Lecture notes fr S Valdes 011813
Incidence 1/100,000-300,000, but not really known
-incr w hugh intensity sports bball, ftball, track
-5:1 male:female, but more males in sports at the time
Etiology
-HCM 26%
-Commotio cordis 20%
-coronar abNly- 14%
-LQT <1% (but not all genetic testing avail at time if the study...)
-in Italy, ARVD was #1...
-study of NCAA deaths- 16% of death was CV, most were not medical, but 56% of medical deaths were CV in nature...
-SCD >3x more likely in black athletes vs whites
-HCM much more common in blacks, ARVD much more in whites...
HCM
-auto dom usually
-1/500 ppl in US
-=hypertphied w/o diln
-usually ASx
-cor arts usually heavy muscularization, often intramuscular course
-75-95% w nonSp ECG changes
-1-6% annual mortality rate; fr VT/VF
-RF for SCD- prior arrest, FHx of HCM related death, multiple syncopal episodes, multiple nonsust VT, hypotension w exercise, extreme LVH >30mm
Commotio Cordis
-blunt chest traua --> VF w/o struxtural changes to ribs...heart
-poor survival rate (15%) if pts who present (biased bc many dont present if recover...)
-? 2y to a large incr in LV P quickly
-AED's can reduce mortality
Congen Coronar Artery AbNly
-uncommon 0.2-1.2% gen population
-in study of autopsy specimens in Italy: all w L off right had SCD, and 42% of R off L had sudden death
-1/2 SCD is ppt by exercise; only a few had syncope or CP
-?ostial narrowing or acute angle kinking...
-usually Nl ECG & stress test
-surgery possible, ? efficacy
Arrhythmogenic RV CM
-myocardial atrophy w fat replacement
-M>F
-?etiology
-EKG-R precordial depol/repol changes
-p/w VT w LBBB path, or VF/death
-see T waves inverted in V1
-rare to present at <20yo, but at times in teens...
-+ epsilon waves- small + depol after QRS in v1
LQTS
-15-25% of all SCD; = 400 cases in adults and kids/yr
-athletes have longer QT at baseline
->440 men, 460 in females; if >500 ~def a Long QT
--> check FHx... sudden death, sz, drowning
-check Holter for T waves alternans (vary bn + & -), and for VT/VF
-Exercise- see QT prolongs w exercise, instead of shortening like it should Nly.
-c/s if Torsades de pointes and VF, unexplained drowning...
WPW
-low, 305% of cases
-fr rapid conduction of a-fib --> degeneate to VF
-low risk of SCD in WPW - <0.1% lifetime risk
-check exersise stress test - reassuring if you have sudden loss of preexcitation, in 1 be athlete can get
-if negative, then not interpretable--> must check w EP testing- induce a-fib, high risk is if pt conducts at <250..._____
Myocarditis
Marfans
5-8/1000 get SCD
-fr dissection
Brugadas
incomplete RBBB, ST elevation, w concavity/sloping down of ST segment
(ddx fr Nl athlete who can have RBBB and some ST elevation, but w upsloping ST)
Drug use