David Ballantyne

Sudden cardiac death in sport.

Etude de la frequence des morts subites liees au sport. Causes: cardiopathies coronariennes, anomalies anatomiques cardiovasculaires, autres causes. Prevention : controle medical avant les activites, interdiction des efforts excessifs, reconnaissance des prodromes, prevention du choc thermique, abstention du tabac

Lipoprotein analysis in bodybuilders

The use of anabolic steroids to augment athletic performance is widespread. It is known that these drugs can adversely affect lipoproteins in normal volunteers, leading to increased cholesterol and low density lipoprotein and depressed high density lipoprotein. It has been shown that endurance type exercise can lead to beneficial effects on lipoproteins but the effects of power exercise are less clear-cut and made more difficult to interpret by prior anabolic steroid use. This paper details the lipoprotein results in 24 subjects, eight sedentary controls, eight non-steroid and eight steroid using bodybuilders. The results revealed no significant difference between sedentary controls and non-steroid bodybuilders suggesting that this form of training does not cause beneficial effects on lipoproteins. However, the steroid-using groups had higher cholesterol and low density lipoprotein, with lower high density lipoprotein, high density lipoprotein2, high density lipoprotein3 and high density lipoprotein2/high density lipoprotein3 ratios compared to the other two groups. The long-term effects of such results may be an increased risk of atherosclerosis and requires long-term follow-up.

Cardiovascular implications of strenuous exercise

The inspiration for marathon running as we know it today resulted from a mythological event. Pheidippides is reputed to have run from Marathon to Athens in 490 BC, bringing news of victory over the Persians. At the end of this effort, he is reputed to have collapsed and died [l]. In the year of the XV Olympiad in Los Angeles, it is appropriate that the association between sport and sudden death should be reviewed. The last decade has witnessed a dramatic increase in the popularity of many forms of sport. There has been a growth in leisure time available to the individual and an increase in his awareness of the probable benefits of exercise. In particular, exercise may diminish the risk of ischaemic heart disease. Mass participation sports such as jogging, squash (similar to raquet-ball, as played in the U.S.A.) and track and field athletics have benefited from this boom. There are now a reported 20 million joggers in the U.S.A., and there may be as many as 2 million in the United Kingdom [2]. This has resulted in a greater number of middle-aged, coronary prone individuals engaging in strenuous exercise. The boom in popularity has unfortunately been accompanied by a disturbing number of sudden deaths which have often excited considerable public concern. Sudden death in sportsmen has been of interest to investigators because of the apparent paradox of superior physical fitness and totally unexpected collapse and death, and has become the concern of participants, sports governing bodies, and the medical profession. With an increasing participation in strenuous exercise, it is important to consider the strength of the association between sudden death and sporting activity. Sudden death in association with sport is defined as death either during exercise or in the first hour post-exercise. The association between sudden death and exercise is in dispute. In one study of 2606 cases of sudden death, Vuori et al. [3] concluded that, in general, sport could not be incriminated as a cause of sudden death, but could precipitate cardiac

Assessment of Hitachi HME-20 pulse and blood-pressure monitor.

The performance of the Hitachi HME-20 pulse and blood-pressure (BP) monitor in comparison with direct intra-arterial BP recording and electrocardiographic monitoring is described. Highly significant (p less than 0.001) correlations were found between intra-arterial systolic and diastolic pressures and pressures recorded by the Hitachi monitor. Similarly, the electrocardiographically computed heart-rate, and that given by the Hitachi monitor were significantly correlated (p less than 0.001). Systolic blood-pressure was underestimated by a mean of -12 mmHg and tended to become more erroneous when intra-arterial pressure was greater than 150 mmHg. These results are comparable to more expensive pulse and blood-pressure monitors. We conclude that the instrument can reproduce a satisfactory estimate of heart-rate and blood-pressure and may be of particular use when a change of blood-pressure is of prime importance, rather than an absolute measurement.

Cardiac adaptations to training: relevance to angina pectoris

Exercise training has for many years been suggested as a useful adjunct to medical therapy for patients with ischaemic heart disease. While its popularity amongst the general public continues to grow, limitations in our ability to assess its effects on the heart have meant that, as cardiologists, our desire to encourage this popular upsurge in physical activity has been tempered by our inability to provide convincing evidence of its value to our patients. In particular the role of exercise in the rehabilitation of patients with angina pectoris is as yet unclear. This review addresses this question and states what has been proven to date and also the questions which remain to be answered. It also suggests some reasons why we have failed to provide answers so far, and ways in which new technology may be used in the future. Studies in animals, asymptomatic humans, and patients with ischaemic heart disease have demonstrated that training reduces the resting heart rate and double product of heart rate times blood pressure at any given level of exercise. This has the benefit of reducing myocardial oxygen consumption during exercise. There is also evidence that it increases end-diastolic volume and left ventricular wall thickness. Evidence for an increase in maximal myocardial oxygen consumption in angina is limited to one or two studies showing an improved maximum double product and to the occasional patient proven by echocardiography or nuclear studies to increase ejection fraction by training. Better selection of patients and use of new imaging techniques should provide further information in the near future.