Management of mature athletes with cardiovascular conditions

Are the Cardiovascular Benefits and Potential Risks of Physical Activity and Exercise Dependent on Race, Ethnicity, or Sex?

Physical activity (PA) is established as a cornerstone of cardiovascular health, however, disparities in participation exist across sociocultural groups, which in turn affect cardiovascular outcomes. Evidence suggests that although the positive cardiovascular effects of exercise are consistent across populations, notable differences in the magnitude of these benefits exist for racial and ethnic minorities and the female sex. Women derive greater protection from PA compared with men, with reduced rates of sudden cardiac death. In this review we examine the complex interplay of race and/or ethnicity and sex on the cardiovascular benefits associated with PA and exercise, cardiovascular adaptations to exercise, risks of sudden cardiac death, and "excessive" volume of exercise. Understanding these factors is crucial for developing targeted interventions to promote cardiovascular health and offset disparities.

The masters athlete and use of antihypertensive medications

Hypertension is the most common cardiovascular condition in recreational athletes, especially older (masters) athletes. The interacting effects of hypertension, cardiac adaptation to endurance training, and antihypertensive medications on exercise performance are complex and of relevance to athletes, trainers, and health care providers. Cardiac adaptations occur in response to aging and endurance training, and findings may overlap with pathologic cardiac remodeling. This review summarizes the influence of antihypertensive medications on exercise performance, which can include both hemodynamic and metabolic effects, and includes practical considerations in choice of antihypertensive agent for the masters endurance athlete. Whereas the overriding priority for choice of antihypertensive is control of hypertension and improving clinical outcomes, other considerations regarding effects on exercise performance may also influence the choice of agent.

The role of cardiac computed tomography in pre-participation screening of mature athletes

The overwhelming majority of sports-related sudden cardiac deaths in mature athletes is attributed to coronary artery disease (CAD). Coronary plaques of mature athletes appear to be more calcified compared to sedentary individuals and thus may be more stable and less likely to be associated with an acute coronary event. Cardiac computed tomography (CT), including unenhanced CT for coronary artery calcium scoring (CACS) and contrast-enhanced coronary CT angiography, is characterized by very high negative predictive value to rule out CAD. Cardiac CT has been shown to have additional diagnostic value for detection of CAD in athletes over and above exercise electrocardiogram. Moreover, measurement of CACS possibly enables a more precise cardiovascular risk stratification of mature athletes. The main advantage of cardiac CT is its noninvasive nature. Although cardiac CT appears to increase the overall cost of cardiac examinations, this additional cost is much lower than the cost of unnecessary invasive coronary angiographies that would be performed in case of false positive results of exercise electrocardiograms. Radiation exposure may not be a major concern for the application of this modality to pre-participation screening of athletes, since recent technical advancements have resulted in low radiation dose of cardiac CT.Highlights Coronary computed tomography angiography can be used in pre-participation screening of mature athletes to increase the negative predictive value for excluding coronary artery disease.The identification of coronary artery calcium score = 0 in an athlete can improve risk stratification, since this athlete can be reasonably managed as an individual with low cardiovascular risk.

The Female Athlete's Heart: Overview and Management of Cardiovascular Diseases

The number of female athletes taking part in elite and amateur sport is ever increasing. In contrast with male athletes, few studies have focused on cardiovascular adaptations to exercise in women, the effects of lifelong exercise on heart muscle and electrical tissue, the risk of exerciserelated sudden cardiac death and the management of cardiovascular disease. Women have a lower prevalence of large QRS complexes, repolarisation changes including inferior and lateral T-wave inversion, and cardiac dimensions exceeding predicted limits compared with men. The risk of exercise-related sudden cardiac death is significantly lower in women than men. Also, women who have engaged in lifelong exercise do not have a higher prevalence of AF, coronary artery calcification or myocardial fibrosis than their sedentary counterparts. Apart from providing an overview of the existing literature relating to cardiac adaptations, this review explores possible reasons for the sex differences and focuses on the management of cardiovascular disorders that affect female athletes.

Abnormal ECG Findings in Athletes: Clinical Evaluation and Considerations

PURPOSE OF REVIEW

Pre-participation cardiovascular evaluation with electrocardiography is normal practice for most sporting bodies. Awareness about sudden cardiac death in athletes and recognizing how screening can help identify vulnerable athletes have empowered different sporting disciplines to invest in the wellbeing of their athletes.

RECENT FINDINGS

Discerning physiological electrical alterations due to athletic training from those representing cardiac pathology may be challenging. The mode of investigation of affected athletes is dependent on the electrical anomaly and the disease(s) in question. This review will highlight specific pathological ECG patterns that warrant assessment and surveillance, together with an in-depth review of the recommended algorithm for evaluation.