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Protecting athletes from sudden cardiac death

JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 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.
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    ABSTRACT: Habitual physical activity reduces coronary heart disease events, but vig- orous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. This scientific statement discusses the potential cardiovascular complications of exercise, their pathological substrate, and their incidence and suggests strategies to reduce these complications. Exercise-associated acute cardiac events generally occur in individuals with structural cardiac disease. He- reditary or congenital cardiovascular abnormalities are predominantly responsible for cardiac events among young individuals, whereas athero- sclerotic disease is primarily responsible for these events in adults. The absolute rate of exercise-related sudden cardiac death varies with the prevalence of disease in the study population. The incidence of both acute myocardial infarction and sudden death is greatest in the habitually least physically active individuals. No strategies have been adequately studied to evaluate their ability to reduce exercise-related acute cardiovascular events. Maintaining physical fitness through regular physical activity may help to reduce events because a disproportionate number of events occur in least physically active subjects performing unaccustomed physical activity. Other strategies, such as screening patients before participation in exercise, excluding high-risk patients from certain activities, promptly evaluating possible prodromal symptoms, training fitness personnel for emergencies, and encouraging patients to avoid high-risk activities, appear prudent but have not been systematically evaluated.
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    ABSTRACT: The sudden death of a young athlete on the playing field remains the most devastating medical event in sports, with compelling reasons to implement effective preventive strategies. Preparticipation screening is widely practiced, but universal agreement regarding the most appropriate method for cardiovascular screening is lacking. The addition of a resting 12-lead electrocardiogram (ECG) to a comprehensive personal and family history and physical examination will increase detection of those athletes with potentially lethal cardiovascular disorders at risk for sudden cardiac death. However, complex issues regarding feasibility, false positive results, cost-effectiveness, and physician and health system infrastructure still remain regarding large-scale implementation of ECG screening in the United States. When used, ECG interpretations based on modern criteria to distinguish abnormal findings from physiologic alterations in athletes must be applied to ensure acceptable accuracy.
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