Sports Cardiology David J

Sports Cardiology David J. Engel • Dermot M. Phelan Editors

Sports Cardiology Care of the Athletic Heart from the Clinic to the Sidelines Editors David J. Engel Dermot M. Phelan Division of Cardiology Sports Cardiology Center Columbia University Irving Medical Center Hypertrophic Cardiomyopathy Center New York, NY Atrium Health Sanger Heart & USA Vascular Institute Charlotte, NC USA

ISBN 978-3-030-69383-1 ISBN 978-3-030-69384-8 (eBook) https://doi.org/10.1007/978-3-030-69384-8

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This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface

Participation in organized sports across the globe has markedly increased over the past decade, and, in parallel, the clinical practice and research activity centered on the cardiac care for athletes within the feld of sports cardiology has expanded expo- nentially. Recognizing the unique diagnostic and management challenges in opti- mizing the heart health of athletes and refective of the increasing importance assigned to protecting the hearts of athletes, the American College of Cardiology (ACC) in 2011 launched the ACC Section of Sports and Exercise Cardiology. A foundation in the growth of sports cardiology has been the development of a refned and enhanced understanding of the physiological manifestations of exercise on the heart. This improved characterization of exercise-induced cardiac remodel- ing, recognizing the relative infuence of such modifers as sport type, duration and intensity of training, age, gender, race, size, and genetics, has vastly improved our ability to screen for subclinical cardiac disease and differentiate normal physiology from pathology. It is essential for healthcare providers who screen and treat athletes at all skill levels to have a frm grasp of the tenets of sports cardiology and readily available reference data encompassing the key elements within this growing feld. The cumulative clinical experience gained from caring for athletes training and competing with existing cardiac conditions has resulted in the rapid evolution of recommendations guiding sporting participation and the recognition of the importance of shared decision-making. A contemporaneous challenge has been the devas- tation wrought by the COVID-19 pandemic. Sport and health organizations now confront signifcant challenges designing and implementing safe athlete return to play (RTP) strategies. In this textbook, we will review the critical issues and data surrounding concerns of potential cardiac sequelae of COVID-19, and their impact on athlete screening and RTP plans, as the newest element in the feld of sports cardiology. Finally, the feld of sports cardiology has pushed the practicing cardiologist from the clinical facilities to the sports training facilities where they must participate in the acute evaluation and management of athletes in addition to provide guidance on effective emergence action plans.

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Refecting these challenges, this textbook is divided into three parts: 1. Pre-participation Cardiac screening of Athletes 2. Management and Recommendations for Athletes with Existing Cardiac Disorders 3. Sideline Management of Acute Cardiac Conditions in Athletes The purpose of this textbook is to assist healthcare providers manage the cardiac care of athletes across the spectrum of these essential components. We will review best practices for using and interpreting diagnostic tests commonly employed in the cardiac evaluation of athletes, including the 12-lead electrocardiogram, advanced cardiac imaging, and genetic testing. Treatment of cardiac disorders, ranging from acute symptoms that develop suddenly during competition to chronic conditions that require longitudinal management and assessment, will be reviewed with incor- poration of latest guideline recommendations. This textbook will provide a frame- work to aid in the provision of optimal care for athletic patients of all ages both on and off the playing feld.

New York, NY, USA David J. Engel Charlotte, NC, USA Dermot M. Phelan Contents

1 The Cardiovascular History and Examination �� 1 John DiFiori, Chad Asplund, and James C. Puffer 2 Using an Electrocardiogram as a Component of Athlete Screening �� 13 David J. Engel 3 Diagnostic Approach after Initial Abnormal Screening �� 31 Matthew W. Martinez 4 Practical Use of Genetic Testing in Athletes �� 53 Isha Kalia, Farhana Latif, Muredach P. Reilly, and Marc P. Waase 5 Management of Hypertension in Athletes �� 69 D. Edmund Anstey and Daichi Shimbo 6 Valvular Heart Disease �� 85 Tamanna K. Singh 7 Hypertrophic Cardiomyopathy �� 97 Dermot Phelan and John Symanski 8 Other Cardiomyopathies �� 111 Bradley Lander and David J. Engel 9 Inflammatory Cardiac Disorders in the Athlete �� 129 Kenneth G. Zahka, Nishant P. Shah, and Kara Denby 10 Atrial Fibrillation �� 143 Kyle Mandsager and Dermot M. Phelan 11 Sports Participation in Patients with Congenital Long QT Syndrome �� 157 Salima Bhimani, Jared Klein, and Peter F. Aziz

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12 Other Arrhythmic Disorders: WPW, CPVT, Brugada and Idiopathic VF/VT �� 171 Jeffrey J. Hsu and Eugene H. Chung 13 Cardiovascular Implantable Electronic Devices in Athletes �� 195 Benjamin H. Hammond and Elizabeth V. Saarel 14 Diagnosis and Management of Coronary Artery Disease in Athletes �� 211 Prashant Rao and David Shipon 15 Marfan Syndrome and Other Genetic Aortopathies �� 227 Jeffrey S. Hedley and Dermot M. Phelan 16 Congenital Heart Disease: Approach to Evaluation, Management, and Physical Activity �� 245 Silvana Molossi and Hitesh Agrawal 17 Sleep Disorders in Athletes �� 275 Meeta Singh, Michael Workings, Christopher Drake, and Thomas Roth 18 Chest Pain and Dyspnea �� 297 David C. Peritz and John J. Ryan 19 The Evaluation of Palpitations and Dizziness in the Athlete �� 321 Brad Witbrodt and Jonathan H. Kim 20 The Collapsed Athlete �� 343 Justine S. Ko and George Chiampas 21 Cardiac Arrest in Athletes �� 361 Brian J. Cross, Shayna Weinshel, and Marc Estes 22 Commotio Cordis in Athletes �� 375 Mohita Singh and Mark S. Link 23 The Impact of COVID-19 on Sports Cardiology �� 383 Bradley Lander, David J. Engel, and Dermot M. Phelan Index �� 395 Contributors

Hitesh Agrawal, MD, MBA, FSCAI Department of Pediatric Cardiology, University of Texas, Austin, TX, USA D. Edmund Anstey, MD, MPH The Columbia Hypertension Center, Columbia University Irving Medical Center, New York, NY, USA Chad Asplund, MD, MPH Department of Orthopedics and Sports Medicine, Mayo Clinic, Minneapolis, MN, USA Peter F. Aziz, MD Cleveland Clinic Children’s, Cleveland, OH, USA Salima Bhimani, MD Cleveland Clinic Children’s, Cleveland, OH, USA George Chiampas, DO, CAQSM, FACEP Departments of Emergency Medicine and Orthopedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Eugene H. Chung, MD Department of Medicine, University of Michigan, Ann Arbor, MI, USA Brian J. Cross, MD Division of Cardiology, VA Pittsburgh Health System, Pittsburgh, PA, USA Kara Denby, MD Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA John DiFiori, MD Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA Christopher Drake, PhD Department of Sleep Medicine, Henry Ford Health System, Detroit, MI, USA David J. Engel, MD, FACC Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA Marc Estes, MD Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA

ix x Contributors

Benjamin H. Hammond, MD Division of Pediatric Cardiology, Cleveland Clinic Children’s and Pediatric Institute, Cleveland, OH, USA Jeffrey S. Hedley, MD Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, OH, USA Jeffrey J. Hsu, MD, PhD Department of Medicine (Cardiology), University of California, Los Angeles, CA, USA Isha Kalia, MS, MPH Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA Jonathan H. Kim, MD, MSc Emory Clinical Cardiovascular Research Institute, Atlanta, GA, USA Jared Klein, MD, MPH Cleveland Clinic Children’s, Cleveland, OH, USA Justine S. Ko, MD Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Bradley Lander, MD Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA Farhana Latif, MD Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA Mark S. Link, MD Department of Medicine, Cardiology Division, Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, TX, USA Kyle Mandsager, MD Centennial Heart, TriStar Centennial Heart and Vascular Center, Nashville, TN, USA Matthew W. Martinez, MD, FACC Director of Sports Cardiology, Morristown Medical Center, Atlantic Health System, Morristown, NJ, USA Silvana Molossi, MD, PhD Department of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA David C. Peritz, MD Heart and Vascular Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA Dermot M. Phelan, MD, PhD, FASE, FACC Sports Cardiology Center, Hypertrophic Cardiomyopathy Center, Atrium Health Sanger Heart & Vascular Institute, Charlotte, NC, USA James C. Puffer, MD Division of Sports Medicine, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Prashant Rao, MBBS, MRCP(UK) Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA Muredach P. Reilly, MBBCh, MSCE Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA Contributors xi

Thomas Roth, PhD Department of Sleep Medicine, Henry Ford Health System, Detroit, MI, USA John J. Ryan, MD Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA Elizabeth V. Saarel, MD Division of Pediatric Cardiology, St. Luke’s Health System, Boise, ID, USA Nishant P. Shah, MD Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA Daichi Shimbo, MD The Columbia Hypertension Center, Columbia University Irving Medical Center, New York, NY, USA David Shipon, MD, FACC Thomas Jefferson University Hospital, Philadelphia, PA, USA Meeta Singh, MD Department of Sleep Medicine, Thomas Roth Sleep Disorders Center, Henry Ford Health System, Detroit, MI, USA Mohita Singh, MD Department of Medicine, Cardiology Division, Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, TX, USA Tamanna K. Singh, MD, FAAC Sports Cardiology Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA John Symanski, MD Sports Cardiology Center, Hypertrophic Cardiomyopathy Center, Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC, USA Marc P. Waase, MD, PhD Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA Shayna Weinshel, BS, MS Department of Medicine, University of Central Florida, Orlando, FL, USA Brad Witbrodt, MD Emory Clinical Cardiovascular Research Institute, Atlanta, GA, USA Michael Workings, MD Department of Family Medicine, Henry Ford Health System, Detroit, MI, USA Kenneth G. Zahka, MD Department of Pediatric Cardiology, Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA