Sports Cardiology Case Presentation Dr. Sabiha Gati @s_gati St. - - PowerPoint PPT Presentation

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Sports Cardiology Case Presentation Dr. Sabiha Gati @s_gati St. - - PowerPoint PPT Presentation

Sep 08, 2023 234 likes •629 views

Sports Cardiology Case Presentation Dr. Sabiha Gati @s_gati St. Georges University of London United Kingdom Disclosures: None 52 52 year old Caucas ear old Caucasian ian male male Recreational runner Runs 1-2h per week,

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Sports Cardiology Case Presentation

  • Dr. Sabiha Gati

@s_gati

  • St. George’s University of London

United Kingdom Disclosures: None

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52 52 year old Caucas ear old Caucasian ian male male

  • Recreational runner
  • Runs 1-2h per week, completed several 5K, 10K

runs prior

  • No cardiac symptoms
  • No medical history, no medications
  • Never smoker
  • Silverstone Half Marathon
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Silv Silver erstone stone – The r he race ace

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Witness itness repor eport

  • No signs of difficulty prior to collapse.
  • Fell forward without clear mechanical cause with

fascial injury.

  • First responders.
  • No convincing pulse and CPR commenced/tolerated.
  • By the time difibrillator arrived and applied there was

rhythm.

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Post “ictal ictal”/event period

  • Immediate GCS 3/15
  • within 3 mins GCS 7/15 (E2,V1,M4) with head

turning to the left, jaw clenching and eye diviation to the left, tonic posture, remained unresponsive

  • Airway patent
  • Pupils equal and reactive to light
  • Within 10mins GCS 14/15
  • Disorientation in time
  • Repeated questioning “ did i finish?”

“Where is my family”

  • Blood glucose normal
  • Normal intial observations
  • No focal motor or sensory deficit
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Initial Initial tests? tests?

  • A) Temperature, Sodium, Glucose
  • B) ECG & Cardiac monitoring
  • C) None of the above, CT head
  • D) All of the above
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Initial Initial tests? tests?

  • Temperature
  • Sodium
  • Glucose
  • ECG
  • Cardiac monitoring
  • CT head
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12 12-lead lead ECG ECG

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Admitt Admitted ed under car under cardiolog diology

  • ECGs and 24h rhythm monitoring: No dynamic

changes, single episode NSVT, 7 beats

  • Cardiac troponins – 338ng/L (initial), 334 ng/L (12h)

[normal <100ng/L]

  • Echocardiogram unremarkable
  • CT Head: right maxillary fracture, soft tissue injury
  • …What next?
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Wha hat ne t next? xt?

  • A) Discharge, do nothing?
  • B) ICD?
  • C) Home with Life vest?
  • D) Anything else ?
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Dia Diagnosis gnosis

  • Head injury with concussion, secondary brady-

asystole and spontaneous recovery

  • Profound vasovagal syncope with prolonged

cerebral hypoperfusion in context of acidosis/dehydration

  • Cardiac rhythm disturbance, secondary to…
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Cer Cerebr bral al Hypop Hypoperfusion erfusion

Volume depletion Vasodilation Heat ADP Acidosis Reduced Activity from Muscle Pump Empty LV Increased Mechano- receptor activity

Altered Neuro-cardiogenic reflexes ? Potentiated by sudden withdrawal of sympathetic tone

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Ref efer erred ed to Lo to Lond ndon

  • n Spo

Sports ts Car Cardiolog diology y Cen Centr tre

  • ECG
  • Echo
  • 24h tape
  • ETT (supervised)
  • Bloods: Total cholesterol 4.0, TG 0.59, HDL 1.8,

LDL 1.9

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SLIDE 14
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SLIDE 15

Results esults

  • 24h tape:

– 8x VEs – variable morphologies, occasional AEs, short episodes atrial bigeminy

  • ETT:

– 15min34 Bruce protocol on treadmill, achieved 98% max HR at a workload of 18 METS. Test terminated due to fatigue and lightheadedness. Isolated PVCs with one couplet. No significant ST

  • changes. Marked drop in BP in initial recovery.
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ETT ETT

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ETT ETT

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ETT ETT

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ETT ETT

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ETT ETT

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ETT ETT

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ETT ETT

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ETT ETT

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Wha hat ne t next?.... xt?....

  • A) Do nothing, discharge
  • B) CT coronary angiogram
  • C) Coronary angiogram
  • D) Cardiac MRI
  • E) B±C & D
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SLIDE 27
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CMR CMR

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CMR CMR

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Dia Diagnosis gnosis

  • Primary myocardial pathology resulting in

compromising ventricular arrhythmia (e.g. cardiac sacoidosis) and IHD incidental

  • Ischaemia-perfusion demand mismatch

driving compromising ventricular arrhythmia and resultant hypoperfusion myocardial infarction

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Findings Findings

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Lear Learning ning points points

  • 1
  • 2
  • 3
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  • 1. R
  • 1. Red

ed Fla lags gs in Ath in Athlete letes s with with Syn Synco cope pe

  • Age > 45 years old
  • Syncope whilst lying supine or syncope without warning
  • Chest pain, palpitation, headache, transient seizure like activity.
  • New or unexplained breathlessness
  • Known history of cardiovascular disease
  • Family history of premature SCD
  • Cardiac murmur/ focal neurology
  • Abnormal ECG
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2.

  • 2. SCD/SC

SCD/SCA A and endur and endurance r ance running unning

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2.

  • 2. SCD/SC

SCD/SCA A and endur and endurance r ance running unning

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3.

  • 3. Pitf

Pitfalls alls of

  • f the ET

the ETT

  • If asymptomatic, ETT drops to

Sens 46% Spec 16%

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  • 3. P
  • 3. Pitf

itfalls alls of

  • f the

the ETT ETT - Isc Ischa haemia emia Cas Casca cade de

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Thank hank you

  • u