CARDIOVASCULAR WORK-UP BEFORE YOU WORK OUT!

By Dr. Sal Trazzera M.D., Cardiologist

Competing in Athletics has come a long way over the years.  With the advancement in performance training, injury prevention, nutrition, and supplementation, we forget a major factor athlete’s neglect.  Keeping check on your heart is not only smart but can add depths to your training.  We decided to speak with top Cardiologist, athlete, and Hockey team owner Dr. Sal Trazzera and ask for an introduction on key steps to begin profiling athletes and cardiovascular testing.  These are steps Dr. Trazzera begins with each Athlete.

4 Steps for Diagnosing Cardiovascular Abnormalities in Competitive Athletes

1. 1.       Use the 12-point American Heart Association Recommendations for Screening for Cardiovascular Abnormalities in Competitive Athletes, (below)
2. 2.       An Electrocardiogram
3. 3.       Conduct more advanced testing in certain individuals based on what you believe you will find. (i.e., echocardiography, exercise and cardiopulmonary stress testing, ambulatory arrhythmia monitoring, advanced imaging such as cardiovascular computed tomography or magnetic resonance imaging or angiography to assess for congenital anatomic abnormalities)
4. 4.       Apply 36^th Bethesda guidelines determining eligibility to participate, available at www.acc.org/qualityandscience/clinical/bethesda/beth36/index.pdf

Medical History*

Personal history

1. 1.       Exertional Chest Pain
2. 2.       Unexplained syncope/near syncope #
3. 3.       Excessive exertional and unexplained shortness of breath/fatigue associated with exercise
4. 4.       Prior recognition of a heart murmur
5. 5.       Elevated systemic blood pressure

Family History

1. 6.       Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in 1 or more relatives
2. 7.       Disability from heart disease in a close relative <50 years of age
3. 8.       Specific knowledge of certain cardiac conditions in family members: hypertrophic Cardiomyopathy, long QT syndrome or other ion channelopathies, Marfan Syndrome, or clinically important arrhythmias

Physical Examination

1. 9.       Heart Murmur ++
2. 10.   Femoral pulses to exclude aortic coarctation
3. 11.   Physical Stigmata of Marfan Syndrome
4. 12.   Brachial Artery Blood Pressure (sitting position)

*Parental verification is recommended for high school and middle school athletes

# judged not to be neurocardiogenic (vasovagal); of particular concern when related to exertion

++ Auscultation should be performed in both the supine and standing positions (or with valsalva maneuver), specifically to identify murmurs of dynamic left ventricular outflow tract obstruction

Source: Marron, BJ., et al (2007)  Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and metabolism: Endorsed by the American College of Cardiology Foundation. Circulation 1151643-55.