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Case Study B.C. was a Division I varsity basketball guard at a large Midwestern university. He had a history of “fainting” on multiple occasions, even once while taking a shower ­ after a game. Both his coach and the team doctor felt the fainting, at least in that instance, was due to the hot shower. Other than ­ these fainting episodes, B.C. was in good physical shape with no known medical prob­ lems. Then he had another fainting episode while simply sitting on the bench during a game. Once again, he was evaluated by the coach and team physician and given fluids and electrolytes . He played the remainder of the season with no further incidents and was repeatedly reminded to stay hydrated and take in electrolytes. During a game the next season, B.C. collapsed on the court and did not awake immediately . The team physician instructed the coach to call 911 and started CPR. When the ambulance arrived, the emergency crew immediately used a defibrillator and ­ were able to successfully shock the patient back to life. B.C. was taken to the hospital, where he was diagnosed with long QT syndrome, an inherited disorder characterized by prolongation of the QT interval on the ECG and a propensity to develop a lethal arrhythmia termed torsade de points, which can lead to sudden cardiac death (SCD). Subsequently, B.C. was treated with an implantable cardioverter-­ defibrillator (ICD). B.C. was fortunate to be resuscitated; he could easily have succumbed to any one of­ these “fainting” episodes. ­ There ­ were several missed opportunities for B.C. to have been properly evaluated. A ­ simple ECG could have made the diagnosis. Unfortunately for B.C., the Bethesda Conference guidelines (1) would have recommended that he not participate in basketball ­ because it is a high-­ intensity sport. In addition, an ICD, once implanted, is another reason to recommend against participation in high-­ intensity sports. INTRODUCTION SCD is the leading medical cause of death in athletes. The precise incidence is unknown and annual rates vary widely, from 1 per 917,000 participants to 1 per 3,000 participants, but the range is more likely to be between 1 per 40,000 to 1 per 80,000. African American athletes and basketball players appear to be at higher risk (2). It is imperative that high-­ intensity and high-­ level athletes (e.g., Division I college athletes, professional athletes, Olympic athletes) be screened for the possibility of SCD. This means taking a thorough medical history, including a history of syncope CHAPTER 26 Sports Cardiology Giovanni Campanile History of Marathon ­ Running / 319 inactivity decreased to 27.6% in 2015 from 28.3% in 2014 (where it had climbed from 26.9% in 2010). The council divided activity levels into high-­ calorie activities and more than 51 exercise events per year. It found that the highest participation at ­ these levels ­ were members of Generation Y, or millennials, (born between 1980 and 1999) with a participation rate of 49%; ­ those with the lowest participation rate ­ were baby boomers (born between 1945 and 1964) at 37%; and in between ­ were members of Generation X (born between 1965 and 1979) at 47.7%, and Generation Z (born ­ after 2000) at 46%. Some 35 million youth participated in sports, 7.7 million of them in high school and 450,000 in college. ­ There­ were more than 19 million recreational runners and 175,000 triathletes. ­ People who completed marathons increased from 353,000 in 2000 to more than 500,000 in 2011, and during the same period triathlon membership ­ rose from 21,000 to 146,000 (6). HISTORY OF MARATHON­RUNNING The first recorded sports cardiology casualty was Phidippides (530–490 b.c.), a foot courier for the Greek government. During the war between Greece and Persia, he once ran 150 miles over two days. ­ Later he ran 25 miles, from Marathon to Athens, to announce that the Greeks had defeated the Persians. As soon as he arrived in Athens and made the announcement, he collapsed and died suddenly. ­ Today, this is sometimes referred to as Phidippides cardiomyopathy, the cardiomyopathy of endurance athletes. The ancient Olympic Games started in Greece around 776 b.c., and the long-­ distance run in ­ those games was much shorter than ­ today’s 26.2 miles. ­ Until the 1908 Summer Olympics in London, ­ England, the distance of the modern marathon was 25 miles. At that point, it was officially extended to 26.2 miles at the request of the Queen, so...


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MARC Record
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