La evaluación cardiovascular predeportiva en niños y adolescentes / Cardiovascular screening prior to sport practice in children and adolescents

No disponible

[Clinical practice guidelines of the Spanish Society of Cardiology for physical activity in patients with cardiac disease]. / Guías de práctica clínica de la Sociedad Española de Cardiología sobre la actividad física en el cardiópata.

This chapter includes general recommendations regarding the eligibility for recreational and competitive sports participation. Although based on the latest knowledge in sports medicine and cardiology, these recommendations should be updated according to advances in the understanding of the athlete's heart. Physical exercise plays an important role in the leisure time of our society. Many patients with cardiac disease don't want to give up their physical or sport activity programs. Moreover, there is no doubt that many cardiovascular abnormalities may benefit from a controlled physical exercise program. Understanding the cardiac adaptations to exercise training, individualised evaluation of each cardiac pathology and adequate exercise prescription is essential in order to minimize the risks for every cardiac patient.

[Sudden death (IV). Sudden death in the athlete. The minimal requirements before performing a competitive sport]. / Muerte súbita (IV). Muerte súbita en el deportista. Requerimientos mínimos antes de realizar deporte de competición.

In our society, athletes project the ultimate image of well being in the health status spectrum. Though very uncommon, the sudden death of a young athlete has always great impact on the community and the athlete's surroundings (physicians, athletes, coaches, etc.). Due both to this and to the growing number of physical exercise practitioners, there is an increasing demand for more and precise information on the recommendations of participation in certain sports with the minimum possible risk. Together with the most recent and detailed statistics concerning the cardiovascular causes of sudden death in athletes, the objective of the present article is to review the present controversy regarding the preparticipation medical examination as a useful method to identify those athletes with greater potential risk, as well as to propose a few and simple recommendations concerning the tests that should be performed in each case.

["The athlete's heart": most common electrocardiographic findings]. / "El corazón del deportista": hallazgos electrocardiográficos más frecuentes.

The morphological and functional cardiac adaptations induced by physical training may be reflected in several athlete's electrocardiographic variants. Rhythm and heart rate disturbances are the most common findings, and sinus bradycardia is the most frequent adaptation. Non-specific intraventricular conduction delay and incomplete right bundle branch block are also frequent, but other bundle branch and fascicular blocks are extremely rare. While the atrioventricular conduction may be prolonged, the occurrence of first degree and type I second degree atrioventricular blocks depends on the individual's susceptibility. Advanced second and third degree atrioventricular blocks are exceptional, and when present, the possibility of underlying heart disease must be excluded. High QRS voltage is more frequent in male athletes, but its correlation with left ventricular hypertrophy is low. The ST segment elevation in the so called "early repolarization" pattern is typical of the athlete's electrocardiogram. Vagotonic or high T wave voltages and U waves are also frequent when sinus bradycardia is present. Tachyarrhythmias and increased automatism arrhythmias are rare and usually benign. The increased vagal tone is responsible for the suppression of the physiological and ectopic pacemakers. While Wolff-Parkinson-White syndrome per se does not exclude an athlete from sports activity, the risk of a sudden death makes it mandatory to perform an exhaustive cardiac evaluation. We may conclude that no sport can be considered arrhythmogenic or as a predisposing factor for malignant ventricular arrhythmias.