INTERNIST UNEXPECTED FINDINGS IN MEDICAL TREATMENT OF A MATURE-AGE ATHLETE
https://doi.org/10.57256/2949-0715-2024-3-63-70
Abstract
Relevance. Regular physical activity is one of the key principles of a healthy lifestyle, which has been proven to prolong life in both healthy people and people with cardiovascular diseases. However, there is a lot of data on the potential adverse effects of intense physical activity required to participate in professional or amateur sports.
Case descriptions. The work describes a clinical case of severe coronary atherosclerosis of a mature-aged athlete. The clinical, laboratory, and instrumental data of the patient are presented, as well as detailed management tactics taking into account the current state of the issue. Possible mechanisms of increased calcification of the coronary bed in people involved in intensive training are discussed.
Conclusion. It is necessary to understand the features of the course of coronary heart disease in athletes of older age groups: high tolerance to physical activity, often subclinical course of the disease, which implies more active questioning and the use of stress visualization techniques. Low-symptom nature of clinical manifestations, hemodynamic features require careful selection of antianginal therapy. Treatment of ischemic heart disease in this cohort of individuals should be carried out in accordance with current clinical guidelines, while the doctor's recommendations regarding the intensity of physical activity should be strictly individual and based on the results of stress tests.
About the Author
Olga A. IvanovaRussian Federation
Cand. Sci. (Med.), аssistant at the Department of Therapy, Irkutsk State Medical Academy of Postgraduate Education - branch of the Federal State Budgetary Educational Institution of Higher Professional Education, Russian Medical Academy of Postgraduate Education, Russia, 664049, Irkutsk, microdistrict. Yubileiny, 100.
References
1. ЛИТЕРАТУРА / REFERENCES
2. Sang-Woo Jeong et al. Mortality reduction with physical activity in patients with and without cardiovascular disease, European Heart Journal, Volume 40, Issue 43, 14 November 2019, Pages 3547–3555, https://doi.org/10.1093/eurheartj/ehz564
3. Vasankari V. et al. Subjects with cardiovascular disease or high disease risk are more sedentary and less active than their healthy peers. BMJ Open Sport Exerc Med. 2018 May 2; 4(1): e000363. doi: 10.1136/bmjsem-2018-000363.
4. Garatachea N. et al. Elite athletes live longer than the general population: a meta-analysis. Mayo Clin Proc. 2014 Sep;89(9):1195-200. doi: 10.1016/j.mayocp.2014.06.004.
5. Chugh SS, Weiss JB. Sudden cardiac death in the older athlete. J Am Coll Cardiol. 2015 Feb 10;65(5):493-502. doi: 10.1016/j.jacc.2014.10.064.
6. Mittleman M.A. et al. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N English J Med. 1993 Dec 2;329(23): 1677-83.
7. 2020 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2020;25(11):4076. (In Russ.) doi:10.15829/1560-4071-2020-4076.
8. Pelliccia A, Sharma S, Gati S, et al., от имени рабочей группы ESC. Рекомендации ESC по спортивной кардиологии и физическим тренировкам у пациентов с сердечно-сосудистыми заболеваниями 2020. Российский кардиологический журнал. 2021;26(5):4488. doi:10.15829/1560-4071-2021-4488; [Pelliccia A, Sharma S, Gati S, et al., ot imeni rabochej gruppy ESC. Rekomendacii ESC po sportivnoj kardiologii i fizicheskim trenirovkam u pacientov s serdechno-sosudistymi zabolevaniyami 2020. Rossijskij kardiologicheskij zhurnal. 2021;26(5):4488. doi:10.15829/1560-4071-2021-4488]
9. Boden WE et al. Evolving Management Paradigm for Stable Ischemic Heart Disease Patients: JACC Review Topic of the Week. J Am Coll Cardiol. 2023 Feb 7;81(5):505-514.
10. ISCHEMIA Trial Research Group; Maron DJ et al. International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial: Rationale and design. Am Heart J. 2018 Jul;201:124-135. doi: 10.1016/j.ahj.2018.04.011. Epub 2018 Apr 21.
11. Weintraub WS et al. Effect of Coronary Anatomy and Myocardial Ischemia on Long-Term Survival in Patients with Stable Ischemic Heart Disease. Circ Cardiovasc Qual Outcomes. 2019 Feb; 12(2): e005079. doi: 10.1161/CIRCOUTCOMES.118.005079.
12. Zheng L et al. Effects of high-intensity and moderate-intensity exercise training on cardiopulmonary function in patients with coronary artery disease: A meta-analysis. Front Cardiovasc Med. 2022 Sep 20; 9:961414. doi: 10.3389/fcvm.2022.961414.
13. Aengevaeren VL et al. Exercise Volume Versus Intensity and the Progression of Coronary Atherosclerosis in Middle-Aged and Older Athletes: Findings From the MARC-2 Study. Circulation. 2023 Mar 28;147(13):993-1003. doi: 10.1161/CIRCULATIONAHA.122.061173.
14. Aengevaeren VL et al. Exercise and Coronary Atherosclerosis: Observations, Explanations, Relevance, and Clinical Management. Circulation. 2020 Apr 21;141(16):1338-1350. doi: 10.1161/CIRCULATIONAHA.119.044467.
Supplementary files
Review
For citations:
Ivanova O.A. INTERNIST UNEXPECTED FINDINGS IN MEDICAL TREATMENT OF A MATURE-AGE ATHLETE. Baikal Medical Journal. 2024;3(3):63-70. (In Russ.) https://doi.org/10.57256/2949-0715-2024-3-63-70