Erik Ekker Solberg Overlege dr. med. FESC Spesialist indremedisin, kardiologi, idrettsmedisin Diakonhjemmet sykehus Medisinsk avdeling

Transkript

1 Erik Ekker Solberg Overlege dr. med. FESC Spesialist indremedisin, kardiologi, idrettsmedisin Diakonhjemmet sykehus Medisinsk avdeling Leder Arbeidsgruppe preventiv kardiologi, hjerterehab.og sportskardiologi, Norsk Cardiologisk Selskap Chair

2 Trening - men skaper det form? Hva er riktig trening? Atrieflimmer og trening Hva er faresignaler? Risiko ved idrett? Trene med sykdom - hvordan gjør man det? Eldre og trening Trening og infeksjon..

3

4

5

6

7 ACSM trender trening

8

9

10 Overdreven sitting er den nye røykingen

11 Trening - men skaper det bedre form? Hva er riktig trening? Atrieflimmer og trening Hva er faresignaler? Risiko ved idrett? Trene med sykdom - hvordan gjør man det? Eldre og trening Trening og infeksjon..

12 Atrieflimmer

13

14

15 60 år mann Spreke Innlagt med akutte brystmerter EKG: Rask AF Konverterte på væskeinfusjon Trent 3 harde ski økter på 3 påfølgende dager Skøyteski Lite væske Senere funnet: Mitralinsufficiens grad II Lett dillatert venstre atrium

16

17

18

19 Trening - men skaper det bedre form? Hva er riktig trening? Atrieflimmer og trening Senior athletes Trene med sykdom - hvordan gjør man det? Eldre og trening Trening og infeksjon..

20 Aagaard P MSSE 2012

21

22 Preparticipation cardiovascular screening (PPS) has mostly focused on young athletes below 35 years old. But what about adults, basically sedentary or active, who want to take part in (further) athletic activities? This paper by Børjesson et al highlights this issue and recommends that PPS in adults should be conducted on an individual basis. Their burden of classical cardiovascular (CV) risk factors and their present fitness level, as an indication of cardio-respiratory fitness, are markers to consider. Self-reporting forms like American Heart Association Preparticipation Screening Questionnaire or the simpler Physical Activity Readiness Questionnaire may be used to define risk profile. Especially, those with high coronary risk are to be noted. The SCORE system is recommended by ESC to define CV risk profile and defines high- and low-risk profiles precisely. This clinically useful paper provides a guided way to evaluate the athlete individually. A positive score is based on symptoms, high-risk profile, abnormal findings on examination or positive ECG findings. The authors underline the increased risk during high-intensity activities. The scope of the paper is to provide feasible and safe exercise prescription for adults Authors: E. Solberg, on behalf of the EACPR Sports Cardiology Section

23

24

25 Trening - men skaper det bedre form? Hva er riktig trening? Atrieflimmer og trening Hva er faresignaler? Risiko ved idrett? Trene med sykdom - hvordan gjør man det? Eldre og trening Trening og infeksjon..

26

27 Trening - men skaper det bedre form? Hva er riktig trening? Atrieflimmer og trening Hva er faresignaler? Risiko ved idrett? Trene med sykdom - hvordan gjør man det? Eldre og trening Trening og infeksjon..

28

29 Aleksander Dale Oen, Norway, died Claire Squires died running the London marathon Livorno football player Piermario Morosini, died Fabrice Muamba sudden cardiac arrest (aborted)

30 Joacim Ernstsson (32) fikk hjertestans og falt livløs om midt i håndballkampen mot Kristianstad Ung håndballspiller døde på trening Et ungt håndballtalent døde av hjertesvikt under trening i Ålesund mandag kveld, skriver Sunnmørsposten. Tirsdag Fotballspilleren Gregory Mertens, Belgia, død Daan Myngheer (22) døde på sykehus etter at han fikk hjerteinfarkt under et ritt : Basketpræsident sørger over dansk stortalent Rasmus Glarbjerg død

31 Incidens av SD in sports og i trafikken hva tror dere? Division I Male basketball Men s basketball Male African Americans African Americans Men s soccer Death in Car accident NCAA Athlete Harmon, Circulation, 2015

32 Death in Car Accidents Incidence of Death Division I Male basketball 1 in 5,200 Men s basketball 1 in 8,978 Male African Americans 1 in 15,829 African Americans 1 in 21,491 Men s soccer 1 in 23,689 Death in Car accident 1 in 26,851 NCAA Athlete 1 in 53,703 Harmon, Circulation, 2015

33 Annual risk of SCD in athletes from Veneto, Italy6 and Minnesota,13 and more recent incidence data in NCAA college athletes2 and US military personnel.7 The differential risk of SCD in targeted athlete populations should be considered when choosing an appropriate CV screening strategy. Jonathan A Drezner et al. Br J Sports Med 2016;50: Copyright BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

34 Etiology Maron B et al

35 Etiology of SCD in NCAA Athletes Cardiomyopathy 25%

36 aorta (Marfan) aorta -Marfan hjerteklaffene anomal coronar arterie avgang hjerteklaffene koronarsykdom myocard -cardiomyopati (Hypertrofisk obstruktiv cardiomyopati, HOCM) -myocarditt -arytmogen høyre ventrikkel dysplasi (ARVD)

37 Aleksander Dale Oen 21. mai april 2012

38 L Meyers Circulation 2012

39 Materials SCD in young athletes due to CAD Country 1st au Athletes Journal Year No. of SCD % CAD yes/no examined Italy Corrado y NEngJMed Norway Solberg y EJPC England Noronha y Heart US Maron y Circ France Fornes y AmJFor Med Spain Suarez-Mier y For Sci Intern Australia Puranik n Heart Rhythm Turkey Øzdemir y JSportSci&Med US Meyer n Circ mean 24

40 Fig 3: No cases SCD by sport No cases SCD Football/ Soccer Basketball Running/ Orienteering Swimming Gymnastics/ Aerobics Rugby Tennis Hockey/ Lacrosse Cycling Cross-country skiing Baseball/ Softball Volleyball Wrestling Skiing Scuba diving Boxing Dancing Physical training Judo Track-sprinting Weight lifting Treadmill Softball Table-tennis Surfing Bille K EJCP 2006

41

42 Risk by sport Sport Incidence Men s basketball 1 in 8,978 Men s soccer 1 in 23,689 Men s Football 1 in 35,951 Men s Swimming 1 in 42,784 Men s Cross-country 1 in 42,857 Men s Lacrosse 1 in 45,850 Women s Cross-country 1 in 47,089 Women s Volleyball 1 in 49,217 Men s Baseball 1 in 50,023 NCAA Athletes 1 in 53,703 Women s Swimming 1 in 57,611 Women s basketball 1 in 77,061 Men s track 1 in 120,521

43 SCD in NCAA Athletes Time Frame Resolution s List Media Database Insurance Claims % 67% 9% % 70% 15% % 70% 11%

44 Webner MSSE 2012

45 hank-gathers-basketball-collapse.wmv

46 Chain of survival 1990

47 Fotballspiller fikk hjertestans og døde dommeren trodde han filmet og ga gult kort Kroatia 2010

48 Chain of survival revisited 2014 Solberg EE 2014

49 Screening?

50 Autopsy study 162 premature cardiac deaths, years (Pre) Syncope, chest pain, palpitations, dyspnea 57% Cardiac pos. family history 16 % Wisten Aa Scan Cardiovasc J 2005

51 Warning symptoms and family history of cardiovascular disease in families with a child or young SCA SCA victims 16 years (5-29 years), 69% male, 68% white 72% cardiovascular symptoms before SCA fatigue (44%) near-syncope (30%) Cardiovascular symptoms first occurred 30 months (19-71 months) before SCA symptom brought to child's physician in 41% of cases 27% of families reported a family member suffered SCD before age 50 Drezner J J Am Board Fam Med 2012

52 Proof of principle Yes SCA in sports is preventable Proof of practice? Corrado D JAMA 2006

53 Contra Stress on athletes False safety Specialist dependent Unnecessary abruption of sports career False positive finding

54

55 Screening does not stress athletes

56

57 1. Primary electrical disease 2. Cardiomyopathy 3. ECG interpretation of athletes ecg 4. Ecg recognizing physiological adaption to sports Fritt tilgjengelig, også fra app (AMSSM, F-MARC, BJSM)

58 (A) Early repolarization pattern in a healthy black athlete characterized by B )right (B) precordial T-wave inversion (arrowhead) preceded by ST-segment elevation (arrow) Normalt EKG hos en sort atlet ARVC Arytmogen høyre ventrikkel dysplasi Corrado D et al. Eur Heart J 2010;31:

59 Sharma S Eur Heart J 2017

60

61

62

63 Trening - men skaper det form? Hva er riktig trening? Atrieflimmer og trening Hva er faresignaler? Risiko ved idrett? Trene med sykdom - hvordan gjør man det? Eldre og trening Trening og infeksjon..

64 Keep your heart healthy