Cardiovascular Medicine Book

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Arrhythmias in Athletes

Aka: Arrhythmias in Athletes, Dysrhythmias in Athletes
  1. See Also
    1. Sudden Death in Athletes
    2. Athletic Heart Syndrome
    3. Pre-participation History
    4. Sports Participation Disqualifiers
  2. Causes: Non-Cardiac Causes
    1. Lack of sleep
    2. Volume depletion
    3. Caffeine Intake
    4. Emotional stress
    5. Anemia
    6. Illicit Drug Use
    7. Viral illness
    8. Personality Disorder
  3. Causes: Cardiac Dysrhthmia types
    1. Conduction defects
      1. Underlying Coronary Artery Disease (over age 40)
      2. Manifested with rising level of ischemia
    2. Enhanced automaticity
      1. Sympathetic load
      2. Increased Afterload stimulates stretch receptors
      3. Irritability of pacers due to ischemia
    3. Re-entry phenomena: Accessory bundles
      1. Wolff-Parkinson-White Syndrome
      2. Long-Ganong-Levine Syndrome
    4. Re-vascularization
      1. Post thrombolsis
      2. Post arteriospasm
  4. Symptoms: Red Flags
    1. Decreased Cardiac Output
      1. Dizziness
      2. Vision changes
      3. Lightheadedness
      4. Syncope
      5. Nausea
      6. Chest discomfort
      7. Angina
    2. Wall motion abnormality
      1. Awareness of heart beat
      2. Palpitations
  5. Signs: Red Flags
    1. Resting Tachycardia
    2. Hypertension
    3. Chest deformity (e.g. Pectus Excavatum)
    4. Suspicious cardiac murmur
  6. Diagnostics: EKG - Normal Rhythm variants in athletes
    1. See Athletic Heart Syndrome
    2. Sinus Bradycardia (>30 bpm)
    3. First degree AV Block
    4. Mobitz I Second degree AV Block (Wenckebach)
    5. Junctional rhythm
    6. Premature Beats: PACs and PVCs
    7. Incomplete Right Bundle Branch Block
    8. Isolated QRS voltage criteria for LVH
      1. Abnormal if associated left atrial enlargement, Left Axis Deviation, ST depression, T inversion or Q Waves
  7. Diagnostics: EKG - Abnormal findings suggesting Cardiomyopathy
    1. T Wave inversion >1 mm in >1 lead v2-6, II and avF or I and avL (except III, aVR, V1)
    2. ST segment depression >0.5mm in >1 lead
    3. Pathologic Q waves >3 mm or >40 ms in >1 lead (except III and aVR)
    4. Complete Left Bundle Branch Block
    5. Wide QRS >140 ms duration
    6. Left Axis Deviation
    7. Left atrial enlargement
    8. Right Ventricular Hypertrophy
  8. Diagnostics: EKG - Abnormal findings suggesting life threatening arrhythmia risk
    1. QT Prolongation
    2. Brugada Syndrome
      1. Right bundle branch with ST Elevation in the anterior leads
    3. WPW Syndrome (ventricular preexcitation)
      1. Short PR Interval and Delta wave at QRS suggests accessory pathway
    4. Third degres AV Block
      1. Presents as Syncope
      2. Suggests underlying Coronary Artery Disease
    5. Severe Sinus Bradycardia (<30 bpm)
    6. Ventricular arrhythmias
    7. Atrial tachyarrhythmias (e.g. Atrial Fibrillation or Atrial Flutter)
  9. References
    1. Drezner (2013) Br J Sports Med 47:122–4 [PubMed]

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