Revista de Medicina Desportiva (English) September 2018 | Page 26
Figure 3 – Cardiac MRI images of athletes with HC – structural evaluation with various
patterns of parietal hypertrophy (A-D) and late enhancement (e-G).
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will be detected in case of cellular
injury/destruction. The location, the
pattern and the extension of the late
enhancement make the differential
diagnosis among various diseases,
for example between cardiomyopa-
thies, infiltration diseases, myocardi-
tis and coronary disease. In addition
to the diagnostic importance, late
enhancement is an important prog-
nosis marker, due to the fact that it
is an arritmogénico substrate, and it
is proven that the higher its extent
in the myocardium, the greater the
risk of potentially fatal ventricular
arrhythmias.
Specifically with HC, late enhance-
ment is located in the most hyper-
trophy segments and in the insertion
zones of the right ventricle in the
interventricular septum. However,
there are still a number of aspects to
be clarified regarding the presence
and relevance of late enhancement
in athletes. A significant percentage
of athletes, especially practition-
ers of high intensities sports, have
unspecific late enhancement in the
MRI. The causes for this fact remain
unknown, but some hypothesis
indicate the existence of genetic pre-
disposition, silent pre-myocarditis,
pressure overload in the pulmonary
artery induced by extreme exercise
and repeated microlesions.
Although imaging techniques are
in constant development and still
there are many aspects to under-
stand, cardiac MRI is currently a
fundamental tool in the evaluation
of the athlete, particularly under the
suspicion of a cardiomyopathy, but
its application is limited by high cost
and reduced accessibility.
It seems we can conclude that
complaints, family history and
cardiac auscultation remain
fundamental in the sports medical
exam...
The personal and family clinical his-
tory, with an emphasis on cardiovas-
cular history, as well as the objective
examination, are fundamental steps
in the sports medical exam, allow-
ing the suspicion of some potentially
fatal pathologies. Contrary to the
controversy and the dichotomy that
still persists regarding the inclu-
sion of the EKG on the evaluation
of competitive athletes that exists
between European countries and the
United States of America, the clini-
cal history and the objective exam
are consensual.
Specifically in the MCH, the pres-
ence of a positive family history
for sudden death or of HC is high-
lighted, especially in first-degree
family members, as well as personal
histories of syncope or arrhythmic
episodes, especially when triggered
by the physical exercise. A positive
family history is a red flag for the
presence of HC, especially if there
are pathological changes in the
EKG. In the physical examination
an important information will be
the presence of a systolic murmur
on the cardiac auscultation, which
according to its characteristics can
correspond to the obstruction on the
exit chamber of the left ventricle.