Clinical Dilemma - Cardiac Memory vs Myocardial Ischemia.

Cardiac memory (CM) is a commonly unrecognized entity in which electrocardiograph (EKG) changes demonstrate T wave inversions (TWI) that appear consistent with ischemia. Inability to recognize and distinguish CM from actual ischemia can be a burden for both patients and hospitals, leading to unnecessary hospital admission, cardiac testing, and cardiac catheterization. Simple EKG analysis and meticulous interpretation of T-wave axis and morphology can help differentiate between the two.

A covert complication of arteriovenous fistulas.

Our patient is a 65-year-old man with a history of hypertension, aortic stenosis, and end-stage renal disease on hemodialysis who presented with worsening dyspnea. On examination, he exhibited signs of volume overload and had a radiocephalic arteriovenous fistula (AVF) with a significantly palpable thrill. Coronary angiogram showed normal coronary arteries.

Reliability and validity of clinician ECG interpretation for athletes.

Background: Electrocardiogram (ECG) with preparticipation evaluation (PPE) for athletes remains controversial in the United States and diagnostic accuracy of clinician ECG interpretation is unclear. This study aimed to assess reliability and validity of clinician ECG interpretation using expert-validated ECGs according to the 2010 European Society of Cardiology (ESC) interpretation criteria.

Methods: This is a blinded, prospective study of diagnostic accuracy of clinician ECG interpretation.

Atypical stress-induced cardiomyopathy: a case series.

Stress-induced cardiomyopathy (SIC) is characterized by reversible left ventricular (LV) systolic dysfunction, which appears to be triggered by an intense, stressful event in the absence of significant coronary artery disease. It manifests typically with transient left ventricular wall motion abnormalities (WMA) involving the apical and/or mid-ventricular myocardial segments, associated with minimal troponin rise (<5 ng/ml), and typical EGG changes. Described are 3 cases of stress-induced cardiomyopathy with atypical distribution of wall motion abnormalities.

Practical management: a systematic approach to the evaluation of exercise-related syncope in athletes.

Syncope and presyncope are relatively common presentations among athletes. The distinction between post-exercise and during-exercise syncope is critically important. While the great majority of these episodes occur just after exercise and are benign, syncope can be an indication of serious underlying cardiovascular disease if it occurs during exercise.

The athletic preparticipation evaluation: cardiovascular assessment.

Thousands of young athletes receive preparticipation evaluations each year in the United States. One objective of these evaluations is to detect underlying cardiovascular abnormalities that may predispose an athlete to sudden death. The leading cardiovascular causes of sudden death in young athletes include hypertrophic cardiomyopathy, congenital coronary artery anomalies, repolarization abnormalities, and Marfan syndrome.

Hypertension, athletes, and the sports physician: implications of JNC VII, the Fourth Report, and the 36th Bethesda Conference Guidelines.

Over the past decade, numerous studies have contributed to a growing evidence-based recommendation that the prevention, diagnosis, and management of hypertension can significantly lower cardiovascular morbidity and mortality. Several leading guidelines have been updated recently. Because hypertension is a common cardiovascular disease in athletes, sports medicine providers must remain vigilant in diagnosing this disorder and current with treatment and participation recommendations.

A pilot study of clinical agreement in cardiovascular preparticipation examinations: how good is the standard of care?

Objective: To evaluate the interobserver agreement between physicians regarding a abnormal cardiovascular assessment on athletic preparticipation examinations.

Design: Cross-sectional clinical survey.

Setting: Outpatient Clinic, United States Military Academy, West Point, NY.

Electrocardiographic findings in sports medicine: normal variants and the ones that should not be missed.

There are a few "red flag" findings in the history and physical examination of an athlete that may require obtaining an electrocardiogram (ECG) as part of a cardiac evaluation. In this article we discuss the normal variants seen in the ECG brought on by regular physical training and ECG abnormalities that are seen with a few of the structural and conduction abnormalities associated with an increased risk of sudden cardiac death. These conditions are all relatively uncommon and the ECG may reveal the first clue to the presence of a potentially significant underlying abnormality.

Sudden cardiac death: ethical considerations in the return to play.

The team physician-athlete relationship prompts many basic questions in medical ethics. Return-to-play decisions form many of the core responsibilities facing team physicians, and occasionally these decisions can have overriding ethical dilemmas. Therefore, a structured ethical decision-making process is a valuable skill for every successful sports medicine physician.

Diagnosis and management of myocarditis in athletes.

Myocarditis is a pathologic entity that has serious potential consequences for competitive athletes. Myocarditis is an inflammation of the myocardium accompanied by myocellular necrosis. Cardiotropic viruses, in particular the Coxsackie B virus, have been implicated as the most common cause of acute myocarditis in the United States.

Asymptomatic Aortic Insufficiency in a Runner.

In brief The case of an asymptomatic 21-year-old male college sprinter demonstrates that aortic insufficiency may go undiagnosed despite severe underlying cardiac pathology: A murmur detected during the preparticipation exam was the first sign. Activity modification was an important initial intervention. Echocardiography documented severe aortic regurgitation.