Research Institute for Sport & Exercise Sciences FACULTY OF SCIENCE 16 th FINA World Sports Medicine Conference The Athletes’ Heart: From Physiology to Pathology Professor Gregory P Whyte PhD FACSM Research Institute for Sport & Exercise Science Liverpool John Moores University
19
Embed
Research Institute for Sport & Exercise Sciences FACULTY OF SCIENCE 16 th FINA World Sports Medicine Conference The Athletes’ Heart: From Physiology to.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
16th FINA World Sports Medicine Conference
The Athletes’ Heart: From Physiology to Pathology
Professor Gregory P Whyte PhD FACSM
Research Institute for Sport & Exercise Science
Liverpool John Moores University
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
VO2max = Qmax * a-vO2diffmax
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
THE ATHLETES’ HEART
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
SCD in the Young
Sharma, S., Whyte, G. & McKenna, W.J. (1997) Sudden cardiac death from cardiovascular disease in young athletes: fact or fiction? BJSM 31: 269-276
Common UncommonHCM* MyocarditisICLVH CADCAA Marfan’sARVC** MVPIonchannelopathies
* Most common cause of ERSCD, ** Most common cause of ERSCD in Northern Italy
N.B. Some athletes with underlying CV disease are capable of high levels of performance
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Exercise Induced Cardiac Damage0.8
0.6
0.4
0.2
0.10.08
0.06
0.04
0.02
0.01
Positive cTnT samples following the London marathon (scale is log-plotted due to the spread of data)
0.1g/L cut-off
0.03g/L cut-off
0.05g/L cut-off
cT nT
g /L
Shave et al. Heart, 2005
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Dysfunction & Damage
Myocardial injury followed by repair as a result of myocyte hypertrophy (super-compensation)
» Physiological Signal for Adaptation
Myocardial injury followed by scarring leading to fibrotic replacement associated with
arrhythmia generation» Pathologic process of myocardial replacement
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Arrhythmia• Ector et al., EHJ 2007;28:345-353
» RV dysfunction leading to RV arrhythmia» Whyte et al., EHJ 2007 [first on-line]
• Heidbuchel et al., EHJ 2003;24(16):1473-1480» RV abnormalities acting as a substrate for arrhythmogenic focus
in athletes presenting with VT» ‘EXERCISE INDUCED VENTRICULAR DYSPLASIA’» Poor prognosis; incidence of SCD = 25%
• Jensen-Urstad et al., Heart 1998;79:161-164.» Increased prevalence of complex ventricular arrhythmia,
• Northcote et al., Br Heart J 1989;61:155-160.» Heart block and bradyarrhythmias more prevalent in veterans
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Cardiac Inflammation & Exercise
Chen et al., JAP 2000;88(5):1749-1755
Rats: 8% BM attached to tail and forced to swim for 3.5h/5hHistologic evidence of localised myocyte damage demonstrated by interstitial inflammatory infiltrates consisting of neutrophils, lymphocytes and histiocytes (5h swim)
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Exercise & Reactive Scar Tissue Formation in Humans
• Virmani et al., Am J Med 1982;72:874-882.» SCD in 30 Joggers» 25% (7/30) no identifiable cause – 3 cardiac hypertrophy, 6 myocytolysis and
contraction band necrosis (CV?)
• McKechnie et al., S Afr Med J 1979;56:261-265» PE in 2 ultramarathon runners secondary to dysfunction?
• Rowe, WJ, Chest 1991;99:1306-1308» 62 year old world record marathon runner (cause of death: lymphoma)» Circadian variation in coronary vasospasm – ‘Prinz-metal’s» Heart weight 360g. Small patchy non-transmural scar in LV posterior wall. Focal
fibrosis of L papillary muscles consistent with remote ischemic insult (normal coronaries & microvasculature)
» ISCHEMIA ASSOCIATED WITH CV?
• Wesslen et al., EHJ 1996;17(6):902-910.» 16 SCD Swedish orienteers (5 active myocarditis, 4 ARVC-like alterations)
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Myocardial Fibrosis in a Lifelong Endurance Runner (RH): 2C & 4C LGE images
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Persistent Elevation in cTnT at Rest - RS
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
SCD in a Marathon Runner (RC)
Whyte et al. BJSM, 2008
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE
Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE