Épidémiologie de la mort subite du sportif

Introduction. – Lack of habitual physical activity is an important risk factor for cardiovascular disease. However apparently healthy athletes can die suddenly during exercise. Sudden death in athletes is not well documented. It is still particularly to identify high risk. What is now well known is that the resuscitation rate is lower than 2% in France while it reaches 20% in Seattle (USA).Fact's synthesis. – We have been commissioned by the CPLD to assess the incidence of sudden death during sport activity. The study began on January 1^st 2005. It should last four years.SAMU, firemen's department, but also referees and medical doctors responsible for sports federation will be asked to fill out a standardized form about the circumstances of death. All those informations will be centralized and analysed at the Inserm unit and verified by a medical committee.Conclusion. – This study will help to: 1) assess the incidence and describe circumstances of sudden death during physical activity; make proposals on resuscitation methods to improve chances of survival.     

Prolapsus valvulaire mitral: quand faut-il interdire le sport?

Mitral valve prolapse (MVP) is the most common cardiac anomaly in the young (17% of women under thirty in the Framingham study and 5% of the general population). Cardiac dysrhythmias, left ventricular failure, sudden death are possible complications which may cause concern when deciding about eligibility for sports participation. How likely are they to appear in the athlete? When can competition be authorized and when not? The case of a cyclist who died during a race is reported here. His MVP had been diagnosed, it was highly arrhythmogenic and competition had been forbidden. This eventuality is fortunately exceptional and in the great majority of cases, idiopathic asymptomatic MVP does not justify any restriction for sports participation. Competition is allowed except in case of mitral insufficiency with left ventricular failure and/or arrhythmia triggered by exercise, exercise-induced functional symptoms (pre-syncope or syncope, thoracic pain) or a family history of sudden death.     

Sudden death and physical activity in athletes and nonathletes

Among young athletes, sudden deaths are predominantly associated with cardiomyopathies, coronary artery abnormalities and myocarditis, but coronary heart disease is a reality already in this group. The absolute risk of sudden death is, however, low and the benefits of routine medical screening are small. If an athlete has had any symptoms that arouse suspicion of cardiac disease, the athlete must be meticulously investigated, as an underlying life-threatening illness may be present. Among all nonathletes, as well as athletes ≥30 years, the predominant cause of sudden death is coronary heart disease. A large number of studies have provided strong evidence suggesting the benefits of physical activity regarding prevention of cardiovascular death and disease. The immediate risk for sudden death is higher during physical activity than during other times, especially among usually sedentary individuals, but inactivity is much more dangerous in the long run. Regular exercise at moderate intensity gives large benefits with small risks. The benefits of irregular and intensive exercise are less clear and the risks higher. For the individual without known heart disease who exercises regularly, the risk for sudden death during physical activity is extremely small.     

Troubles du comportement alimentaire chez le sportif

The increase in the prevalence of eating disorders in the general population and in athletes requires a better understanding of this pathology. The purpose of this literature review is to explain the various aspects of eating disorders (semiology, aetiology and physiological consequences). Athletes constitute a unique population, and the impact of factors such as training, eating pattern, extreme diets, and psychopathological profile must be evaluated differently from this impact in nonathletes. Therefore, the concept of anorexia athletica (AA) has been introduced.     

Aerobic Dance Injuries

In brief: During an 18-month period 61 patients who had problems associated with aerobic dance were evaluated. Fifty-four had overuse injuries, including all but two of the 24 patients who were instructors. The authors used three-phase radionuclide scintigraphy to evaluate some of the injuries and prescribed balanced orthoses for the management of pain related to lower extremity malalignment. Most of the injuries occurred when people began exercising vigorously after a period of inactivity.     

住院老年人猝死45例临床分析

本文对45例老年猝死原因分析。室性心律失常是任何原因所致的急慢性心力衰竭、急性心肌梗塞、心肌病及肺心病等的主要致死因素。有原发性室颤病史者有高度再发猝死的危险;心前区隐痛不适,烦燥不安,胸闷气短,便意频发及抽搐等是猝死先兆;疲劳、暴饮暴食、情绪波动是诱发恶性心律失常的主要因素。对高危猝死者宜住入心脏病监护病房(ICU)监护。     

Sudden death in case of syringomyelia

Summary Report of a case of sudden death in a 28 year old man, with known disease of the spinal cord. Autopsy showed hydromyelia, syringomyelia and a moderate intoxication by ethyl alcohol, which in combination are considered to have caused the death.

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Zusammenfassung Bericht über den plötzlichen Tod eines 28jährigen Mannes mit einer klinisch bekannten Erkrankung des Rückenmarks. Bei der Autopsie wurden eine Hydromyelie und Syringomyelie festgestellt. Es bestand eine mittelgradige Alkoholisierung. Die Kombination dieser Gegebenheiten wird als Todesursache angesehen.

     

Vieillissement et désaturation oxyhémoglobinée du sportif

A extreme athlete can be defined as an athlete able to exceed the limit of one function in such a way that failure of another function appears. For example extreme athletes in endurance events are able to exceed the normal limits of cardiac output but show a hemoglobin desaturation by the end of exhaustive exercise. Usually, these athletes have had a maximal oxygen uptake (O₂ max) greater than 65 ml·min⁻¹. The aim of this study was to determine whether hemoglobin desaturation occurs in master athletes and whether aging facilitates this phenomenon. Nine master athletes aged 62–75 participated to this study. They practised leisure cycling 5000 to 14000 km per year. Hemoglobin saturation was measured non-invasively using the transcutaneous method during both incremental exercise until exhaustion and constant load exercise at 70% and 90% of O₂ max for a 15 min period. We considered that there was a desaturation if SaO₂ decreased by 4%. During maximal incremental exercise we observed desaturation in six subjects. These results were confirmed during constant load exercise at 90% of O₂ max. It is interesting to note that one of the subjects, whose desaturation was 8% during incremental exercise, showed a desaturation of 16% at the 15th minute of constant load exercise at 90% O₂ max. In our master athletes this desaturation was observed for O₂ max and pulse oxygen values respectively equal to 1/2 and 2/3 of the values of young athletes. Aging thus seems to facilitate the mechanisms of athlete's desaturation. These mechanisms are highly speculative. One can, however, suspect the role of relative hypoventilation, a ventilation-perfusion inequality, and a diffusion limitation. A decrease of red blood cell transit time in the pulmonary capillary may also play a role, as there is a decrease in pulmonary capillary volume in master athletes over 60 years and that maximal cardiac output does not seem to decrease with age.