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sports cardiology

Life saved in semi final of SAFF Championship 2013 by FIFA-supplied AED (FMEB – FIFA Medical Emergency Bag)

11 Sep, 13 | by Karim Khan

Preventing sudden cardiac death was a critical forum topic at the 2012 FIFA Medical Conference in Budapest.  Advocates argued that pitch-side automated external defibrillators (AED) be required at FIFA competitions all over the world. In the last 5 years, only 24 of 84 football players who suffered cardiac arrest survived. Tragically, there was no AED available at the stadium in 80% of cases. 

So what happened next – what ACTION was taken?

We are delighted to share this good news story, this GREAT news story forwarded via email to us by Jiří Dvořák (FIFA Chief Medical Officer, Chairman F-MARC, BJSM co-author of: Consensus statement: The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: setting a global standard and promoting consistent football field emergency care)     

Dear Dr. Jiri,

Wanted to inform you that in Kathmandu, Nepal during a semi final match of SAFF Championship 2013 between Nepal and Afghanistan on 8th September 2013 one player of the Afghanistan team, had a minor cardiac arrest. His life was saved due to timely intervention of competition doctor Dr. Binmra Bista. He used the FIFA-supplied AED to successfully revive the player and then quickly shifted to hospital within the span of 3-4 minutes. In hospital all tests were carried out and the tests reports were normal.

I spoke to Dr. Bista after the end of the match, he used the AED for the first time and he also thanked FIFA for supplying AEDs. It was a great experience for this doctor and he was very quick sense the real problem and thus he ended up using  the AED.

I think tomorrow you might be able to read some news stories on this.

Thanks and best regards,

shaji

Shaji Prabhakaran, Regional Development Officer at FIFA

Remember that BJSM has published theme issues on Sports Cardiology including screening and prevention of sudden cardiac death (November 2012 and February 2013). The AMSSM and FIFA collaborated on an ECG interpretation module hosted by BMJ Learning

AMSSM Module

 

Register now! Prevention of Sudden Cardiac Death in the Young. CME course (January 17 & 18, 2013)

3 Dec, 12 | by Karim Khan

Nick of Time Foundation invites you to a continuing medical education course (CME) titled “Prevention of Sudden Cardiac Death in the Young” to be held at the Fairmont Olympic Hotel in Seattle, WA on January 17 & 18, 2013.

Sponsored by the University of Washington School of Medicine, Dept. of Family Medicine and Office of Continuing Medical Education. In Collaboration with: Parent Heart Watch and the American Medical Society for Sports Medicine.

Who Should Attend?

Primary care providers – including family physicians, pediatricians, internists, nurse practitioners, and physician assistants – as well as sports medicine physicians, cardiologists and others who conduct pre-participation sports physicals or have an interest in cardiovascular disease in athletes or children and preventing sudden death.

Course Objectives

At the conclusion of this activity, participants should be able to:

  • Define the leading causes of sudden cardiac death (SCD) in children and young athletes
  • Recognize warning symptoms and physical examination findings suggestive of intrinsic cardiovascular disease in the young
  • Describe the added value of electrocardiogram (ECG) as a screening and diagnostic tool in the cardiovascular care of young athletes
  • Apply specific ECG criteria for distinguishing physiologic adaptations in athletes from abnormal ECG findings associated with conditions at risk for sudden death
  • Outline the appropriate evaluation of abnormal ECG findings and the management of identified cardiac disorders

Follow the link for more course and registration details:  http://depts.washington.edu/cme/live/

Register early as space is limited!

 

Advances in Sports Cardiology supplement: 17 terrific open access articles!

30 Oct, 12 | by Karim Khan

17 fantastic articles from leading experts comprise BJSM’s Advances in Sports Cardiology supplement. From:

…Hot debates in US vs European approaches…

Ventricular arrhythmias, stress, and adaptations associated with endurance sports athletes …

To… Peripheral vascular structure and function in hypertrophic cardiomyopathy…

This supplement is packed with variety and quality.

What’s more — all articles are open access (thanks to Aspetar Hospital, Doha, Qatar).

and they are available online now.

Check it out here, or via the links below.

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Editorials

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Advancing sports cardiology: blue sky thinking in Qatar. Bruce Hamilton, Mathew G Wilson, Hakim Chalabi. Br J Sports Med 2012;46 i1 Open Access

Sports cardiology: current updates and new directions. Mathew G Wilson, Jonathan A Drezner. Br J Sports Med 2012;46 i2-i4 Open Access

Cardiac screening: time to move forward! Mats Borjesson, Jonathan Drezner. Br J Sports Med 2012;46 i4-i6 Open Access

Standardised criteria for ECG interpretation in athletes: a practical tool. Jonathan A Drezner. Br J Sports Med 2012;46 i6-i8 Open Access

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Current updates

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Debate: challenges in sports cardiology; US versus European approaches. Bruce Hamilton, Benjamin D Levine, Paul D Thompson, Gregory P Whyte, Mathew G Wilson Br J Sports Med 2012;46 i9-i14 Open Access

Aetiology of sudden cardiac death in sport: a histopathologist’s perspective. Mary N Sheppard Br J Sports Med 2012;46 i15-i21 Open Access

Impact of ethnicity upon cardiovascular adaptation in competitive athletes: relevance to preparticipation screening. Michael Papadakis, Mathew G Wilson, Saqib Ghani, Gaelle Kervio, Francois Carre, Sanjay Sharma. Br J Sports Med 2012;46 i22-i28 Open Access

The endurance athletes heart: acute stress and chronic adaptation. Keith George, Greg P Whyte, Danny J Green, David Oxborough, Rob E Shave, David Gaze, John Somauroo Br J Sports Med 2012;46 i29-i36 Open Access

Atrial fibrillation and atrial flutter in athletes. Naiara Calvo, Josep Brugada, Marta Sitges, Lluis MontBr J Sports Med 2012;46 i37-i43 Open Access

Ventricular arrhythmias associated with long-term endurance sports: what is the evidence? Hein Heidbuchel, David L Prior, Andre La Gerche. Br J Sports Med 2012;46 i44-i50 Open Access

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New directions

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Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: practical solutions for managing the diagnostic conundrum. M G Wilson, S Sharma, F Carre, P Charron, P Richard, R O’Hanlon, S KPrasad, H Heidbuchel, J Brugada, O Salah, M Sheppard, K P George, G Whyte, B Hamilton, H Chalabi. Br J Sports Med 2012;46 i51-i58 Open Access

Advising a cardiac disease gene positive yet phenotype negative or borderline abnormal athlete: Is sporting disqualification really necessary? Pascale Richard, Isabelle Denjoy, Veronique Fressart, Mathew G. Wilson, Francois Carre, Philippe Charron Br J Sports Med 2012;46 i59-i68 Open Access

Imaging focal and interstitial fibrosis with cardiovascular magnetic resonance in athletes with left ventricular hypertrophy: implications for sporting participation. Deirdre F Waterhouse, Tevfik F Ismail, Sanjay K Prasad, Mathew G Wilson, Rory O’Hanlon. Br J Sports Med 2012;46 i69-i77 Open Access

Performance enhancing drug abuse and cardiovascular risk in athletes: implications for the clinician. Peter J Angell, Neil Chester, Nick Sculthorpe, Greg Whyte, Keith George, John Somauroo. Br J Sports Med 2012;46 i78-i84 Open Access

Emergency cardiac care in the athletic setting: from schools to the Olympics. Brett Toresdahl, Ron Courson, Mats Borjesson, Sanjay Sharma, Jonathan Drezner. Br J Sports Med 2012;46 i85-i89 Open Access

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Original articles

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Do big athletes have big hearts? Impact of extreme anthropometry upon cardiac hypertrophy in professional male athletes. Nathan R Riding, Othman Salah, Sanjay Sharma, Francois Carre, Rory O’Hanlon, Keith P George, Bruce Hamilton, Hakim Chalabi, Gregory P Whyte, Mathew G Wilson. Br J Sports Med 2012;46 i90-i97 Open Access

Peripheral vascular structure and function in hypertrophic cardiomyopathy. Nicola Jayne Rowley, Daniel J Green, Keith George, Dick H J Thijssen, David Oxborough, Sanjay Sharma, John D Somauroo, Julia Jones, Nabeel Sheikh, Greg Whyte Br J Sports Med 2012;46 i98-i103 Open Access

 

Sudden Cardiac Arrest and Cardiac Screening: A trainee perspective

18 Oct, 12 | by Karim Khan

By  Dr. Khine Win 

Sport and Exercise Medicine: The UK trainee perspective (A twice-monthly Guest Blog)

I recently had the honour of assisting with cardiac screening in a dance company and an academy football team. I came across many concerned parents and athletes. Some refused to participate in screening tests.  Some even attempted to hide their family history, including a heart attack at a young age.

Saying a prayer: Owen Coyle, Darren Pratley, Dedryck Boyata and Ryo Miyaichi looks on as Fabrice Muamba lies on the floor after collapsing on the pitch. Photo: ACTION IMAGES

One of the parents had suffered a heart attack when he was 27 years old. He asked me when his son, who was 9 years old, would need to start screening. One parent also asked, since Fabrice Muamba underwent cardiac screening and still collapsed, how effective, really, are the screening processes.

If any of the results turned out to be abnormal, would the person be treated or protected from SCD?

Or would the club be informed of the results and the players be disqualified from their sport?

These were valid million-pound questions, which made me wonder.

I recalled my time at Liverpool Heart and Chest Hospital, when I was part of the team performing family screening for rare cardiac diseases. Even after extensive tests, some of the results remained uncertain, leading to psychological disturbances in patients. One of my patients with suspected Brugada syndrome told me that she had stopped doing anything physical because of the worry of sudden death.

As a Sport and Exercise Medicine trainee, managing “Sudden Cardiac Death” was one of the competencies in our training curriculum. I hope to have gained this competency through training, background reading and practical involvement. Notwithstanding, in ‘real world’ scenarios, many uncertainties still exist.

Background literature

Sudden Cardiac Death (SCD) or Sudden Cardiac Arrest (SCA) is defined as an event that is non-traumatic, unexpected, and resulting from sudden cardiac arrest within six hours of previously witnessed normal health without other explanation. (Sharma et al. BJSM 1997)

Common Etiology

The most common cause of SCA in older athletes (>35 years) is unsuspected coronary artery disease but in the younger group inherited or congenital cardiac disorders are more common. (Sharma et al. BJSM 2012)

Causes of SCA can be widely variable.

Inherited/Congenital causes

  1. Myocardial diseases (Hypertrophic Obstructive Cardiomyopathy, Arrthymogenic Right Ventricular Cardiomyopathy)
  2. Valvular diseases (such as Aortic root dilatation, aortic stenosis etc)
  3. Coronary artery pathologies (congenital anomalies, spasm, dissection, vasculitis etc)
  4. Conduction system (such as Wolff-Parkinson-White syndrome, long QT)
  5. Ion Channelopathies (eg: Brugada)

 

Acquired conditions (such as infection, myocarditis, drugs, electrolytes imbalance, blunt trauma etc)

Screening

In Italy, cardiac screening has been compulsory since 1982 in all athletes participating in competitive sports. To prevent one SCD, over 500 athletes are disqualified. Many other European countries also offer Cardiac screening but it is not compulsory. In the UK, screening for heart disease is still not fully funded in the NHS and is provided by charities such as Cardiac Risk in the Young (CRY)

FIFA made the pre-competition medical assessment mandatory for all FIFA competitions and recently initiated the establishment of a database for SCA/SCD for all 208 Member Associations to obtain more information. (Weiler et al. BJSM 2012)

SCA is rare but can be highly traumatic. It usually attracts a lot of media attention and may negatively impact the public view on sport and physical activity.

Improving Protocols

There is a need to establish a Central or National data registry on all SCA/SCD across sport and encourage research using this data to develop a robust and practical screening program.

Meanwhile it is essential to ensure the availability of defibrillators at all stadiums, accessibility of appropriately trained medical professionals across sport, and increasing public and athletes awareness and understanding on heart screening.

And finally pray that you never come across SCD/SCA in any sports team or sporting event that you cover throughout your career.

Related BJSM blogs

A South African Perspective on AEDs

Sudden Cardiac Death screening: notes of caution

Call for NHS to review its policy on screening of young people at risk of sudden cardiac death

ECG Summit in Seattle: Successes and Next Steps

References

  1. Ghani S, Sharma S: Pre-participation cardiovascular screening in athletes: when and how. Cardiovascular Medicine 2012;15(1):7–13
  2. Sharma S, Ghani S, Papadakis M. ESC criteria for ECG interpretation in athletes: improved but not replete. Heart. 2011;97:1540–1
  3. Weiler R, Goldstein MA, Beasley I, Drezner J, Dvorak J: What can we do to reduce the number of tragic cardiac events in sport? Br J Sports Med 2012 46: 897-898
  4. Thompson PD: Preparticipation Screening of competitive athletes Seeking simple solutions to a complex problem. Circulation. 2009;119:1072-1074

***************************************************

Dr. Khine Win is a Specialty Registrar in Sport and Exercise Medicine, West Midlands deanery.

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.

Call for NHS to review its policy on screening of young people at risk of sudden cardiac death

11 Apr, 12 | by Karim Khan

Guest blog by Dr Steven Cox (from CRY – Cardiac Risk in the Young

The UK’s National Health Service (NHS)  policy – that “screening should not be offered*”  is currently discouraging young people who may be at risk of sudden cardiac death from having simple, non-invasive and potentially life-saving tests.

The National Screening Committee need to review its position which is out of date

It is the view of the charity Cardiac Risk in the Young (CRY) that:

  • All young people (14-35 years old) should be offered the option to have cardiac screening
  • Cardiac testing should only be conducted by specialist cardiologists with the necessary skills and expertise to ensure accurate interpretation of the investigations.
  • The National Screening Committee policy should widen the remit to consider all cardiac conditions that can cause young sudden cardiac death
  • The National Screening Committee policy directly contradicts with the general NHS policy of “prevention”

Can anyone do these tests?

Cardiac screening needs to be overseen by a cardiologist with expertise in this specialist area of cardiology, including; athletes heart, ethnic differences in cardiac adaptation to exercise, and structural/electrical cardiac conditions. Professor Sanjay Sharma is a leading sports cardiologist and CRY’s consultant cardiologist who gives his time to oversee the CRY screening programme.

When a specialist cardiologist conducts the tests the number of false positives and false negatives significantly decrease (i.e. fewer people are told they may have a problem and are subjected to further investigations when they do not have a problem, and fewer people with a problem are given an all clear).

Could the NHS handle so many people wanting testing?

In the current economic era the answer is probably not. Moreover the NHS does not have the infrastructure, including the facilities or the expertise, to immediately implement a national screening programme for ALL young people.

However, CRY is leading the way in training specialist doctors, conducting research and providing educational resources so this will be possible in the future.

Although the implementation of nationwide screening is hampered at this point due to the economic constrains and lack of infrastructure and expertise that does not mean that screening should not be recommended. On the contrary, these limitations should prompt the development of a collaborative scheme between the Government, NHS, charity organisations such as CRY and sporting bodies to provide an initiative to offer cost effective screening.

Is there any evidence from other countries that screening is worthwhile?

In Italy where screening prior to participation in organised sport is mandatory they have reduced the incidence of young sudden cardiac death by 90%. This research has informed international policies that either mandate or recommend cardiac screening prior to participation in organised sport.

The current National Screening Policy is inconsistent with current practice at an elite level in most sports in the UK (including: the Football Association, Lawn Tennis Association, Rugby Football Union, Rugby Football League, Cricket, English Institute of Sport) and the fact that screening is often mandated for athletes when competing outside the UK.

Important Links

Support CRY’s epetition for the UK governement to change their policy on cardiac screening in young people here.

Learn more about the National Screening policy here 

Read Professor Sharma’s team’s response to the most recent National Screening Committee Review here [‘Unlocked’ courtesy of BMJ Group]

Follow CRY on twitter

*****************************************************

Dr Steven Cox is the Director of Screening and Deputy Chief Executive of CRY. Unit 7, Epsom Downs Metro Centre

Waterfield, Tadworth, Surrey.

 

Summit on Electrocardiogram (ECG) Interpretation in Athletes – Seattle, Feb 13-14, 2012

26 Jan, 12 | by Karim Khan

Guest blog by Jon Drezner, Sports Cardiology Senior Associate Editor

Photo by Andrew E. Larsen, Flickr cc

A Summit on Electrocardiogram (ECG) Interpretation in Athletes is being held in Seattle on February 13-14, 2012.  The meeting is sponsored by the American Medical Society for Sports Medicine (AMSSM) in partnership with the Pediatric & Congenital Electrophysiology Society (PACES), European Society of Cardiology Sports Cardiology Subsection, the British Journal of Sports Medicine, and the FIFA Medical Assessment and Research Center (F-MARC).  Seattle will host experts on ECG interpretation in athletes from the U.S., Italy, Sweden, U.K., Belgium, Switzerland, Qatar and Brazil.

Summit participants aim to:

  1. Define ECG interpretation standards in athletes and;
  2. Develop a comprehensive, freely-available online training module for physicians to gain a common foundation in ECG interpretation in athletes.

This educational resource will help physicians distinguish normal ECG variants in athletes from ECG patterns that suggest an underlying cardiac disorder.

This state of the art E-learning program will be hosted by BMJ Learning and will be accessible to any physician in the world with the aim of improving the cardiovascular care of athletes.

Participants include:

AMMSM:

Jonathan Drezner, MD  (Chair)

Jeff Anderson, MD

Chad Asplund, MD

John DiFiori, MD

Kim Harmon, MD

Stephen Paul, MD

ESC Sports Cardiology Section:

Mats Borjesson, MD

Domenico Corrado, MD, PhD

Hein Heidbuchel, MD

Antonio Pelliccia, MD

Sanjay Sharma, MD

PACES

Michael Ackerman, MD, PhD

Bryan Cannon, MD

Peter Fischbach, MD

Jack Salerno, MD

Other U.S. Cardiologists

Euan Ashley, MD

Aaron Baggish, MD

Vic Froelicher, MD

Joseph Marek, MD

David Owens, MD

Jordan Prutkin, MD

Victoria Vetter, MD

F-MARC (FIFA Medical Assessment and Research Centre)

Christian Schmied, MD

Qatar (Aspetar)

Mathew Wilson, PhD

Brazil

Ricardo Stein, MD, ScD


Related Publications:

Podcast:

Blogs:

Research into action – AED installed 3 months ago saves life!

17 Nov, 11 | by Karim Khan

Guest Blog by Jon Drezner – Sports Cardiology Senior Associate Editor

I heard some amazing news today and still gathering the details.  Last night at [anonymized] Middle School a 45 yo [anonymized] suffered sudden cardiac arrest during a basketball game.  Witnesses pulled the AED off the wall, delivered two shocks before EMS arrived, and the patient is alive and doing well today!

It is less than 3 months since the Heart of Seattle Schools project installed 136 AEDs into Seattle Public Schools, with at least one in every school.  This was our AED and administered by a school staff member for a member of our community… just how public access defibrillation programs are supposed to work.

From the beginning, University of Washington Medicine has played a major role in the success of this project and the safety of our community.  To think the benefit of this program has been realized so quickly!

Related Publications

Drezner, J, Harmon, K, and Borjesson, M. 2011. Incidence of sudden cardiac death in athletes: where did the science go? BJSM, 45: 947-948.

September 2009 BJSM – deals specifically with cardiac issues and the athlete

Blogs:

Dr. Jonathan Drezner is an Associate Professor of the Department of Family Medicine, Associate Director of the Sports Medicine Fellowship , and Team Physician for the Seattle Seahawks & UW Huskies.

Authoritative resource for sudden cardiac death – finally! Guest blog by Jon Drezner

9 Sep, 11 | by Karim Khan

iStockphoto.com/soupstock

Sudden Death in Young Adults (JACC 2011, 58:12),  has a wealth of information and will be an article  to reference for a long time.  Finally a large, systematic incidence and etiology study on sudden death in young adults with sound methodology, a defined population (military), mandatory reporting, and post-mortem protocols.

The authors openly question the ascertainment and referral bias of studies with ‘passive surveillance’ methods.  Almost all of the information on the etiology of SCD in young athletes in the U.S. comes from a single registry reporting that hypertrophic cardiomyopathy (HCM) is the leading cause of SCD.  Although competitive athletes may represent a different population, there is potential for ascertainment bias in any study without a systematic and/or mandatory identification of cases.

All other studies find autopsy-negative sudden unexplained death as the leading cause of SCD in young adults, and a proportion of HCM similar to this study (10-15%).  It is striking that sudden unexplained death represented 41% of the cases in this study.

The incidence of SCD in those <20 yo is alarming (3.25/100,000 or 1 in 30,000) and actually higher than we found in NCAA athletes (Circulation, 2011).  This increases to nearly 1 in 25,000 for <35 yo (exactly the incidence found in Italy in the same age range before more rigorous screening).  The authors also found a higher risk in African Americans who represented 15% of the study population but 33% of the SCD cases <35 yo (although the exact risk is not reported).  They include Wolff Parkinson White (WPW)  in the list of possibilities for sudden unexplained death — something I think may represent a higher proportion than we think – in addition to the ion channel disorders.  It is a little surprising to me they report no cases of aortic root dissection.  Also, only 7.5% of deaths due to sudden unexplained death had prodromal symptoms (within a week) of syncope or palpitations, and only 4.3% had chest pain or dyspnea. This provides powerful support of screening with more than just a history questionnaire if the intention is truly to identify those at risk.

Related Publications

Drezner, J, Harmon, K, and Borjesson, M. 2011. Incidence of sudden cardiac death in athletes: where did the science go? BJSM, 45: 947-948.

September 2009 BJSM – deals specifically with cardiac issues and the athlete

Blogs:

Dr. Jonathan Drezner is an Associate Professor of the Department of Family Medicine, Associate Director of the Sports Medicine Fellowship , and Team Physician for the Seattle Seahawks & UW Huskies.

Now the Wall Street Journal chimes in on athlete’s heart

24 Aug, 11 | by Karim Khan

Today a short link to the Wall Street Journal. [this link is to a free, shorter version of the paper – subscription version highlighted below].
BJSM Senior Associate Editor Jon Drezner is quoted liberally – all good stuff for sports medicine and for his University of Washington. Sports cardiology is a hot topic when it makes the mainstream media. We ran a sports cardiology blog yesterday — interpreting athletes’ ECG/EKG and now WSJ adds interesting new issues! Mandatory exclusion is clearly a tricky issue.

Next thing the editorial team will get accused for making this the BJSC – British Journal of Sports Cardiology!

See the links in yesterday’s guest blog (by Dr Babette Pluim – her PhD was in sports cardiology!). Also, Jon Drezner did a nice job explaining all this in his podcast!
There are key papers Online first and a couple of very interesting ones in the pipeline! Keep an eye out in the BJSC, oops, I mean BJSM for the latest in Sports Cardiology.

BJSM blogs are flagged for you on Twitter (@BJSM_BMJ). We also send other interesting links using that medium (one to two tweets per day).

Don’t forget our current home page – great IOC-supported theme issue on sport in young people and health.

BJSM blog homepage

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