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Han iniciado los Juegos Olímpicos y con ello todo el mundo vuelve la vista hacia Londres. La medicina del deporte es una actividad llena de sorpresas y de retos de la que poco conocemos. Durante estos días de competencias intenacionales Anestesiología y Medicina del Dolor estará enviando algunos artículos interesantes relacionados con patologías propias de los atletas con el objetivo de llevarle información que le pueda ser de utilidad en el manejo integral de sus futuros pacientes.
The Olympic Games have begun and with it, the whole world looks back to London. Sports medicine is an activity full of surprises and challenges that we know little. During these days of world sports competition, Anestesiología y Medicina del Dolor will be sending some interesting articles related to pathologies of the athletes with the goal of bringing information that may be useful in the comprehensive management of some of your future patients.
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| El riesgo de los deportes: ¿Necesitamos una investigación pre-participación de los deportistas competitivos y de los ociosos? |
Risk of sports: do we need a pre-participation screening for competitive and leisure athletes?
Corrado D, Schmied C, Basso C, Borjesson M, Schiavon M, Pelliccia A, Vanhees L, Thiene G.
Department of Cardiac, Thoracic and Vascular Science, University of Padua Medical School, Via Giustiniani, 2-35121 Padova, Italy.domenico.corrado@unipd.it
Eur Heart J. 2011 Apr;32(8):934-44. Epub 2011 Jan 29.
Abstract
Sudden cardiac arrest is most often the first clinical manifestation of an underlying cardiovascular disease and usually occurs in previously asymptomatic athletes. The risk benefit ratio of physical exercise differs between young competitive athletes and middle-age/senior individuals engaged in leisure-time sports activity. Competitive sports are associated with an increase in the risk of sudden cardiovascular death (SCD) in susceptible adolescents and young adults with underlying cardiovascular disorders. In middle-age/older individuals, physical activity can be regarded as a 'two-edged sword': vigorous exertion increases the incidence of acute coronary events in those who did not exercise regularly, whereas habitual physical activity reduces the overall risk of myocardial infarction and SCD. Although cardiovascular pre-participation evaluation offers the potential to identify athletes with life-threatening cardiovascular abnormalities before onset of symptoms and may reduce their risk of SCD, there is a significant debate among cardiologists about efficacy, impact of false-positive results and cost-effectiveness of routine screening. This review presents an appraisal of the available data and criticisms concerning screening programmes aimed to prevent SCD of either young competitive athletes or older individuals engaged in leisure-time sports activity.
http://eurheartj.oxfordjournals.org/content/32/8/934.long
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| Muerte cardiaca súbita en los atletas: revisión sistemática. |
Sudden cardiac death athletes: a systematic review.
Ferreira M, Santos-Silva PR, de Abreu LC, Valenti VE, Crispim V, Imaizumi C, Filho CF, Murad N, Meneghini A, Riera AR, de Carvalho TD, Vanderlei LC, Valenti EE, Cisternas JR, Moura Filho OF, Ferreira C.
Departamento de Clínica Médica, Disciplina de Cardiologia, Núcleo de Saúde no Esporte, Faculdade de Medicina do ABC, Santo André, SP, Brasil. celsoferreira.dmed@epm.br.
Sports Med Arthrosc Rehabil Ther Technol. 2010 Aug 3;2:19.
Abstract
Previous events evidence that sudden cardiac death (SCD) in athletes is still a reality and it keeps challenging cardiologists. Considering the importance of SCD in athletes and the requisite for an update of this matter, we endeavored to describe SCD in athletes. The Medline (via PubMed) and SciELO databases were searched using the subject keywords "sudden death, athletes and mortality". The incidence of SCD is expected at one case for each 200,000 young athletes per year. Overall it is resulted of complex dealings of factors such as arrhythmogenic substrate, regulator and triggers factors. In great part of deaths caused by heart disease in athletes younger than 35 years old investigations evidence cardiac congenital abnormalities. Athletes above 35 years old possibly die due to impairments of coronary heart disease, frequently caused by atherosclerosis. Myocardial ischemia and myocardial infarction are responsible for the most cases of SCD above this age (80%). Pre-participatory athletes' evaluation helps to recognize situations that may put the athlete's life in risk including cardiovascular diseases. In summary, cardiologic examinations of athletes' pre-competition routine is an important way to minimize the risk of SCD.
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| Incidencia y etiología de la muerte cardiaca súbita en atletas jóvenes: perspectiva internacional |
Incidence and aetiology of sudden cardiac death in young athletes: an international perspective.
Borjesson M, Pelliccia A.
SU/Ostra, Sahlgrenska Academy, Goteborg University, Goteborg, Sweden.mats.brjesson@telia.com
Br J Sports Med. 2009 Sep;43(9):644-8.
Abstract
The incidence of sudden cardiac death (SCD) among young athletes is estimated to be 1-3 per 100,000 person years, and may be underestimated. The risk of SCD in athletes is higher than in non-athletes because of several factors associated with sports activity that increase the risk in people with an underlying cardiovascular abnormality. A clear gender difference in the incidence of SCD exists in young athletes, with the risk in male athletes being up to 9 times higher than in female athletes. The most common causes of SCD in young athletes is underlying inherited/congenital cardiac disease, such as cardiomyopathies, congenital coronary anomalies and ion channelopathies. Blunt chest trauma also may cause ventricular fibrillation in a structurally normal heart, known as commotio cordis. Although geographical differences in the causes of SCD in young athletes have been reported, these disparities are more likely to be related to the type and implementation of pre-participation screening leading to the identification of athletes at risk, rather than reflecting a truly different ethiology. More studies are needed to clarify the role of ethnicity in the prevalence of diseases known to cause SCD in young athletes.
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