Understanding Cardiovascular Conditions in Athletes

Valve Disorders

Valve disorders can be caused by congenital deformities or acquired diseases. Stenosis (narrowing) restricts blood flow. Structural malformations prevent the valve from closing properly, causing murmurs. These often present with other cardiac conditions/disorders. Athletes with electrical (arrhythmia) or structural changes (hypertrophy) may have limitations on their ability to play.

Mitral Valve Prolapse

Mitral valve prolapse prevents the valve from closing properly and is the most common valve disorder. Return to play (RTP) is often possible if there is no significant family history.

Systemic Hypertension

Systemic hypertension is common in athletes but is not the etiology of sudden cardiac death (SCD). The pathogenesis involves both genetic and environmental factors. Management includes lifestyle modifications and medication. Complications may lead to restrictions on activity.

Hypertension Classification

• Normal: <120 sys, <80 dia
• Prehypertension: 120-139 sys, 80-89 dia
• Stage 1: 140-159 sys, 90-99 dia
• Stage 2: 160+ sys, 100+ dia

Coronary Artery Disease (CAD)

CAD is the most common cause of exercise-related SCD. Athletes with CAD are at increased risk.

Deep Vein Thrombosis (DVT)

DVT can occur post-surgically or due to immobilization. Signs and symptoms include ecchymosis, edema, pain, tenderness, and neuralgia.

Anemias

Anemias involve a decrease in erythrocyte quantity or hemoglobin quantity or quality.

Dilutional Pseudoanemia

Aerobic training increases blood volume. The increase in plasma is greater than the increase in red blood cells (RBCs), leading to a decrease in hematocrit in elite aerobic athletes.

Hemolytic Anemia

Hemolytic anemia involves premature hemolysis and can occur in high-impact aerobic sports. Severe levels are rare.

Iron Deficiency Anemia

Iron deficiency, with or without anemia, is the most common anemia. It affects 1-3% of the population worldwide, with anemia, and 20% of young females without anemia. Causes include menses, gastrointestinal bleeding, inadequate diet, and hematuria.

Sickle Cell Disease

Sickle cell disease is an inherited blood disorder characterized by abnormal hemoglobin. It is a permanent condition with no cure and is prevalent in individuals of equatorial origin. Sickle cell trait (SCT) does not typically restrict activity (~8-10% of cases). Sickle cell anemia (SCA) rarely allows for sports participation (~1% of cases).

Exertional Sickling

Exertional sickling is an intermittent phenomenon triggered by exertion, increased temperature, hypoxia, and acidic conditions. It can lead to rhabdomyolysis.

Exertional Rhabdomyolysis

Exertional rhabdomyolysis is the sudden metabolic breakdown of muscle. Myoglobin and enzymes enter the bloodstream, potentially causing acidosis, organ failure, intravascular coagulation, heat illness, and death. SCT is a risk factor.

Hemophilia A

Hemophilia A is an often unrecognized hereditary disease that primarily affects males, with females being carriers. A tailored emergency action plan (EAP) is essential.

Pulmonary Embolism (PE)

PE is an occlusion of pulmonary vessels. 90% of cases originate from the lower extremities or pelvis and often follow DVT.

Aneurysms

Aneurysms are localized weaknesses in blood vessel or cardiac walls, often caused by atherosclerosis or infection. Rupture can occur in the aorta, iliac, subclavian, and cerebral arteries.