1. General Medical Conditions
PHED 120
Krzyzanowicz- Fall ‘12

2. Sudden Death
Causes include cardiac conditions, pulmonary problems, hyperthermia, drug abuse, blunt trauma, exercise-induced anaphylaxis
Defined as death that occurs within 24 hours of symptom onset
Uncommon in athletes

3. Sudden Death Hypertrophic Cardiomyopathy
Responsible for 1/3 of cardiac-related sudden deaths in athletes
Congenital condition that may involve primary arrythmias, hemodynamic events with diminished stroke volume and ischemia
Associated with impaired systolic filling and impaired ventricular emptying  results in hypertrophy of interventricular septum and left ventricle
Pre-participation screenings with ECG may allow for detection; echocardiogram is a better test (

4. Primary Electrophysiological Abnormalities
Long QT syndrome
Inherited = genetic heterogeneity
Acquired forms = medication-related or electrolyte imbalances (potassium or magnesium)
Often involves prolongation of cardiac repolarization

5. Primary Electrophysiological Abnormalities
Wolff-Parkinson-White syndrome (WPW)
Congenital cardiac abnormality where ventricle of heart receives electrical stimulation from accessory pathways from the atrium
Pathways result in pre-excitation
Ventricular myocardium receives electrical signal from atrium prior to normal conduction from the AV node
Associated with syncope and considered a potential cause of sudden death in athletes
Diagnosis can be made with ECG
Treatable by ablating accessory pathways from atrium to ventricle

6. Valvular Heart Disease
Mitral valve prolapse
Involves significant mitral regurgitation, ventricular ectopy, and a positive family history of sudden death
Diagnosis is made on physical examination with auscultation of a mild systolic to late systolic click
Most physicians adopt a permissive attitude toward sports participation

7. Valvular Heart Disease
Aortic stenosis
Should be easily identified in a pre-participation physical
Presence of harsh systolic murmur that increases on squatting and decreases with Valsalva maneuver
Patients with mild stenosis may participate in all competitive sports, while those with moderate stenosis should consider lower intensity sports

8. Valvular Heart Disease
Commotio Cordis
Cardiac concussion
Result of blunt, non-penetrating chest trauma
Athletes do not have antecedent heart disease
Occurs in younger athletes
Believed that they have more compliant chest wall facilitating transmission of force from blow through chest wall to myocardium
Direct blow must occur directly over heart within microseconds of T-wave peak

9. Management of Sudden Cardiac Death
Begins with basic life support
CPR changes to meet life support needs
30:2 compressions:breaths ratio for CPR at a rate of 100 compressions per minute
Use of AED

10. Pulmonary Problems Asthma
Chronic inflammatory disorder of the airways associated with hyper-responsiveness of the inflammatory system, reversible airflow limitation and respiratory symptoms
Most common chronic lung disease
Present with shortness of breath, wheezing, chest tightness, decreased expiratory airflow
Communication may be limited due to difficulty with airway exchange & dypsnea
May become sleepy and fatigued during attack

11. Pulmonary Problems
Triggered by allergen exposure, air pollutants, respiratory tract infections, exercise, weather changes, food, additives, drugs, and extreme emotional responses
Allergen-induced bronchoconstriction results from release of mast cell mediators (histamines, prostaglandins, leukotrienes) causing smooth muscle contraction
Airway restriction occurs due to edematous swelling of airway wall (with or without muscle spasm)
Increases in microvascular permeability and leakage leads to mucousal thickening and swelling of airway outside of smooth muscle
Without correction of obstruction, airway failure can occur

12. Pulmonary Problems Determining severity of asthma Classification
Clinical examination
Pulmonary function measures
Asthma symptoms
Need for rescue medicine
Classification
Based on symptoms prior to initiating treatment
Variable disease
General appearance is important
Sitting position
Use of accessory muscles (sternocleidomastoid)

13. Pulmonary Problems Treatment & Management
Rapid reversal of airflow obstruction
Medication
Variety of short-acting beta 2-agonists, including albuterol, are available
Long-acting beta 2-agonists are also available
Doses and dose intervals are individualized
Some may need delivery of medication via nebulizer
Both meter-dosed and nebulizer use have been found to be effective
Use of corticosteroids as soon as insufficient improvement seen with beta-agonist
Side effects = blurry vision, abdominal pain, gastric irritation, nausea, vomiting, frequent urination, increased thirst, numbness, confusion, excitement, depression, hallucinations

14. Diabetes Mellitus
Group of metabolic disorders resulting from defects in insulin secretion, action or both
Absolute insufficiency
Impaired insulin secretion and peripheral insulin resistance
Secondary to metabolic disease/disorder
Gestational diabetes
Type I = Insulin deficiency
Type II = Peripheral insulin resistance
(continued)

15. Diabetes Mellitus Type II diabetes
Thought of as a gradual process
May have to manage hypoglycemia, hyperglycemia, dehydration and electrolyte imbalances with exercise when disease first occurs
May require treatment in emergency room
With regard to medication/treatment, the AT and physician will need to supervise the patient
Older athletes with diabetes are at risk for cardiac disease, foot fractures, ocular complications

16. Diabetes Mellitus Diabetes & Exercise Main risk is hypoglycemia
Intensity, duration, and level of training can predispose to hypoglycemia, especially in poorly conditioned athletes
Planning is necessary to prevent
Result of poor management/dosing
Hyperglycemia
Diabetic ketoacidosis (often seen in type I diabetics)

17. Diabetes Mellitus Treatment for Ketoacidosis
Fluid and electrolyte therapy
Insulin therapy
Treatment of precipitating causes
Monitoring of urine output
Blood pressure
Mental status
Electrolytes
Glucose
Ketones
*Hyperglycemia = hyperosmolar state; often higher mortality rate

18. Mononucleosis Epstein-Barr virus = infectious agent in mononucleosis
Most commonly seen in adolescents and young adults
Characterized by prolonged incubation with a wide variety of clinical manifestations
Signs & Symptoms
Sore throat, fever, headache, lymphadenopathy, malaise, lymphocytosis
Must be mindful of spleen health

19. Sickle Cell Trait Risk factors = heat, hydration, altitude, asthma
Increased risk of splenic infarctions and rhabdomylosis
Athletes with a history of collapse with exercise should be well hydrated and monitored
Often complain of cramping pain in legs and back when sickling occurs

20. Hypertension (HTN)
Pre-hypertension = systolic BP or diastolic BP
Stage I = systolic BP or diastolic BP
Stage II = >160 systolic BP or >100 diastolic BP
Lifestyle modifications are critical for prevention, treatment and control of HTN

21. Hypertensive Emergency
HTN with acute impairment of the central nervous system, cardiovascular system or renal system
These organs are most directly affected by changes in BP
BP should be lowered to limit permanent damage to target organs