I had the pleasure of giving a talk at UCSF last week.  The talk was part of the “Cycling to Health” series, which is one of the UCSF Osher Mini Medical School programs offered to the general public.

The talk was videotaped and will be uploaded on the UCTV network in a few months, but I thought I would summarize here for you the main points that I addressed.

In the first part of the talk, I described the normal cardiac adaptions to high intensity cycling, and I made some comments to distinguish cycling from other sports and other endurance sports.

Cycling is considered a sport with high dynamic as well as high static stress.  This causes the cardiovascular system of cyclists to adapt in some major ways.  In fact, there is some data to show that cyclists have the biggest hearts among all athletes!Read more

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

Your Heart Health in a Heartbeat – Episode 5

Transcript:

Hello everyone and thank you for joining me.

I’m Dr. Accad, medical director of Athletic Heart of San Francisco, and today I would like to talk about high blood pressure in relationship to exercise.  I am doing this in light of a document recently published jointly by the American College of Cardiology and American Heart Association that makes some recommendations for competitive athletes who have blood pressure concerns.Read more

Many of our patients tell us that they are athletic, not athletes. How do we decide who’s an athlete and who’s not?

The American College of Cardiology recently released the proceedings from a meeting on sports and exercise cardiology that took place in October 2012.  The document states that there is no agreement on how to define an athlete!Read more

Last Sunday, an experienced marathon runner in his mid-50’s collapsed a few yards from the finish line during the Road2Hope half-marathon in Hamilton, Ontario.  Regrettably, the paramedics were unable to resuscitate him.  This unfortunate story illustrates the rare but tragic phenomenon of exercise-induced sudden cardiac arrest.Read more

The American Heart Association recently published an excellent document that very comprehensively examines the  12-lead electrocardiogram (ECG) as a tool to screen populations of youth and young adults (age range 12-25).

This will be a very useful reference document for years to come.  It covers medical, technical, logistical, socioeconomic, legal, and ethical aspects of screening in great detail, and lists a vast number of references.

The final recommendation against endorsing the use of the ECG for “mandatory and universal mass screening” is unsurprising, and was anticipated by most attendees of the recent Sports and Exercise Cardiology Summit.Read more

I have recently returned from attending the 3rd Annual Sports Cardiology Summit of the American College of Cardiology.  This year, the meeting took place in Hoosier territory.

The meeting was informative, and it was gratifying to see the growing interest in sports cardiology.  The presentations were for the most part excellent.  The faculty came from all corners of the country and from overseas.  Dr. Sharma, a pediatric cardiologist from Britain, runs one of the largest youth screening program in the world, the sports cardiology unit of St. George Hospital in London.  He is also the medical director for the London marathon.Read more