We are pleased to announce the addition of the “carotid intima-media thickness” test (CIMT) to the array of non-invasive diagnostic tools available at Athletic Heart SF.

The idea behind the CIMT is simple: an ultrasound image of the carotid artery can provide information about the health of the artery itself and, more generally, about the overall health of the cardiovascular system.

The ultrasound image can identify two conditions.  First, the ultrasound can detect if there is actual plaque build-up which, if advanced, can block the flow of blood and contribute to the risk of stroke.  Fortunately, advanced plaque build-up is relatively rare.

Second, even in the absence of plaque build-up, the thickness of the vessel wall (CIMT) can give a broad indication of cardiovascular health.  The intima is the name of the inner lining of a vessel wall, and the media is the middle layer.  Both are seen in the image below as the bright thin line and the thin darker band behind it.

Ultrasound image of a carotid artery. The thin intima-media layer is indicated by the arrow.

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Dr. Larry Creswell recently wrote a blog post summarizing the excellent research work that he and his colleagues have conducted to better understand the causes and conditions of death during triathlon events.

They have identified all triathlon fatalities that occurred during a 31-year period (1985-2016) and analyzed as many of the relevant factors as possible.  Their work was published in the journal Annals of Internal Medicine.

They observed the following:

• Average age was 47 with a wide range, but the risk of death increases dramatically with age.
• Most victims were male (85%).  This is also the case among marathon fatalities, as we saw previously.
• About 40% of victims were fist time participants, and none of them were elite triathletes.
• Almost 75% of fatalities occurred during the swim event, frequently within the first few minutes.  No specific swimming condition (e.g., water temperature) could be identified.
• Many of the biking segment deaths were traumatic in nature.

In many cases of non-traumatic death, preexisting heart or vascular disease was discovered at autopsy.  The article notes that:

“A surprising and important observation of this investigation, on the basis of autopsy reports, was the high frequency of clinically silent cardiac abnormalities (present in about 50% of the cases with an autopsy report available) that may have caused or contributed to sudden cardiac death.”

Dr. Creswell recommends that athletes should consider their heart health before participating.  Middle-aged men in particular should consider undergoing cardiovascular screening ahead of the event.  Read his excellent blog here.

-Dr. Accad

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I have just returned from attending a course on the “Prevention of Sudden Cardiac Death in Athletes,” hosted by the University of Washington medical school in Seattle.  It was a terrific conference at which academic leaders in the field gave updates on the latest research.

Dr. Aaron Baggish, from the Massachusetts General Hospital in Boston, summarized two recent studies that have persuasively shown that coronary calcifications are more common in long-term endurance athletes compared to more sedentary controls.

When the studies were published this past summer, Dr. Baggish was asked to write an editorial commentary to share his perspective.  That editorial was provocatively subtitled “Hearts of Stone.”  The phrase refers to the appearance on CT scans of hearts with heavily calcified arteries as shown in this image:

Calcium in coronary artery detected by CT scan.
Image attribution: Wikimedia Commons

Background

In the last several years, a few reports were published suggesting that endurance athletes may be more prone to having build-up of plaque and calcium in their coronary arteries.  Those reports presented a paradox, because we also know beyond any doubt that regular, moderate level exercise promotes cardiovascular health and longevity.  The studies raised the concern that exercise could be harmful after a certain point.Read more

The phrase “mammogram of the heart” refers to the heart scan that detects calcium build-up in the coronary arteries.  The phrase was coined by the pioneers in this technology to try to impress on the public and on the medical community the simplicity and value of this test.

Calcium in coronary artery detected by CT scan.
Image attribution: Wikimedia Commons

Just as a mammogram can identify cancer before it spreads, a heart scan can identify the presence of coronary artery disease before it causes symptoms.  And like the mammogram, the heart scan is easy to perform, uses a low amount of radiation, and is inexpensive.Read more

For most people, the cardiac stress test is the epitome of modern cardiology.  For some, the thought of undergoing one may also cause cold sweats…Perhaps a little introduction can help clarify what it is and what it does, and will minimize any misplaced fear about this helpful diagnostic tool.Read more

Image attribution: Julian Mason/Flickr.

Professional athletic trainer and sports journalist Ian MacMahan asked us that question as part of an article he published in The Atlantic Monthly magazine.

McMahan reported on recent research that raises concerns about ultra-endurance sports carried to an extreme level for many years.  Such an exercise regimen increases one’s chance of having arrhythmia, such as atrial fibrillation, and may also cause scarring in the ventricle of the heart.

Some cardiologists have sounded alarm bells, comparing such exercise regimens to a “toxin.”  In my opinion, it is not yet clear if long-term, high-intensity exercise alone is the cause of the problem, or if those affected have other factors that come into play.  Nevertheless, the research should not be dismissed.   Here are some highlights:Read more

We are delighted to have been featured in a San Francisco Chronicle article which highlights the rising interest in cardiac screening among athletes.  I was correctly identified as being among the growing number of cardiologists who believe that current screening tools are excellent and underutilized.

The article covered the subject of screening in general, so I would like to offer some additional information for clarification. Read more