Sports Cardiology: Exercise in health and cardiovascular disease

248 Pages·1986·4.281 MB·English

by  I. Bekaert (auth.), R. H. Fagard, I. E. Bekaert (eds.)

SPORTS CARDIOLOGY
DEVELOPMENTS IN
CARDIOVASCULAR MEDICINE
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SPORTS CARDIOLOGY
Exercise in health and cardiovascular disease
edited by
R.B. FAGARD
Hypertension and Cardiac Rehabilitation Unit
Department of Internal Medicine and Institute of Physical Education
University of Leuven, Belgium
I.E.BEKAERT
Department of Cardiology and Cardiac Rehabilitation
General Hospital Sint Jozef
Turnhout, Belgium
1986 MARTIN US NIJHOFF PUBLISHERS
a member of the KLUWER ACADEMIC PUBLISHERS GROUP
DORDRECHT I BOSTON I LANCASTER
Distributors
for the United States and Canada: Kluwer Academic Publishers, 190 Old Derby
Street, Hingham, MA 02043, USA
for the UK and Ireland: Kluwer Academic Publishers, MTP Press Limited, Falcon
House, Queen Square, Lancaster LA1 1RN, UK
foral! other countries: Kluwer Academic Publishers Group, Distribution Center,
P.O. Box 322,3300 AH Dordrecht, The Netherlands
Library of Congress Cataloging in Publication Data
ISBN-13: 978-0-89838-782-7 e-ISBN-13: 978-94-009-4257-8
001: 10.1007/978-94-009-4257-8
Copyright
© 1986 by Martinus Nijhoff Publishers, Dordrecht.
Reprint of the original edition 1986
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, mechanical, photoco
pying, recording, or otherwise, without the prior written permission of the
publishers,
Martinus Nijhoff Publishers, P.O. Box 163, 3300 AD Dordrecht,
The Netherlands.
Foreword
Participation in athletics at both the recreational and competitive levels has
grown enormously over the last decade, and now involves a substantial segment
of the population of many countries, particularly those in Europe and North
America. This change in the life-style of many individuals has been accompanied
by the desire and necessity on the part of physicians to define the consequences of
chronic athletic training and competition to the participant. Coincident with the
growth of public interest in sporting competition has been the evolution and
development of new non-invasive technologies in cardiology (such as M-mode
and two-dimensional echocardiography and radionuclide angiography) which
have permitted investigators to study directly and more precisely the morphology
and function of the heart and cardiovascular system. Hence, over the past several
years our knowledge has been greatly enhanced with regard to the features of the
normal 'athlete heart' and the relationship of athletic conditioning to preexistent
cardiovascular disease, as well as the causes of sudden death in athletes.
The present treatise on 'Sports cardiology: Exercise in Health and Cardio
vascular Disease' is an impressive reference document which is also timely. It
fulfills an important role in summarizing most of the available data that has been
accumulated over the last 10 years in a large number of athletes participating in a
variety of different sports. Drs. I. Bekaert and R. Fagard have assembled 29
impressive contributions from more than 75 respected investigators from dif
ferent parts of the world; these chapters constitute the essence of the Interna
tional Conference on 'Sports cardiology' held in Knokke, Belgium in May 1985.
This is a comprehensive book with broad scope. It begins with two chapters
which describe in detail the 'athlete heart', including its significance, morphologic
and functional features, and historical perspective. These contributions are fol
lowed by chapters describing the electrocardiographic, echocardiographic, and
radionuclide angiographic findings in athletes. Also included are several chapters
concerned with the impact of exercise programs on athletes, including those with
or those without underlying cardiovascular disease. The final two chapters are
devoted to the very important issue of sudden death in athletes and describe those
cardiovascular diseases known to be responsible for sudden catastrophes on the
athletic field, in youthful and in older athletes.
Barry 1. Maron, M.D.
Preface
In May 1985 the Belgian working group on sports cardiology organized an
international symposium in Knokke. Several years had passed since the last larger
meeting on the topic was held in Rome in 1978. The program in Knokke
comprised lectures by invited speakers and oral and poster presentations selected
from the response to the call for abstracts. Because more and more physicians and
health counsellors are confronted with exercise-related problems, and the re
search in the field is rapidly expanding, it was felt useful to publish a book based
on material from the symposium. However, contributions were selected and
additional authors invited, so that the book would be more than the mere
proceedings of the meeting and cover four important topics in the field of sports
cardiology. A major first chapter is devoted to the structure and the function of
the heart of athletes, some parts directed to familiarize the practising physician
with athlete's heart, others meant for the researcher in the field. A brief second
chapter relates the benefit of physical activity for the healthy subject and dis
cusses aspects of the screening process. The third chapter covers exercise for the
patient with cardiovascular disease, mainly coronary heart disease, Wolff-Parkin
son-White pattern, hypertension and congenital heart disease. Finally the rare
but dramatic event of exercise-related sudden death is reviewed.
Any book is open to criticisms and the editors are aware of some. The book is
certainly not complete, but topics on which only personal opinions can be given,
without hard data, were not included. Since the book has been written by several
authors, some contradictions in facts and opinions do occur. The editors have not
tried to reconcile divergent views and leave the role of referee to time and future
research.
We express our gratitude to all authors and welcome any criticism or sugges
tions which may be helpful in a future edition.
R.H. Fagard
I.E. Bekaert
Contents
Foreword by B.J. Maron v
Preface VII
Contributors XIII
Chapter I Athlete's heart
The athlete's heart: an overview
Bekaert I. 3
The athlete's heart: a lOO-year long discussion
Rost R. 12
§ 1. Electrocardiography in athletes
Rhythm and conduction abnormalities
Campbell R. 23
Bradycardia, ventricular pauses and sports
Ector H., Bourgois J., Verlinden M .. Hermans L., Vanden Eynde E.,
Fagard R., De Geest H. 33
Repolarization abnormalities
Zeppilli P., Aspromonte N. 41
Effects of intensive physical conditioning on cardiovascular parameters in
high level athletes
Herman T., Rousseau M., Brohet C. 46
Electrocardiograms of endurance athletes
Fagard R., Bekaert 1. 54
x
§ 2. Echocardiography in athletes
Echocardiographic evaluation of the heart of athletes: cross-sectional and
longitudinal observations
Fagard R. 61
Left ventricular function in athletes: analysis of relaxation
Gillebert T., Rademakers F., Brutsaert D. 70
Aerobic exercise and cardiac size: an echocardiographic study of Rotter
dam marathon runners
Roelandt J., Verdouw P., Rijsterborgh H., Hartog J. 85
The windsurfer's heart
Meloni L., Bonomo P., Cherchi A. 92
An investigation of athlete's heart by chest X-ray, electrocardiography and
echocardiography
Reinke A., Rost R. 97
§ 3. Radionuclide scintigraphy in athletes
Value of radionuclide angiography at rest and during exercise in the assess
ment of cardiac function in athletes
De Landsheere c., Rigo P. 105
Abnormal electrocardiographic exercise test in middle-aged athletes: cor
relation with exercise myocardial perfusion scintigraphy
Di Pasquale G., Pinelli G., Manini G., Dondi M., Corbelli c., Tencati R.,
LolliG. 112
Myocardial scintigraphy and cardiospecific creatine kinase responses in
female and male athletes after streneous exercise
Ohman M., Teo K., Johnson A., Collins P., Horgan J. 119
§4. Athlete's bradycardia
Carotid baroreceptor control of heart rate and physical fitness
Fiocchi R., Fagard R., Vanhees L., Bielen E., Amery A. 129
Beta-adrenoceptor changes in exercise and physical training
Ohman M., Kelly J. 136
XI
Chapter II Exercise in healthy subjects
Primary prevention of coronary heart disease by physical activity
De Backer G., KornitzerM., SobolskiJ., Dramaix M., Degre S., Denolin H. 145
Exertional risk factors in apparently healthy males: an interim report
Davies B., Ashton W.D., Rowlands D.l. 151
Chapter III Exercise in cardiovascular disease
The role of physical activity in post-infarct patients
De Backer G. 161
The organization and implementation of a cardiac rehabilitation program
in a district general hospital
Dugmore D., Bone M., Kubik M. 167
Correlates of the effect of physical training in cardiac patients
Vanhees L., Fagard R., Grauwels R., De Geest H., Amery A. 175
Coronary collaterals: protective effects during physical training?
Wolf R., Lichtlen P. 181
Follow-up study in 25 asymptomatic sportsmen with Wolff-Parkinson
White pattern
Maciel L., Costa 0., Oliveira A., Sepulveda F., Espiga Macedo M., Falcao
de Freitas J\. 188
Sports and hypertension
Fagard R., Staessen 1., Vanhees L., Amery A. 195
Exercise and sports in congenital heart disease
Van der Hauwaert L. 205
The evaluation of exercise performance in children after surgical correction
of congenital heart disease
Matthys D., Devloo-Blancquaert A. 214
XII
Chapter IV Exercise and sudden death
Sudden death and sports
Pool J. 223
Sudden death and vigorous exercise
Northcote R. 228
Index 241