Revista de Medicina Desportiva (English) July 2018 - Page 4

Rev . Medicina Desportiva informa , 2018 ; 9 ( 4 ): 2

Interview

Dr . Hélder Dores Cardiologist . Hospital das Forças Armadas and Hospital da Luz . Lisbon
Who is Dr . Helder Dores ?
I ’ m a cardiologist and a doctor at Hospital das Forças Armadas and Hospital da Luz in Lisbon , where I coordinate the sports cardiology . Also , I ’ m assistant at NOVA Medical School and I ’ m doing a PhD program .
You have been very dedicated to sports cardiology . Where does this interest come from ?
First of all , it comes from the passion for sport in general , as a practitioner and spectator , and several circumstances came together and created this inevitable interest . On military medicine , sports cardiology is of paramount importance due to the evaluation of persons subjected to intense exercise training . Realizing that this medical specialty could be differentiating , I performed an internship in a reference center in London , under the guidance of Professor Sanjay Sharma . Altogether , it came out that a significant part of my clinical practice is sports cardiology .
Despite the rigorous sports medical evaluation ( SME ), with many cardiologic exams , sudden death still occurs in sport . Are we failing ?
I wouldn ’ t say we are failing , but still there is so much to do . It is utopian to say that the risk of sudden death may be null because several causes are paroxysmal , and it might be the first disease manifestation . However , the correct Interpretation of the ECG allows the identification of most causes of sudden death in athletes , directly or after additional investigations . Due to the inability to identify all subjects at increased risk , and as the majority of the cases occur during or immediately after the exercise , is crucial to have medical emergency equipment and trained professionals at the sports venues .
Certainly , the SME in the young is different from the one for the elderly practitioner ...
The main objective of SME is to identify athletes with increased risk of sudden death , whose epidemiology varies with the age range , justifying a different assessment . In the young athletes the ECG is essential because the main causes of sudden death are hereditary diseases , while among veterans the main cause is coronary artery disease , emphasizing the importance of risk stratification and early detection of coronary artery disease with risk scores and additional exams , where the stress testing is the most used . Since risk stratification based on clinical characteristics and stress testing has some limitations , more objective markers have been developed that may change the paradigm of this evaluation in the future .
And should be different for the leisure practitioner and for the athlete ?
In my opinion , the level of the athlete should not be the main factor to differentiate the methodology of evaluation . This dichotomy is controversial – an athlete can be registered in golf or run recreationally trails longer than 100km ! The increased number of recreational sports practitioners is healthful , but carries additional risks . Many people begin regular exercise training on the middle-age , with risk factors or even previous cardiovascular events . At least the individuals involved in organized sports should be subjected to some kind of evaluation . However , we must not forget that adding so many variables , especially bureaucratic , can reduce the adherence to a healthy lifestyle . Other problem is the difference between to do a SME and just fulfill the form ! In short , it is needed to optimize the evaluation of athletes and to discuss the pros and cons in extending this assessment to recreational sport .
The inclusion of echocardiogram in the SME routine is discussed . When should it be performed ?
In my opinion , the echocardiogram should not be a routine examination due to both clinical and economic reasons . It is first-line exam in the presence of symptoms and “ pathological ” changes on ECG . It is also recommended for the overgrading medical exam and before some specific competitions . A strategy that can be discussed is to perform at least one echocardiogram on the youth ages to exclude congenital heart disease , but the costs of this strategy would be unfeasible for such widespread application .
... and what are the other more recent exams that can help define the fitness of the candidate for exercise ?
Among the latest exams the MRI is the gold-standard to exclude structural pathology , and it makes sense in the presence of a “ pathological ” ECG and a normal echocardiogram . Another increasingly used exam , especially in veteran athletes with high cardiovascular risk , chest pain or changes on the stress testing , is the cardiac Angio-CT . Besides the high negative predictive value to exclude coronary disease , it can identify other changes associated with sudden death , such as anomalous coronary origin and coronary bridging .
In the future , the genetic evaluation of the athlete will certainly be a routine exam ...
I don ’ t know if it will be routine , but it could be applied to multiple situations . For the evaluation of physical capacities , partially genetic determined , there are available tests that define the individual profile and evaluate some variables , such as aerobic capacity , strength or predisposition to injury . In this way , it may be possible to identify the type of exercise most appropriate for each individual and to predict the ability to succeed . Clinically , genetic evaluation will allow an earlier diagnosis of hereditary diseases , especially in cases in the ‘ gray zone ’ with overlap between physiological and pathological changes .
2 july 2018 www . revdesportiva . pt
Rev. Medicina Desportiva informa, 2018; 9(4):2 emergency equipment and trained professionals at the sports venues. Certainly, the SME in the young is different from the one for the elderly practitioner... Dr. Hélder Dores Cardiologist. Hospital das Forças Armadas and Hospital da Luz. Lisbon Who is Dr. Helder Dores? I’m a cardiologist and a doctor at Hospital das Forças Armadas and Hospital da Luz in Lisbon, where I coordinate the sports cardiology. Also, I’m assistant at NOVA Medical School and I’m doing a PhD program. You have been very dedicated to sports cardiology. Where does this interest come from? First of all, it comes from the passion for sport in general, as a practitioner and spectator, and several circum- stances came together and created this inevitable interest. On military medicine, sports cardiology is of par- amount importance due to the evalu- ation of persons subjected to intense exercise training. Realizing that this medical specialty could be differen- tiating, I performed an internship in a reference center in London, under the guidance of Professor Sanjay Sharma. Altogether, it came out that a significant part of my clinical prac- tice is sports cardiology. Despite the rigorous sports medical evaluation (SME), with many cardiologic exams, sudden death still occurs in sport. Are we failing? I wouldn’t say we are failing, but still there is so much to do. It is utopian to say that the risk of sudden death may be null because several causes are paroxysmal, and it might be the first disease manifestation. However, the correct Interpretation of the ECG allows the identification of most causes of sudden death in athletes, directly or after additional investiga- tions. Due to the inability to identify all subjects at increased risk, and as the majority of the cases occur during or immediately after the exercise, is crucial to have medical 2 july 2018 www.revdesportiva.pt The main objective of SME is to iden- tify athletes with increased risk of sudden death, whose epidemiology varies with the age range, justify- ing a different assessment. In the young athletes the ECG is essential because the main causes of sudden death are hereditary diseases, while among veterans the main cause is coronary artery disease, emphasiz- ing the importance of risk stratifica- tion and early detection of coronary artery disease with risk scores and additional exams, where the stress testing is the most used. Since risk stratification based on clinical characteristics and stress testing has some limitations, more objective markers have been developed that may change the paradigm of this evaluation in the future. And should be different for the leisure practitioner and for the athlete? In my opinion, the level of the ath- lete should not be the main factor to differentiate t HY]Bو][X][ۋ\X^H\˜۝ݙ\X[8$[]]H[BY\\Y[܈[XܙX][ۋB[HZ[ۙ\[ L HHB[ܙX\Y\وXܙX][ۘ[ܝX][ۙ\\X[[ ]\Y\Y][ۘ[\ˈX[H[BY[Y[\^\\HZ[[ۂHZYKXYK]\Xܜ܂][][\\[ݘ\[\][˂]X\H[]YX[[Y[ܙ[^Yܝ[HXBXYYH[و][X][ۋ]\H]\ܙ]]Y[X[H\XX\\XX[B\X]Xܘ]X[YXHHY\B[HHX[HY\[K\؛[H\HY\[H]Y[HQH[\[[HܛHB[ܝ ]\YYY[Z^HB][X][ۈو]]\[\\H[ۜ[^[[\˜\\Y[XܙX][ۘ[ܝ H[\[ۈوX\[ܘ[B[HQH][H\\\Y [[]H\ܛYY’[^H[[ۋHX\[ܘ[B[HH][H^[Z[KB[ۈYH[X[[XBZXX\ۜˈ]\\ [[H^[B[H\[Hو[\\[']X[8'H[\ۈPˈ]\˜[X[Y[Y܈Hݙ\ܘY B[YYX[^[H[YܙHYBXYX\]][ۜˈH]YB][H\\Y\\ܛB]X\ۙHX\[ܘ[HۈB[]Y\^YHۙ[][X\\X\K]Hو\œ]YH[H[X\XH܂XY\XY\X][ۋ[]\HH\[ܙBX[^[\][[Y[BH]\وH[Y]H܂^\\O[[ۙH]\^[\HTH\H \[\^YHXB\[]K[]XZ\[B[H\[HوH8']X[8'BP[HܛX[X\[ܘ[K[\[ܙX\[H\Y^[K\XX[H[]\[]]\]Y\[ݘ\[\\\Z[܂[\ۈH\\[\B\XX[[P \Y\HYY]]HYX]H[YH^YBܛۘ\H\X\K][Y[YH\[\\X]Y]Y[X] X\[X[\ܛۘ\BܚY[[ܛۘ\HY[˂[H]\KH[]X™][X][ۈوH]]H[\Z[HHH][H^[KH۸&]ۛY][H][K]][H\YY][\H]XKB[ۜˈ܈H][X][ۈو\X[\X]Y\\X[H[]X]\BZ[Y \H\H]Z[XH\]Y[HH[]YX[ٚ[H[][ BX]HYH\XX\X\Y\ؚX˜\X]K[܈Y\][ۈš[\K[\^K]X^HHXBY[YHH\Hو^\\H[\X]H܈XX[]YX[[œYXHX[]HXYY [KB[K[]X][X][ۈ[[[X\Y\XYۛ\و\Y]\H\BX\\\XX[H[\\[H8&ܘ^Bۙx&H]ݙ\\]Y[\KBX[[]X[[\