Heart Disorder: The Disorder All Athletes Should Know About !
"Under normal conditions, the heart conforms to a certain size and thickness. In hypertrophic cardiomyopathy, the heart muscle becomes overgrown and the walls of the heart are abnormally thick." A thickening of the heart's walls can lead to an abnormal heart rhythm that can cause sudden and unexpected death in athletes.
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The following strategy is recommended at present:
1.- From each individual seen because of the diagnosis or suspicion of Brugada syndrome take a medical history with special attention to symptoms that may suggest arrhythmias like syncope, presyncope, dizziness, palpitations.
Special attention must also be given to a family history of unexplained syncope, sudden death and unexplained traumatic deaths like car accidents that may result from loss of consciousness. Do not accept a diagnosis of the causes of sudden death or syncope unless proven. In 50% of the cases of sudden death in families with Brugada syndrome the cause of sudden death is Brugada syndrome, but in the other half the cause is a myocardial infarction or is unclear.
2.- Physical examination will usually be normal, but it should be carefully done to exclude any condition that may simulate Brugada syndrome.
3.- Record a 12-lead resting electrocardiogram and an electrocardiogram after the administration of either:
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a.- ajmaline 1mg/kg body weight iv in 5 minutes, or
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b.- flecainide 2 mg/Kg body weight iv in 10 minutes, or
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c.- procainamide, 10 mg/kg body weight iv in 10 min.
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These tests should be performed in an environment with facilities for CPR because in 0.5% of tests the patient may develop ventricular fibrillation. Ajmaline is the preferred drug because of the very short half-life. If necessary, consider approval of the test by your local ethical committee before performing it.
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A pharmacologic test is considered positive if an additional 1 mm ST segment elevation appears in leads V1, V2 and V3. The ST segment elevation is measured 0.08 s after the J wave.
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4.- All positive individuals should undergo programmed ventricular stimulation to assess inducibility of ventricular arrhythmias and to measure the conduction intervals (the H-V interval is frequently prolonged in Brugada syndrome).
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Programmed ventricular stimulation should at least include two different pacing cycle lengths from the right ventricular apex and at least two ventricular premature beats.
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