Role of exercise stress test in master athletes.

BACKGROUND: The effectiveness of cardiovascular screening in minimising the risk of athletic field deaths in master athletes is not known. OBJECTIVE: To evaluate the prevalence and clinical significance of ST segment depression during a stress test in asymptomatic apparently healthy elderly athletes. METHODS: A total of 113 male subjects aged over 60 were studied (79 trained and 34 sedentary); 88 of them (62 trained and 26 sedentary) were followed up for four years (mean 2.16 years for athletes, 1.26 years for sedentary subjects), with a resting 12 lead electrocardiogram (ECG), symptom limited exercise ECG on a cycle ergometer, echocardiography, and 24 hour ECG Holter monitoring. RESULTS: A significant ST segment depression at peak exercise was detected in one athlete at the first evaluation. A further case was seen during the follow up period in a previously "negative" athlete. Both were asymptomatic, and single photon emission tomography and/or stress echocardiography were negative for myocardial ischaemia. The athletes remained symptom-free during the period of the study. One athlete died during the follow up for coronary artery disease: he showed polymorphous ventricular tachycardia during both the exercise test and Holter monitoring, but no significant ST segment depression. CONCLUSIONS: The finding of false positive ST segment depression in elderly athletes, although still not fully understood, may be related to the physiological cardiac remodelling induced by regular training. Thus athletes with exercise induced ST segment depression, with no associated symptoms and/or complex ventricular arrhythmias, and no adverse findings at second level cardiological testing, should be considered free from coronary disease and safe to continue athletic training.

Vigorous exercise training is not associated with prevalence of ventricular arrhythmias in elderly athletes.

AIM: Physical activity, when vigorous, is not devoided of arrhythmic risk. Since the risk of developing arrhythmias increase as an otherwise healthy person ages, the question arises as to whether high intensity physical activity could be dangerous in the elderly person. The present study addressed the incidence of arrhythmias in elderly athletes in comparison to age-matched control subjects. METHODS: We studied 49 male athletes engaged in various sport disciplines, mean age 62.3+/-2.3 and 24 sedentary or moderately physically active healthy males, mean age 62.9+/-1.7 years (Controls). All subjects underwent 2-D, M-mode and Doppler echocardiographic examination, resting ECG and exercise stress test followed by 24-hour electrocardiographic monitoring. RESULTS: No pathological findings were detected in both experimental groups at echocardiographic examination. Exercise performance was greater in athletes than controls (206.9+/-5.2 vs 156.3+/-12 watt, p<0.01). During exercise test, no significant between-groups difference was detected in the incidence of ventricular arrhythmias, that is multiple premature ventricular contractions (MPVC), polymorphous premature ventricular contractions (PPVC) and repetitive premature ventricular contractions (RPVC). No subject featured horizontal or downsloping ST segment depression in both groups. At 24-hour electrocardiographic monitoring the incidence of the overall number of premature ventricular contractions was significantly greater in controls than athletes (87.0% vs 63.3%, p<0.05), whereas no significant difference were detected in the incidence of discrete ventricular arrhythmias between athletes (4.1% MPVC, 14.3% PPVC, 8.2% couplets) and controls (0.5% MPVC, 16.7% PPVC, 12.5% couplets). CONCLUSION: These finding indicate that in elderly, otherwise healthy, athletes vigorous training even to competition does not result in a greater incidence of ventricular arrhythmias, although caution should be made for a careful preparticipation evaluation.

Oral theophylline supplementation and high-intensity intermittent exercise.

AIM: The present study was carried out to investigate whether oral theophylline supplementation exerts an ergogenic effect during intermittent high-intensity exercise. METHODS: Ten healthy subjects undertook intermittent exercise (1 min cycling at 120% of VO(2max) with 3 min of recovery until exhaustion). The exercise test was repeated twice, 1 week apart. On each occasion, the subject ingested, in a double blind setting, either theophylline (4.5 mg/kg) or placebo 90 min before commencing the exercise test. RESULTS: Three subjects could not complete both trials due to nausea and dizziness after theophylline had been administered. Time to exhaustion in the remaining subjects was slightly increased after theophylline administration (55.9+/-6 min vs 59.3+/-5.9 min; p<0.05). CONCLUSION: Present data indicate that oral theophylline supplementation delays fatigue onset during intermittent high-intensity exercise. The effect, although statistically significant, does not appear to be marked. The possibility of occurrence of negative side effects and the evidence for its ergogenic potential suggests the necessity to include theophylline in the International Olympic Committee (IOC) World Antidoping Agency (WADA) list as a banned or restricted substance.

Complex ventricular arrhythmia induced by overuse of potassium supplementation in a young male football player. Case report.

People practising regular physical activity usually drink hydrosaline beverages. In this study is reported the case of a young football player suffering from premature ventricular beats. He used to take regularly an hydrosaline supplementation which gave him a daily intake of potassium of about 5 g. A stress test on a cycle ergometer showed many monomorphus premature ventricular beats which disappeared when the heart rate was higher than 110 beats/min. Moreover, 3629 polimorphus premature ventricular beats were recorded during a 24 hr ECG monitoring. At the time of the first examination, the plasma potassium concentration was 7,8 mEq x l(-1). The football player was then suspended from practicing sport and he was asked to stop his intake of potassium. The clinical examination was repeated after 3 and 6 months and no ventricular arrhythmias were observed during the stress test as well as during the 24 hours ECG monitoring. The plasma potassium concentration was normal again. The present case report is an example of how the misuse of saline supplementations could result in hyperkalemia and how this condition may lead to ventricular arrhythmias.

Effects of aerobic exercise training on 24 hr profile of heart rate variability in female athletes.

BACKGROUND: The aim of this study was to investigate the effects of exercise training on autonomic regulation of heart rate under daily life conditions. METHODS: Twenty-six healthy female athletes (age 24.5 +/- 1.9 yrs) involved in regular physical activity were recruited during a period of yearly rest and randomly assigned to a five-week aerobic exercise training program (n = 13) or to a non-exercise control group (n = 13). MEASURES: Before and after the five-week training, all subjects underwent a bycicle ergometer stress test and a 24-hour dynamic ECG monitoring. Autonomic regulation of heart rate has been investigated by means of both time and frequency domain analyses of heart rate variability (HRV). Spectral analysis of R-R interval variability (autoregressive algorithm) provided markers of sympathetic (low frequency, LF, 0.10 Hz) and parasympathetic (high frequency, HF, 0.25 Hz) modulation of the sinus node. RESULTS: Trained subjects showed a reduced heart rate response to submaximal workload. Before training there was no significant difference between the two groups. After training resting heart rate did not significantly differ between trained and untrained subjects. No significant differences were observed in the different time domain indexes of heart rate variability. The day-night difference in SD and SDRR were significantly less in the trained as compared to the untrained group. Normalized LF and HF components did not significantly differ between trained and untrained subjects, during the awake period. The decrease in the LF and the increase in the HF component during nighttime were significantly less in the trained group. The LF/HF ratio was significantly decreased during the night in the untrained group whereas it was not significantly different from the awake state in the trained group. CONCLUSIONS: These findings of the relative night-time increase in LF and the decrease in the day-night difference in time domain indexes of heart rate variability suggest that, in young female athletes, exercise training is able to induce an increase in the sympathetic modulation of the sinus node which may coexist with signs of relatively reduced, or unaffected, vagal modulation.

The electrocardiographic T wave changes in highly trained athletes during training. An old problem revisited.

OBJECTIVE: To evaluate the T-wave pattern alterations during vigorous training in elite athletes. SETTING: Institute of Sport Science in Rome and National Rowing Center in Piediluco, Italy. STUDY POPULATION: Nine male and 7 female rowers of the national team were examined prospectively at different times of their conditioning period. METHODS: All athletes underwent electrocardiography and echocardiography; the ecg was analyzed for QRS voltages and axis, T-wave pattern and QTc interval; from echocardiography the left ventricular (LV) cavity dimension, wall thickness and mass were calculated. From Doppler-echocardiography the transmitral diastolic LV filling pattern was evaluated. RESULTS: Variation of T-wave voltages was seen in all the athletes. Specifically, during the low-intensity training period the T-wave pattern was positive and increased in voltage (T-wave max amplitude in V6 increased to 130% in male and 100% in female than pretraining values). During the peak training a variety of patterns was observed, and a transient flattening was present in 50% of subjects. No concomitant alteration of heart rate, QRS and T-wave axis and QTc duration were observed. No significant changes of cavity dimension, wall thickness, LV mass index and Doppler-derived diastolic peak flow velocities were detected during the study period. CONCLUSIONS: Transient changes of T-wave pattern may occur in athletes as an effect of athletic conditioning, without changes of cardiac dimension or alteration of indexes of LV function. This finding supports the role of ecg monitoring to follow-up the individual athletes response to training exercise load.

Creeping eruption of larva migrans--a case report in a beach volley athlete.

The authors describe a case of cutaneous larva migrans in a beach volley athlete. This pathology is found more often in tropical zones than in European countries. There are no previous publications with regard to this condition in athletes. The nematode responsible for this affliction often is the Ancylostoma braziliense. Larval stage of the nematode migrates through the skin; within 72 hours after larval penetration, serpiginous, elevated tunnels are observed. This affliction can be complicated by Loeffler's syndrome. In the case described only dermatological involvement was observed. The patient was treated with 400 mg albendazole tablets twice a day for five days. Within two days of therapy the patient reported less itching; a medical control after ten days did not reveal any signs of active infection.

Coronary arteries in physiological hypertrophy: echocardiographic evidence of increased proximal size in elite athletes.

One hundred and twenty-five healthy, male top-level athletes were evaluated by echocardiography (Echo) and assigned to six groups according to the size of the left ventricular mass (L. V. Mass), calculated according to Devereux R. B. et al.: less than or equal to 200, 201-250, 251-300, 301-350, 351-400, or greater than 400 g. Echo evaluation of coronary artery (c.a.) proximal size was performed following the method described by Kalavathy et al. (J Am Coll cardiol 1986, 8, 1119-1124). Two of us separately conducted the measurement of the c.a. diameter at congruent to 1 cm from the respective aortic ostium on M-Mode tracings and 2-D end-diastolic frames. The inter-observer variability was lower for the M-Mode (4.2%) than 2D (9.3%) measurements: the correlation between A and B observers equals r = 0.867 for the right c.a., and r = 0.859 for the left main c.a.