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Sports Cardiology at the Heart & Vascular Institute pulseTHE SPRING 2015 The Physicians' Quarterly Newsletter of the Heart & Vascular Institute SPORTS CARDIOLOGY AT THE HEART & VAscULAR INSTITUTE 45-year-old man was making plans to evaluated by their primary care physicians for physically intense sports such as basketball, fulfill his lifelong dream of climbing the appropriate type of exercise programs.” soccer and football. The most common cause A the Himalayas and sought medical of this devastating event is hypertrophic advice from Dr. David Hsi, Chief of Cardiology “I consider it prudent to perform cardiac cardiomyopathy, which can be identified and Co-Director of Stamford Hospital’s Heart & screenings that include ECG on most at-risk through cardiac screening. Vascular Institute (HVI). The active gentleman, adults who want to exercise,” Dr. Hsi continued. who was also a physician, had a history of “Cardiac screenings can identify and prevent “Sports cardiologists have an obligation hypertension, high cholesterol and abnormal heart problems before they become serious to reassure people at low risk for cardiac echocardiogram (ECG) and was concerned and can unmask problems that haven’t disease that they avoid excessive testing and about the risk that such a rigorous, high-altitude surfaced yet.” provide guidance to high-risk patients to exertion may have on his heart. Dr. Hsi, who prevent serious cardiac events,” said Dr. Hsi. Many healthy adults who participate in at the time was Chair of the Department “As a general rule, adults with known health endurance sports such as long-distance of Cardiology at the Deborah Heart and risks should be screened before they begin running, cycling, rowing and swimming Lung Center in New Jersey, performed a exercising. Adults who want to participate develop Athlete’s Heart Syndrome, cardiac comprehensive sports cardiac evaluation and in certain sports such as marathon running, remodeling in response to vigorous considered the patient’s heart able to handle scuba diving and high-altitude mountain endurance exercise. Exercise-induced cardiac the climb. Subsequently, the patient summited climbing should undergo the appropriate remodeling can also cause arrhythmias such the Himalayas without any cardiac events. sports-specific pre-screening evaluations.” as atrial fibrillation in currently or previously 1. J Am Coll Cardiol. 2002;40(10):1856-1863. doi:10.1016/ Sports cardiology addresses the unique trained athletes. “One elegant MRI–based study demonstrated balanced, biventricular S0735-1097(02)02478-6 physiology and needs of active persons of all 2. N Engl J Med. 2008; 358:152-161 ages and fitness levels, a concept that perfectly enlargement among endurance athletes,” said 1 dovetails with the HVI’s commitment to Dr. Hsi. “For patients who present with these providing individualized, patient-centered care. findings it is critically important to distinguish “A very viable segment of the population wants extreme cases of exercise-induced ventricular to participate in sports to maintain a healthy remodeling from mild forms of hypertrophic lifestyle,” said Dr. Hsi. “Our goal is to help patients cardiomyopathy, familial or acquired dilated select appropriate sports and fitness activities cardiomyopathy and arrhythmogenic right and to identify those patients who may be at ventricular cardiomyopathy.” risk for cardiac events.” Another study concluded that “markedly “One hotly debated issue in sports cardiology abnormal ECGs in young and apparently is which patient populations should be healthy athletes may represent the initial referred for cardiac screening,” said Dr. Hsi. “The expression of underlying cardiomyopathies European literature suggests that all athletes that may not be evident until many years later and young healthy adults be screened, but and that may ultimately be associated with 2 in the United States there is less support for adverse outcomes.” screening in these populations. Although it’s While extremely rare, sudden cardiac death difficult to prove the efficacy of screening, it is is more likely to occur in participants of usually recommended that adult patients be pulseTHE SPORTS CARDIOLOGY SCREENING GUIDELINES The American Heart Association’s 12-Point • Exercise-induced hypotension Screening Procedure • Exercise-induced myocardial ischemia • Syncope Personal medical history • More than moderately severe valvular disease 1. Exertional chest pain/discomfort • Prior embolic event 2. Syncope/near syncope 3. Unexplained excessive exertional dyspnea Symptoms and Clinical Signs in Young Athletes or fatigue that Should Raise Concern and Initiate Referral to 4. Prior recognition of a heart murmur a Sports Cardiologist 5. Elevated blood pressure • Chest pain or discomfort on exertion FROM THE: EDITOR Family medical history • Unexplained syncope or near syncope during exertion am pleased to present the Spring 2015 6. Premature death related to • Dyspnea that is disproportional to the amount of issue of The Pulse, the physicians’ quarterly cardiovascular disease exercise being performed Inewsletter of Stamford Hospital’s Heart 7. Disability from cardiovascular disease at age & Vascular Institute (HVI). This issue features <50 years • Palpitations associated with any of the above sports cardiology, an emerging subspecialty 8. Hypertrophic cardiomyopathy, dilated • A family history of hereditary cardiac disorder or that addresses the cardiovascular effects cardiomyopathy, Marfan syndrome, arrhythmias, sudden cardiac death in a first degree relative and risks of exercise. At the HVI we are channelopathy (Long QT syndrome) when young (≤40 years) dedicated to providing cardiology services • Suspicion for Marfan syndrome to all individuals who embrace an active Physical examination • Left parasternal, systolic heart murmur that lifestyle, from athletes to “weekend warriors” 9. Heart murmur increases in intensity when standing or with to patients recovering from cardiovascular 10. Femoral vs. radial pulses to exclude Valsalva maneuver disease so they may safely pursue their aortic coarctation • Electrocardiographic abnormalities sports and exercise activities. 11. Physical stigmata of Marfan syndrome • Athletes with clinical symptoms and signs of We are also proud to highlight the 12. Brachial artery blood pressure an infection (e.g., flu-like symptoms) should be Hands for Life® Program spearheaded by advised against intense exercise until they have Sports Cardiology Recommendations by Interventional Cardiologist Dr. Thomas Nero made a complete recovery to avoid the risk Dr. David Hsi, Chief of Cardiology and who, with a team of passionate Stamford of myocarditis Co-Director of the Heart & Vascular Institute Hospital physicians, is galvanizing the • Special consideration should be made regarding community to learn Hands-OnlyTM CPR. Contraindications to High-Intensity Competitive scuba diving for patients with certain conditions Sports (e.g. football, basketball, soccer) such as atrial septal defect, patent foramen ovale Our hope is that this issue of The Pulse • Left ventricular ejection fraction <50% or other intra-cardiac shunts provides valuable information and insights • Exercise-induced tachyarrhythmias that will enhance your clinical practice. I invite you to read on about our news and services and encourage you to provide your feedback and suggestions to make this A FOND FAREWELL TO PEGGY MARTINO, RN, MSN, MBA newsletter a valued resource to physicians in our community. he staff and the hybrid convergent procedure known for physicians at treatment of persistent atrial fibrillation; a hybrid T the Heart and OR to support state-of-the-art cardiac and vascular Vascular Institute (HVI) procedures; a new Structural Heart Disease program; — Joonun (Chris) Choi, MD wish a fond farewell and a successful Valve Center, which utilizes a The Heart Physicians to Peggy Martino, multidisciplinary Heart Team approach in the Stamford Health Integrated Practices Director of the HVI, evaluation of patients with valve disease. This spring, [email protected] Integrative Medicine the HVI will offer the TAVR (transcatheter aortic valve and Population Health replacement) procedure, an alternative for patients at and Prevention at high risk for traditional open-heart surgery. Stamford Hospital. Peggy has accepted A longtime champion of the Planetree model of the position of Vice President of Nursing for the patient-centered care, Peggy has been instrumental NewYork-Presbyterian Healthcare System. in creating an environment at the HVI in which patients and their families feel empowered Peggy was instrumental in expanding the scope and to be partners in their own healthcare. This has breadth of HVI services including the addition of led to exceptional quality outcomes and Preventive Cardiology; an Advanced (EP) Arrhythmia patient satisfaction. Center with the latest bi-plane system that offers SPRING 2015 HANDS FOR LIFE® PROGRAM SAVES LIVES Hands for Life® team broke the world record participate. “I brought my husband and two when they trained 5,141 people in CPR and the kids to the last event and we had a wonderful use of an AED in a single day. time,” said Dr. Ann Williams, Family Practitioner at Stamford Hospital. “It was a huge bonding “After that event we saw a modest increase experience for the entire community.” in the use of CPR and in survival rates,” said Dr. Nero. “However, we know we can do better.” A new, high-tech feature at the upcoming event is PulsePoint Respond, a mobile phone To that end, Dr. Nero and a steering committee app that reduces
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