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). Somos uma equipa que aposta na melhor qualidade possível para os resultados mais perfeitos. A formação contínua e a experiência dão-nos essa garantia de qualidade. Usamos os melhores sistemas tecnológicos: • Sistema de Imagiologia • Sistema CAD/CAM • Tecnologia PRGF (plasma rico em fatores de crescimento). Patologias : • Higiene Oral • Prostodontia Fixa e Removível • Implantologia • Ortodontia • Periodontia • Estética Dentária • Odontopediatria • Endodontia • Cirurgia Oral • Cirurgia Maxilofacial • Oclusão Horário: Segunda a Sexta-feira: 10:00 às 13:00 e 14:00 às 19:00 Sábado: 10:00 as 13:00 Serviço de urgências 24 Horas 964000653 Rua José Coutinho, N.º 20, 1.º Andar Sala 7 4465-180 S. Mamede Infesta – 229011881 Lopesmachassociados@gmail.com 24 september 2018 www.revdesportiva.pt 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.