Information about sudden cardiac arrest (SCA) in sports arises from registries, insurance claims and various reports. Analysing video footage of SCA during sports for scientific purposes has scarcely ...been done. The objective of this study was to examine videotaped SCA in athletes to better understand the mechanisms of SCA.
Publicly available online video databases were searched for videos displaying SCA in athletes.
Thirty-five online videos (26 from professional and 9 from amateur sport; 34 male victims) were obtained. Twenty-one events resulted in survival and 14 in sudden cardiac death. Level of physical activity prior to SCA was assessable in 28 videos; 19 events occurred during low-intensity, 6 during moderate-intensity and 3 during high-intensity activity. SCA predominately occurred during low-intensity compared with both moderate-intensity and high-intensity activities (p<0.01). In 26/35 videos, it was possible to observe if resuscitation was provided. Resuscitation was carried out in 20 cases; cardiopulmonary resuscitation (CPR) alone (8 cases), CPR+defibrillation (10), cardiac thump (1) or shock from an implantable cardioverter defibrillator (1). Thirteen of the 20 cases with resuscitation received an intervention within 1 min after collapse. Survival was high when intervention occurred within 1 min (12/13) compared with those who received delayed (3/5) or no intervention (1/6). Associated signs of SCA such as agonal respirations and seizure-like movements were observed in 66% of the cases.
SCA during sport most often occurred during low-intensity activity. Prompt intervention within 1 min demonstrated a high survival rate and should be the standard expectation for witnessed SCA in athletes.
Sudden death in sports among young adults in Norway Solberg, Erik Ekker; Gjertsen, Finn; Haugstad, Erlend ...
European journal of cardiovascular prevention and rehabilitation,
06/2010, Letnik:
17, Številka:
3
Journal Article
Recenzirano
The aim of the study was to explore sudden cardiac death during physical activity in young adults in Norway.
This retrospective study examined adults aged 15-34 years during the period 1990-1997. The ...Cause of Death Registry was used to identify cases of sudden cardiac death in sports. These cases were validated with information from medical records and autopsy reports.
Twenty-three sports-related sudden deaths (22 men), mean age 27 years (17-34 years), were identified. Causes of death were myocardial infarction (11), myocarditis (5), conduction abnormalities (2), aortic stenosis (1), cardiac rupture (1), hypertrophic obstructive cardiomyopathy (1), congenital coronary anomaly (1), and coronary sclerosis without defined infarction (1). The deaths were distributed across different types of sports activities. The incidence of deaths among physically active young men was 0.9 per 100,000.
The number of myocardial infarctions is higher than expected. The incidence is similar to that found in other studies. A vast majority of the cases of death were men.
Abstract
Myocardial diseases are associated with an increased risk of potentially fatal cardiac arrhythmias and sudden cardiac death/cardiac arrest during exercise, including hypertrophic ...cardiomyopathy, dilated cardiomyopathy, left ventricular non-compaction, arrhythmogenic cardiomyopathy, and myo-pericarditis. Practicing cardiologists and sport physicians are required to identify high-risk individuals harbouring these cardiac diseases in a timely fashion in the setting of preparticipation screening or medical consultation and provide appropriate advice regarding the participation in competitive sport activities and/or regular exercise programmes. Many asymptomatic (or mildly symptomatic) patients with cardiomyopathies aspire to participate in leisure-time and amateur sport activities to take advantage of the multiple benefits of a physically active lifestyle. In 2005, The European Society of Cardiology (ESC) published recommendations for participation in competitive sport in athletes with cardiomyopathies and myo-pericarditis. One decade on, these recommendations are partly obsolete given the evolving knowledge of the diagnosis, management and treatment of cardiomyopathies and myo-pericarditis. The present document, therefore, aims to offer a comprehensive overview of the most updated recommendations for practicing cardiologists and sport physicians managing athletes with cardiomyopathies and myo-pericarditis and provides pragmatic advice for safe participation in competitive sport at professional and amateur level, as well as in a variety of recreational physical activities.
Background
Several studies have linked mutations in the genes encoding cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase complex 1 (VKORC1) to a reduced warfarin dose requirement and an ...increased risk of bleeding with warfarin treatment, but the implementation of genotyping as routine practice is still controversial. The objective of this study was to investigate whether the frequencies of
CYP2C9
variant alleles (
*2
and
*3
), and
VKORC1
haplotypes (
*2A/B
) were increased in a population of warfarin-treated patients with an excessive INR response.
Methods
All patients with INR values >5 detected by routine monitoring at Diakonhjemmet Hospital, Oslo, Norway, between October 2006 and January 2009 were prospectively enrolled in the study (
n
= 131, ‘cases’). A group of patients with normal INR values (2–3) were randomly included as the reference population (
n
= 130, ‘controls’). The frequencies of
CYP2C9
variant alleles
*2
(
430C > T
) and
*3
(
1075A > C
),
VKORC1
haplotypes
*2A
(
1173G > T
) and
*2B
(
1173G > T + 497T >G
), and the respective genotypes were compared between the study groups by chi-square tests odds ratio (OR) of cases vs. controls with 95% confidence intervals (CI) calculated for the various end-points.
Results
About two thirds of the patients in the high INR group were in the maintenance phase of the treatment (>3 weeks from first warfarin dose to measurement of INR >5). The frequency of
CYP2C9
variant alleles (sum of
*2
and
*3
) was significantly higher in patients with high INR cases than in the controls (OR 1.6, 95% CI 1.03–2.52;
p
= 0.036). Observed frequencies for each of the variant alleles were also higher in the cases than in the controls (i.e.,
2C9*3
: OR 1.97, 95% CI 0.91–2.41,
p
= 0.073;
2C9*2
: OR 1.36, 95% CI 0.88–1.58,
p
= 0.246). There were no significant differences in
VKORC1*2
haplotype frequencies between the two subgroups, but the number of homozygous
VKORC1*2B
carriers was significantly higher in cases than in controls (OR 2.72, 1.02–7.24;
p
= 0.039).
Conclusion
The presence of
CYP2C9
variant alleles and the homozygous
VKORC1*2B
genotype was associated with elevated INR values in warfarin-treated patients. These results support the implementation of genotyping as a tool to identify patients with an increased risk of excessive anticoagulation during warfarin treatment.
Treatment of hypertension and its complications remains a major ongoing health care challenge. Around 25% of heart attacks in Europe are already attributed to hypertension and by 2025 up to 60% of ...the population will have hypertension. Physical inactivity has contributed to the rising prevalence of hypertension, but patients who exercise or engage in physical activity reduce their risk of stroke, myocardial infarction, and cardiovascular mortality. Hence, current international guidelines on cardiovascular disease prevention provide generic advice to increase aerobic activity, but physiological responses differ with blood pressure (BP) level, and greater reductions in BP across a population may be achievable with more personalized advice. We performed a systematic review of meta-analyses to determine whether there was sufficient evidence for a scientific Consensus Document reporting how exercise prescription could be personalized for BP control. The document discusses the findings of 34 meta-analyses on BP-lowering effects of aerobic endurance training, dynamic resistance training as well as isometric resistance training in patients with hypertension, high-normal, and individuals with normal BP. As a main finding, there was sufficient evidence from the meta-review, based on the estimated range of exercise-induced BP reduction, the number of randomized controlled trials, and the quality score, to propose that type of exercise can be prescribed according to initial BP level, although considerable research gaps remain. Therefore, this evidence-based Consensus Document proposes further work to encourage and develop more frequent use of personalized exercise prescription to optimize lifestyle interventions for the prevention and treatment of hypertension.
Exercise and type 2 diabetes Moholdt, Trine; Solberg, Erik Ekker
Tidsskrift for den Norske Lægeforening,
2019-Jun-25, Letnik:
139, Številka:
10
Journal Article
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