BJSM Abnormal electrocardiographic findings in athletes: recognising changes suggestive of cardiomyopathy Jonathan A Drezner,1 Ackerman,9,10 Marek,17 Euan Ashley,2 Jeff Anderson,11 Stephen Paul,18 Aaron L Baggish,3 Chad A Asplund,12 Jordan M Prutkin,6 Mats Börjesson,4 Bryan C Cannon,13 Jack C Salerno,19 Domenico Corrado,5 John DiFiori,14 Christian M Schmied,20 David S Owens,6 Peter Fischbach,15 Sanjay Sharma,21 Akash Patel,7 Victor Froelicher,2 Ricardo Stein,22 Antonio Pelliccia,8 Kimberly G Harmon,1 Mathew Wilson23 Victoria L Vetter,7 Hein Heidbuchel,16 Michael J Joseph Introductie Na publicatie (met toestemming) van de eerste twee delen van de “ECG bundel”, overgenomen uit BJSM 2013 in Sport & Geneeskunde, volgt hier het tweede deel van deel 3. In dit deel wordt het ECG bij sporters met een cardiomyopathie onder de loep genomen. Hierin kunt u lezen dat differentiatie tussen fysiologie en pathologie op het ECG bij een sporter soms zeer moeilijk kan zijn, vooral omdat het ECG van een sporter bedrieglijk veel kan lijken op dat van iemand met CMP. Voor de complete introductie zie Sport & Geneeskunde 3-2013, pag. 26-27. Deel II: Arrhythmogenic right ventricular cardiomyopathy ARVC is an inherited heart muscle disease characterised by fibro-fatty replacement of right ventricular myocardium and corollary life-threatening ventricular arrhythmias or SCD, mostly in young people and athletes. Progressive dilation/dysfunction predominantly involves the right ventricle with involvement of the left ventricle in late-stage disease. Variants with predominantly LV involvement are described in about 10% of patients (hence the alternative term of arrhythmogenic cardiomyopathy). Mutations in the desmosomal genes account for approximately 50% of ARVC cases.44 45 In addition, there is emerging evidence that intense endurance sports may lead to a similar phenotype (with similar prognosis) in the absence of desmosomal mutations, so-called exercise-induced ARVC, which may be the result of increased RV wall stress during exercise.46–48 Contribution as a cause of SCD According to data from the Veneto region of Italy where postmortem investigation of young sudden death victims is performed systematically, ARVC is a leading cause of sport-related sudden death accounting for approximately one-fourth of fatalities in young competitive athletes.3 Data from the USA, notably without a mandatory registry for SCD in athletes, suggest that ARVC is a less common cause of SCD.1 Diagnostic criteria The original (1994) and the revised (2010) Task Force Criteria for diagnosis of ARVC are based on major and minor criteria encompassing familial/genetic, ECG, arrhythmic, morphofunctional ventricular and histopathological features.49 The diagnosis is fulfilled in the presence of two The prevalence of familial ARVC is estimated at 1 : 2000–1 : 5000 persons.44 45 major criteria, one major plus two minor criteria, or four minor criteria from different groups.49 30 Sport & Geneeskunde | september 2013 | nummer 4 Pagina 29
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