Protecting Athletes From Sudden Cardiac Death

JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 11/2006; 296(13):1648-50. DOI: 10.1001/jama.296.13.1648
Source: PubMed
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    • "This condition becomes progressively worse affecting the metabolic activity of the heart muscles. Over a period of time, the heart muscles become weak and may lead to heart failure and causing arrhythmias [4]. Even more, often the deposited plaques erode or rupture resulting into thrombus formation restricting the flow of blood to the heart muscles thereby increasing the risk of sudden cardiac death. "
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    ABSTRACT: Coronary artery disease (CAD) is the narrowing of coronary arteries leading to inadequate supply of nutrients and oxygen to the heart muscles. Over time, the condition can weaken the heart muscles and may lead to heart failure, arrhythmias and even sudden cardiac death. Hence, the early diagnosis of CAD can save life and prevent the risk of stroke. Electrocardiogram (ECG) depicts the state of the heart and can be used to detect the CAD. Small changes in the ECG signal indicate a particular disease. It is very difficult to decipher these minute changes in the ECG signal, as it is prone to artifacts and noise. Hence, we detect the R peaks from the ECG and use heart rate signals for our analysis. The manual inspection of the heart rate signals is time consuming, taxing and prone to errors due to fatigue. Hence, a decision support system independent of human intervention can yield accurate repeatable results. In this paper, we present a new method for diagnosis of CAD using tunable-Q wavelet transform (TQWT) based features extracted from heart rate signals. The heart rate signals are decomposed into various sub-bands using TQWT for better diagnostic feature extraction. The nonlinear feature called centered correntropy is computed on decomposed detail sub-band. Then the principal component analysis (PCA) is performed on these CC to transform the number of features. These clinically significant features are subjected to least squares support vector machine (LS-SVM) with different kernel functions for automated diagnosis. The experimental results demonstrate highest classification accuracy, sensitivity, specificity and Matthews correlation coefficient of for Q-factor =24 using Morlet wavelet kernel function with optimized kernel and regularization parameters. Also, we have developed a novel CAD Risk index using significant features to discriminate the two classes using a single number. Our proposed methodology is more suitable in classification of normal and CAD heart rate signals and can aid the clinicians while screening the CAD patients.
    Knowledge-Based Systems 07/2015; DOI:10.1016/j.knosys.2015.02.011 · 2.95 Impact Factor
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    • "The greatest challenge in such events is the limited staircase space where participants must compete (Fig. 1) making it difficult for staff to monitor the event on foot and to aid in emergencies . In addition, public and charity competitions in many countries do not usually require health checks prior to events, therefore increasing the risk for cardiac-related injuries [5] [6] [7] [8] [9] [10] [11] [12] [13] and other injury types [14] [15] [16] [17] [18]. Furthermore, this particular sport is open to individuals of all ages, some having hearing impairments which may cause additional difficulties in communicating during an emergency. "
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    ABSTRACT: Using mobile wireless technology to monitor ECG in participants of mass events and sports taking place in difficult-to-access location could both prevent and easier detect arrhythmias as well as provide real-time monitoring for any type of injury. We assessed the effectiveness of mobile wireless monitoring technology and IT in detecting possible emergencies during a skyscraper race. We attached specially designed wireless surveillance biopatches on 120 individuals participating to monitor their continuous ECG and location during a skyscraper run-up race at Taipei 101 building, Taiwan. The outcomes of interest were detection of abnormal heartbeats and QRS waves indicative of possible cardiac problems and the exact location of participants during the occurrence of emergencies. The devices accurately sent over 50 warnings to our monitoring platform when both, danger limits were reached by competitors (<60 or >195 beats per minute) or competitors stopped moving, proving very effective in quickly detecting abnormities and alerting staff of possible emergencies at exact locations. This efficient and inexpensive monitoring method can also prevent arrhythmias in unscreened competitors, the danger of collision among staff and competitors, and preserves oxygen by eliminating additional on-foot monitoring staff. Additionally, it could have multipurpose usage, especially during disasters and accidents occurring in difficult-to-access locations, in military exercises and personal monitoring. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Computer methods and programs in biomedicine 05/2015; 121(2). DOI:10.1016/j.cmpb.2015.04.014 · 1.90 Impact Factor
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    • "Holter monitoring, indicated when necessary [28 ,29,46]. "
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    ABSTRACT: Electrocardiograms in elite endurance athletes sometimes show bizarre patterns suggestive of inherited channelopathies (Brugada syndrome, long QTc, catecholaminergic polymorphic ventricular tachycardia) and cardiomyopathies (arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy) responsible for unexpected sudden cardiac death. Among other methods, genetic analyses are required for correct diagnosis. To correlate 12-lead electrocardiographic patterns suggestive of inherited channelopathies and cardiomyopathies to specific genetic analyses. Prospective study (2004-2007) of screening 12-lead ECG tracings in standard position and higher intercostal spaces V1 to V3 precordial leads, performed in athletes and normal sedentary subjects aged match. Genetic analyses of subjects with ECG abnormalities suggested inherited channelopathies and cardiomyopathies. All cardiologic exams and electrocardiograms were performed at "Prof. Dr. C.C. Iliescu" National Institute of Cardiovascular Diseases (Bucharest, Romania). The genetic studies were done at "Mina Minovici" National Institute of Forensic Medicine (Bucharest, Romania). 347 elite endurance athletes (seniors--190, juniors--157), mean age of 20; 200 subjects mean age of 21, belonging to the control group of 505 normal sedentary population. Seniors. RSR' (V1 to V3) pattern, in 45 cases (23.68%), 5 of them with questionable Brugada sign (elevated J wave and "coved" ST segment, < 2 mm in one lead, V1. Typically, Brugada 1 sign was found in one case (0.52%) with no SCN5A abnormalities. One athlete (0.52%) had normal ECG and exon1 SCN5A duplication. MRI confirmed three arrhythmic right ventricular cardiomypathy epsilon waves (1.57%), in one case. ST-segment elevation myocardial injury like in V1-V3 precordial leads in 34 athletes (17.89%). Genetic analyses-no gene mutations. Juniors. Upright J wave was found in 43 cases (27.38%). Convex ST segment elevation in V1-V3/V4, in 39 cases (24.84%). Bifid T wave with two distinct peaks was found in 39 cases (24.84%), 5 of them with mild prolonged QTc (0.48"-0.56") and KCN genes mutations. Nine (5.73%) of the elevated ST segment juniors had questionable Brugada sign, two of which with KCN (n=1) and SCN5A (n=1) gene mutations. Ajmaline provocative test was negative in 4 and was refused by 5 subjects. Bizarre QRS, ST-T patterns suggestive of abnormal impulse conduction in the right ventricle, including the right outflow tract, associated with prolonged QTc interval in some cases were observed in highly trained endurance athletes. The genetic analyses, negative in most athletes, identified surprising mutations in SCN5A and KCN genes in some cases.
    11/2009; 2(4):361-72.
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