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Alexandre A, Vieira P, Dias-Frias A, Pereira A, Campinas A, Sá-Couto D, Brochado B, Sá I, Silveira J, Torres S. Myocardial Bridging Leading to Cardiac Collapse in a Marathon Runner. J Cardiovasc Dev Dis 2022; 9:jcdd9070200. [PMID: 35877561 PMCID: PMC9317123 DOI: 10.3390/jcdd9070200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 02/01/2023] Open
Abstract
Myocardial bridging (MB) is a congenital coronary anomaly, which is defined as cardiac muscle overlying a portion of a coronary artery. Although traditionally considered benign in nature, increasing attention is being given to specific subsets of MB. Sports medicine recognizes MB as a cause of sudden death among young athletes. We present a case of a 30-year-old man who suddenly collapsed during a marathon running. Diagnostic workup with coronary computed tomography angiography revealed the presence of three simultaneous myocardial bridges in this patient, possibly explaining the exercise-induced syncope. The other diagnostic tests excluded seizures, cranioencephalic lesions, ionic or metabolic disturbances, acute coronary syndromes, cardiomyopathies, myocarditis, or conduction disturbances. Exertional syncope is a high-risk complaint in the marathon runner. In the context of intense physical activity, the increased sympathetic tone leading to tachycardia and increased myocardial contractility facilitates MB ischemia. In this illustrative case, the patient’s syncope might probably be associated with an ischemia-induced arrhythmia secondary to MB and potentiated by dehydration in the context of prolonged stress (marathon running). In conclusion, this case highlights that MB may be associated with dangerous complications (myocardial ischemia and life-threatening ventricular arrhythmias), particularly during intense physical activity and in the presence of a long myocardial bridge.
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Affiliation(s)
- André Alexandre
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
- Correspondence: or
| | - Pinheiro Vieira
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - André Dias-Frias
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
| | - Anaisa Pereira
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
| | - Andreia Campinas
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - David Sá-Couto
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - Bruno Brochado
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - Isabel Sá
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
| | - João Silveira
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - Severo Torres
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
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Hosatte‐Ducassy C, Correa JA, Lalonde F, Mohindra R, Marton G, Chetrit M, Marcotte A, Tournoux F, Bridges E. Electrocardiographic changes after completion of a triathlon. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - José A. Correa
- Department of Mathematics and Statistics McGill University Montreal QC Canada
| | - François Lalonde
- Département de cardiologie Axe cardio‐métabolique Centre de Recherche du Centre Hospitalier de l'Université de Montréal Montréal QC Canada
- Département des sciences de l'activité physique Faculté des sciences Université du Québec à Montréal Montréal QC Canada
| | - Rohit Mohindra
- Department of Emergency Medicine McGill University Health Center Montreal QC Canada
| | - Gregory Marton
- Department of Emergency Medicine McGill University Health Center Montreal QC Canada
| | - Michael Chetrit
- Department of Cardiology McGilll University Health Center Montreal QC Canada
| | - Audrey Marcotte
- Department of Emergency Medicine McGill University Health Center Montreal QC Canada
| | - François Tournoux
- Département de cardiologie Axe cardio‐métabolique Centre de Recherche du Centre Hospitalier de l'Université de Montréal Montréal QC Canada
| | - Eileen Bridges
- Department of Emergency Medicine McGill University Health Center Montreal QC Canada
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Sousa H, Casanova J. Coronary artery abnormalities: Current clinical issues. Rev Port Cardiol 2018; 37:227-235. [DOI: 10.1016/j.repc.2017.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/18/2017] [Accepted: 06/20/2017] [Indexed: 11/25/2022] Open
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Sousa H, Casanova J. Coronary artery abnormalities: Current clinical issues. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Wijnberg I, Franklin S. The heart remains the core: cardiac causes of poor performance in horses compared to human athletes. COMPARATIVE EXERCISE PHYSIOLOGY 2017. [DOI: 10.3920/cep170012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiac remodelling occurs in response to exercise and is generally beneficial for athletic performance due to the increase in cardiac output. However, this remodelling also may lead to an increased prevalence of cardiac murmurs and arrhythmias. In most cases, these are not considered to be significant. However, in some cases, there may be potentially deleterious consequences. Whilst sudden cardiac death (SCD) is a rare occurrence, the consequences are catastrophic for both the horse and potentially the rider or driver. Furthermore, the sudden death of a horse in the public arena has negative connotations in regards to public perception of welfare during equestrian sports. Prediction of which individuals might be susceptible to potential deleterious effects of exercise is a focus of interest in both human and equine athletes but remains a challenge because many athletes experience cardiac murmurs and exercise-induced arrhythmias that are clinically irrelevant. This review summarises the effects of exercise on cardiac remodelling in the horse and the potential effects on athletic performance and SCD. The use of biomarkers and their future potential in the management of athletic horses is also reviewed.
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Affiliation(s)
- I.D. Wijnberg
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584 CM, Utrecht, the Netherlands
| | - S.H. Franklin
- Equine Health and Performance Centre, School of Animal and Veterinary Science, University of Adelaide, SA 5005, Australia
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Navas de Solis C. Exercising arrhythmias and sudden cardiac death in horses: Review of the literature and comparative aspects. Equine Vet J 2016; 48:406-13. [DOI: 10.1111/evj.12580] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 03/28/2016] [Indexed: 12/25/2022]
Affiliation(s)
- C. Navas de Solis
- Swiss Institute of Equine Medicine; Faculty of Veterinary Science (Vetsuisse); University of Bern and Agroscope; Bern Switzerland
- Texas Veterinary Medical Center; Texas A&M University; College Station USA
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Kaiser-Nielsen LV, Tischer SG, Prescott EB, Rasmusen HK. Symptoms, diagnoses, and sporting consequences among athletes referred to a Danish sports cardiology clinic. Scand J Med Sci Sports 2015; 27:115-123. [PMID: 26661094 DOI: 10.1111/sms.12624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 12/28/2022]
Abstract
As the number of recreational athletes performing exercise and participating in competitions at a high-level increases, exercise-induced cardiac symptoms may become a more common problem, not least because recreational athletes often continue high-level exercise programs into advanced ages. We investigated the prevalence of cardiac symptoms and diagnoses among 201 athletes referred for cardiac evaluation at a Sports Cardiology Clinic in Denmark. To our knowledge, this is the first systematic study of athletes referred for suspected cardiac disease. The athletes were all well-trained recreational to elite athletes who participated in various sports with different training loads and a wide age span (13-66 years). All patients were referred by physicians, primarily their general practitioner (38%), and palpitations were the most common cardiac symptom (40%). Cardiac symptoms had a sensitivity of 86% in detecting cardiac disease and a specificity of 13%. Cardiac disease was diagnosed in 44% of the patients, and atrial fibrillation was the most prevalent diagnosis (7.5%). Cardiac diseases with therapeutic- or sports-related consequences for the patients were diagnosed in 28% of the population, but only 1% received a recommendation to avoid high-level sports indefinitely.
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Affiliation(s)
- L V Kaiser-Nielsen
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University, Copenhagen, Denmark
| | - S G Tischer
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University, Copenhagen, Denmark
| | - E B Prescott
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University, Copenhagen, Denmark
| | - H K Rasmusen
- Department of Cardiology, Bispebjerg Hospital, Copenhagen University, Copenhagen, Denmark
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Statuta S, Mistry DJ, Battle RW. The Impact of Sports Cardiology on the Practice of Primary Care Sports Medicine: Where Were We, Where Are We, Where Are We Headed? Clin Sports Med 2015; 34:381-90. [PMID: 26100416 DOI: 10.1016/j.csm.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article is a commentary on the role of sports cardiologists in the athletic arena and the beneficial impact they offer sports medicine in the comprehensive care of competitive athletes. The focus is a dialogue on current recommendations for primary prevention of sudden cardiac arrest (SCA), incorporating elements of the preparticipation evaluation and continuing care of athletes with diagnosed heart disease (HD). The feasibility and potential advantages of implementing well-designed preparticipation cardiovascular screening programs and the role of sports cardiologists to educate primary care team physicians on secondary prevention of SCA and proper treatment of underlying HD are discussed.
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Affiliation(s)
- Siobhan Statuta
- UVA Division I Athletic Programs, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908-0158, USA
| | - Dilaawar J Mistry
- Department of Physical Medicine and Rehabilitation, Western Orthopedics and Sports Medicine, 2373 G Road, Suite 100, Grand Junction, CO 81505, USA; Department of Physical Medicine and Rehabilitation, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908-0158, USA.
| | - Robert W Battle
- UVA Division I Athletic Programs, Division of Cardiology, University of Virginia Health System, PO Box 800158, Charlottesville, VA 22908-0158, USA
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Martinez MW. Advanced Imaging of Athletes: Added Value of Coronary Computed Tomography and Cardiac Magnetic Resonance Imaging. Clin Sports Med 2015; 34:433-48. [PMID: 26100420 DOI: 10.1016/j.csm.2015.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cardiac magnetic resonance imaging and cardiac computed tomographic angiography have become important parts of the armamentarium for noninvasive diagnosis of cardiovascular disease. Emerging technologies have produced faster imaging, lower radiation dose, improved spatial and temporal resolution, as well as a wealth of prognostic data to support usage. Investigating true pathologic disease as well as distinguishing normal from potentially dangerous is now increasingly more routine for the cardiologist in practice. This article investigates how advanced imaging technologies can assist the clinician when evaluating all athletes for pathologic disease that may put them at risk.
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Affiliation(s)
- Matthew W Martinez
- Division of Cardiology, Lehigh Valley Health Network, 1250 South Cedar Crest Boulevard, Suite 300, Allentown, PA 18103, USA.
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Nickel T, Emslander I, Sisic Z, David R, Schmaderer C, Marx N, Schmidt-Trucksäss A, Hoster E, Halle M, Weis M, Hanssen H. Modulation of dendritic cells and toll-like receptors by marathon running. Eur J Appl Physiol 2011; 112:1699-708. [PMID: 21881949 DOI: 10.1007/s00421-011-2140-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 08/18/2011] [Indexed: 12/11/2022]
Abstract
The focus of this study was to assess exercise-induced alterations of circulating dendritic cell (DC) subpopulations and toll-like receptor (TLR) expression after marathon running. Blood sampling was performed in 15 obese non-elite (ONE), 16 lean non-elite (LNE) and 16 lean elite (LE) marathon runners pre- and post-marathon as well as 24 h after the race. Circulating DC-fractions were measured by flow-cytometry analyzing myeloid DCs (BDCA-1+) and plasmacytoid DCs (BDCA-2+). We further analyzed the (TLR) -2/-4/-7 in peripheral blood mononuclear cells (rt-PCR/Western Blot) and the cytokines CRP, IL-6, IL-10, TNF-α and oxLDL by ELISA. After the marathon, BDCA-1 increased significantly in all groups [LE (pre/post): 0.35/0.47%; LNE: 0.26/0.50% and ONE: 0.30/0.49%; all p < 0.05]. In contrast, we found a significant decrease for BDCA-2 directly after the marathon (LE: 0.09/0.01%; LNE: 0.12/0.03% and ONE: 0.10/0.02%; all p < 0.05). Levels of TLR-7 mRNA decreased in all groups post-marathon (LE 44%, LNE 67% and ONE 52%; all p < 0.01), with a consecutive protein reduction (LE 31%, LNE 52%, ONE 42%; all p < 0.05) 24 h later. IL-6 and IL-10 levels increased immediately after the run, whereas increases of TNF-α and CRP-levels were seen after 24 h. oxLDL levels remained unchanged post-marathon. In our study population, we did not find any relevant differences regarding training level or body weight. Prolonged endurance exercise induces both pro- and anti-inflammatory cytokines. Anti-inflammatory cytokines, such as IL-10, may help to prevent excessive oxidative stress. Marathon running is associated with alterations of DC subsets and TLR-expression independent of training level or body weight. Myeloid and plasmacytoid DCs are differently affected by the excessive physical stress. Immunomodulatory mechanisms seem to play a key role in the response and adaptation to acute excessive exercise.
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Affiliation(s)
- Thomas Nickel
- Medizinische Klinik und Poliklinik 1, Campus Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistr 15, 81377 Munich, Germany.
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