from a pig) valve.
But like I mentioned above, aortic stenosis can sometimes be encountered in a much younger patient….sometimes as young as in the 20’s. And this is often due to a congenital abnormality of the aortic valve in which there are only 2—and not the standard 3—leaflets. This occurs in 1-2% of the general population. For some reason, this arrangement predisposes the individual to earlier calcification and stenosis of the valve as well as leaking of the valve. This is relevant to the athlete because problems are likely to develop during the very active portion of a typical athlete’s active lifetime.
The second important consideration in patients with bicuspid aortic valve is that they are much more likely to develop enlargement (aneurysm) of the beginning portion of the aorta, as it leaves the heart. Over time, the aorta can enlarge from its typical diameter of less than 3 cm to 5 cm or more, the aorta and the aortic valve should be replaced….again, with major heart surgery
Professional triathlete, Torbjorn Sindballe, was recently in the news when he retired from competition because of bicuspid aortic valve and mild aortic enlargement.
Decisions about continued participation for patients with these conditions will need to be individualized, but should only be made after careful consideration of the risks involved. Athletes with mild to moderate aortic stenosis, and who don’t have symptoms, probably can participate fully in athletic activities. Those with severe aortic stenosis should refrain from strenuous activity as treatment plans are made with their physicians. Athletes with bicuspid aortic valve and enlargement of the aorta should refrain from strenuous activity.
Article from a Reader: Mediterranean Diet for Athletes
Losing weight seems like such a simple thing, but in fact it is hard for many people. With well known diets on the market such as The South Beach Diet and Atkins’ Program, many have jumped on the low carbohydrate bandwagon. But what about athletes that need protein and carbohydrates to sustain energy? These types of diets do not address their needs. While they both advocate adequate protein, the carbohydrate levels are too low for anyone in sports activities or bodybuilding.
Athletes use carbohydrates for energy just before an event or competition. Also they need adequate amounts of protein because it helps to repair damaged muscle. A diet for athletes must meet these requirements. One such diet is The Mediterranean Diet. This diet advocates the use of grains, dairy and fats such as olive oil. Olive oil is good for your heart and also lowers cholesterol; Italians eat olive oil on their bread instead of butter or margarine. People living in the Mediterranean have eaten this way all their lives and are very healthy.
The diet is named after the area where it originated and is associated with good health and a long life. The dietary lifestyle of Italy and Greece has shown consistent low mortality rates for the past 25 years. The basics of the diet include whole grains, fruits and vegetables, poultry, eggs, and fish, nuts and seeds, cheese and yogurt, olive oil and a limited amount of red meat.
The diet focuses on healthy fats, whole grains, fruits and vegetables and protein. Complex carbohydrates break down slower in the digestive system and keep energy levels sustained. This makes the diet perfect for runners and triathletes. And although athletes normally limit the consumption of alcohol, one glass of wine a day is allowed.
An example of the daily menu:
Breakfast: Coffee, Oatmeal and whole wheat toast
Lunch: Pasta e Fagioli (pasta with navy beans), salad and piece of fruit
Dinner: Fish with vegetables and fruit for dessert
Some of the benefits of the Mediterranean Diet:
Lowered incidences of heart disease and lowered cholesterol. Studies done in Europe have shown this type of diet to reduce metabolic syndrome which is a precursor to Type 2 Diabetes. Also lower obesity rates, heart disease, cancer and high blood pressure. It is believed that this type of diet also promotes longevity and increases life expectancy.
The Mediterranean Diet is healthy, well balanced and perfect for anyone who wants to lose weight. This diet is approved by doctors and The American Medical Association.
About the Author
Valery Fortie is the Awareness Coordinator of the Mediterraneanbook.com organization. She is also the editor of the blog behind it. She focus her efforts to provide scientifically driven news on healthy Mediterranean Diet eating and drinking to prevent high blood pressure. Mediterraneanbook.com is a non commercial website created to preserve the Italian healthy eating traditions. Founded in 2004 in Italy, Mediterraneanbook.com feels very strongly about having informed consumers on duty in all healthy eating fields.
Useful Website: Mediterranean Diet
One of our readers wanted to share a useful website about the Mediterranean diet.
We know that our diet is particularly important to cardiovascular health and the Mediterranean-style diet has many admirable features. In fact, many of my cardiology colleagues now recommend a Mediterranean diet for their patients with heart disease.
Our reader has also offered to guest-author a piece with recommendations on how athletes can adopt this type of diet. I’m looking forward to sharing this information with you.
- « Previous Page
- 1
- …
- 38
- 39
- 40
- 41
- 42
- …
- 44
- Next Page »