Left ventricular false tendons and electrocardiogram repolarization abnormalities in healthy young subjects

AIM To describe echocardiographically left ventricular false tendon characteristics and the correlation with ventricular repolarization abnormalities in young athletes.METHODS Three hundred and sixteen healthy young athletes from different sport disciplines were evaluated from 2009 to 2011 during routine screening for agonistic sports eligibility. All subjects, as part of standard preparticipation screening medical evaluation, underwent a basal and post step test 12-lead electrocardiogram(ECG). The athletes with abnormal T-wave flattening and/or inversion were considered for an echocardiogram evaluation and an incremental maximal exercise test on a cycle ergometer. Arterial blood pressure and heart rate, during and after exercise, were also measured.RESULTS Twenty-one of the 316 subjects(6.9%) showed false tendons in the left ventricle. The majority of false tendons(52.38%) were localized between the middle segments of the inferior septum and the lateral wall, 19.06% between the distal segments of the septum and the lateral wall, in 5 subjects between the middle segments of the anterior and inferior walls, and in one subject between the middle segments of the anterior septum and the posterior wall. ECG abnormalities, represented by alterations of ventricular repolarization, were found in 11 subjects(52.38%), 90% of these anomalies were T wave abnormalities from V1 to V3. These anomalies disappeared with an increasing heart rate following the three minute step test as well as during the execution of the maximal exercise.CONCLUSION Left ventricular false tendons are frequently localized between the middle segments of the inferior septum and the lateral wall and are statistically associated with ventricular repolarization abnormalities.

Myocarditis in athlete and myocardial bridge:An innocent bystander?

Myocarditis is a bacterial or viral inflammatory disease,often unnoticed or misdiagnosed.Athletes with myocarditis must stop practicing their activity since International medical Literature described some cases of sudden death.In the present report,we describe a case of an asymptomatic,apparently healthy,competitive athletes,who was diagnosed a myocarditis and as incidental finding a myocardial bridging.We focused the attention on the importance of anamnesis,electrocardiogram and athletes' entourage for the diagnosis of such insidious pathologies and we evaluated the follow up,focusing the attention on electrocardiogram changes as well as on restitution ad integrum and prognosis,especially for the athletes.

Effects of physical activity in Parkinson's disease: A new tool for rehabilitation

Parkinson's disease(PD) is a common neurodegenerative disease characterized by bradykinesia, tremor, rigidity, and postural instability. Motor disorders are composite and combined, adversely affecting the patient's health. Tremor and rigidity are correlated with worsening manual dexterity as well as postural changes such as akinesia and camptocormia. Moreover, gait alteration as well as postural instability, with consequent impairment in balance, increase the risk of falls. It is well known that these symptoms respond poorly to pharmacologic therapy in PD patients. Physical therapy is the most effective non-pharmacological aid to PD patients. Available data in the literature indicate that any rehabilitation protocol has to focus on: cognitive movement strategies, cueing strategies, and improved physical capacity and balance. Different training programs for PD patients have been designed and evaluated but only specific training strategies, tailored and individualized for each patient, may produce improvements in gait speed and stride length, decrease motor and balance symptoms and improve quality of life. Furthermore, aerobic training may improve muscle trophism, strength and mobility. It seems reasonable to state that tailoredphysical activity is a valid tool to be included in the therapeutic program of PD patients, considering that this approach may ameliorate the symptoms as well as the overall physical incapacity, reduce the risk of falls and injuries, and ultimately improve quality of life.

Pre-participation screening for the prevention of sudden cardiac death in athletes

Pre-partecipation screening is the systematic practice of medically evaluating large populations of athletes before participation in sport activities for the purpose of identifying abnormalities that could cause disease progression or sudden death.In order to prevent sudden cardiac death(SCD),cardiovascular screening should include a strategy for excluding high-risk subjects from athletic and vigorous exercise.There are two major screening programmes in the world.In the United States competitive athletes are screened by means of family and personal history and physical examination.In Italy there is a mandatory screening for competitive athletes,which includes a resting electrocardiogram(ECG)for the detection of cardiac abnormalities.The most important issue to be addressed is whether a screened subject is really guaranteed that she/he is not suffering from any cardiac disease or at risk for SCD.Conceivably,the introduction of echocardiogram during the pre-participation screening,could be reasonable,despite the discrete sensitivity of ECG,in raising clinical suspicions of severe cardiac alterations predisposing to SCD.It is clear that the costbenefit ratio per saved lives of the ECG screening is abenchmark of the Public Health policy.On the contrary,the additional introduction of echocardiography in a large population screening programme seems to be too much expansive for the Public Health and for this reason not easily practicable,even if useful and not invasive.Even if we strongly believe that a saved life is more important than any cost-efficacy evaluation,the issue of the economical impact of this approach should be further assessed.