Sports Cardiology

Attivita’ fisica e salute sono termini ormai inscidibili; l’esercizio fisico regolare, al pari  di un intervento farmacologico, e’ un  potente mezzo di prevenzione e di cura per molte malattie cardiovascolari. Inoltre il benessere psico-fisico che scaturisce dalla pratica sportiva, spinge molti individui, anche appartenenti alle fasce di eta’ piu’ avanzata, ad iniziare e proseguire la pratica di molti sports.

Gli adattamenti cardiovascolari dell’atleta rappresentano, a volte, una sottile linea di confine tra la fisiologia e la  patologia, e rendono spesso difficile una valutazione del rischio.

Ogniqualvolta un atleta muore sui campi di gioco, il cardiologo e’ chiamato a rispondere alla solita domanda; qual’e’ la causa del decesso e perche’ non e’ stato possibile prevenirla.Attorno a questa questione ruota tutta la competenza professionale del cardiologo moderno ed i limiti delle attuali procedure di  screening.

Se questa e’ una difficolta’ obiettiva, amplificata dal risalto mediatico di seppur rari incidenti fatali, esistono anche contesti clinici a minore impatto mediatico ma non esenti da riflessioni ed implicazioni medico-legali.

La costante evoluzione delle conoscenze nel campo della fisiopatologia cardiovascolare ed i ritmi lavorativi sempre piu’ pressanti  impongono  al cardiologo clinico ed al medico dello sport  una  continuo e rapido aggiornamento. Come, e forse piu’, di altre specializzazioni, la cardiolgia moderna presenta delle aree di settorializzazione delle competenze che rendono ancora piu’ pressante la necessita’ di integrare le novita’ con la pratica clinica quotidiana.

Servono quindi degli strumenti che possano rendere il medico sereno nella riflessione clinica. Questo testo scaturisce da queste esigenze e si caratterizza da un lato per una trattazione sistematica delle indicazioni ad una  moderna diagnostica non invasiva ed invasiva, e dall’altro sull’approccio clinico della grande maggioranza delle problematiche cardiologiche interessanti gli atleti. Particolare attenzione e’ stata data alle terapie interventistiche piu’ moderne che vanno dall’interventisctica coronarica, alle problematiche legate alla chiusura del forame ovale, alle attenzioni da seguire nei pazienti portatori di dispositivi antiaritmici, alle precauzioni per l’attivita’ fisica in pazienti affetti da cardiopatie congenite.

Credo che questo possa essere un testo di ausilio nelle difficolta’ quotidiane del moderno medico dello sport.


The field of sports cardiology gained notoriety over the last  few years when several well-known athletes have succumbed to sudden Cardiac death.  The media attention to these events has inflamed the controversy of whether   better  screening would have prevented any of the deaths or whether the time has come for nations and health organization to agree on a universal approach.

Unfortunately there is no universal approach to screen athletes or the general population. There is no accepted method of screening people of  different ages that want to participate in athletic activity. The challenges to the physicians who have to decide whether to approve or deny the participation and the right to compete are great.

The International Olympic committee (IOC) has recommended, but not mandated, that all countries screen their athletes to minimize the risk of sudden death.  According to the IOC, if the twelve lead ECG  raises the suspicion of an underlining serious problem in an athlete, further testing should be performed.  In many screening programs, the work up also includes an echocardiogram.  By contrast, the American Heart Association, (AHA) and the American College of Cardiology (ACC) do not recommend the use ECG’s for cardiovascular screening of athletes at any  level.   The Canadian Heart and Stroke Foundation also has no screening recommendations for athletes nor does the Canadian Academy of  Sports and  Exercise Medicine. At the far end of the spectrum is the Italian model, in which individuals are not allowed to participate in minor sports unless they have had a family history  taken, physical examination  and twelve lead ECG. In the United States and Canada the sports medicine community had not embraced  mandatory ECG screening because of concerns about cost, access, and risk of false positives, that  leave some healthy kids on the side lines.   Instead North American doctors typically rely on information from family history  and physical exam to guide decisions.

In this manuscript the editors managed to put together a textbook and a reference for physicians and people who have interest in sports medicine.  To my knowledge there is no other textbooks such as this. All the issues that involve cardiac activity and sports from arrhythmia and sudden death to mechanical and hemodynamic issues are addressed.

This book is unique, because it is concise, accurate and extremely helpful in making decisions. Both the general practitioner  as well as the Cardiologist will find this text book a useful resource and  reference when they deal with patients with or  without Cardiac issues,  who want to participate in athletic activity.  Through the collective efforts of all the authors and the editors they were able to catalog the knowledge of this very important branch of medicine that impacts enormously the quality of life of the general populations and athletes in particular.


Chairman Cardiac Institute

Director , Division of Cardiology

Program Director, Cardiovascular Disease

& Interventional  Cardiology

Professor of Medicine

Maimonides Medical Center

Brooklyn, NY

RECENSIONE Moussa Mansour,

Earlier this year and within the span of few weeks, two European football players, Fabrice Muamba and Piermario Morosini sustained sudden cardiac arrests,

sending shock waves across the athletic and medical communities. These and

other similar events over recent years have fueled an increased interest in sports

cardiology. This field has been overlooked for years, which resulted in a poor

understanding of the prevention and management of cardiac conditions among


This book, edited by Massimo Fioranelli and Gaetano Frajese, is a comprehensive practical guideline to sports cardiology. The areas covered include all

aspects of this field, from history and physical examination to advanced im-aging. The chapters are concise and clear, making this book an important tool

for practicing cardiologists who will find themselves increasingly faced with

situations requiring proficiency in the prevention, diagnosis and treatment of

cardiac diseases in athletes.

Moussa Mansour, MD, FHRS, FACC

Director, Cardiac Electrophysiology Laboratory

Director, Atrial Fibrillation Program

Massachusetts General Hospital

Cardiac Arrhythmia Service

Boston, USA


Part I Cardiovascular diagnostics


1 Medical history and physical examination in sports medicine

Non invasive cardiovascular diagnostics

2 Electrocardiographic signal analysis

3 Ecocardiography in the athletes

4 Diagnosis of vascular diseases

5 Coronary CT

6 Cardiac MRI

7 Myocardial radionuclide imaging

Invasive cardiovascular diagnostics

8 Cardiac catheterization

9 Coronary artery angiography

10 Endomyocardial biopsy

11 Integrated imaging

12 Intracardiac electrophysiologic study

Part II Clinical Cardiology in the athletes


13 Syncope

Cardiac arrhythmias

14 Epidemiology, classification and description of cardiac arrhythmias

15 Preeccitation syndromes

16 Electrophysiological study in the athletes

17 Catheter ablation in the athletes

Sudden cardiac death

18 Valvular heart diseases in the athletes

19 Cardiomyopathies in the athletes

20 Myocarditis and pericarditis in the young athletes

21 Non structural causes of sudden death

Sports practice for individuals with heart diseases

22 Arterial hypertension in the athletes

23 Sports practice in patients with chronic ischemic heart disease. Focus on patients treated with coronary angioplasty and stenting

24 Sports practice in congenital heart diseases

25 Sports practice in individuals with cardiac pacemakers and implantable cardioverter-defibrillators

26 Other clinical indications: sports practice in individuals with patent foramen ovale and in patients undergoing non-coronary cardiovascular interventions

Cardiologic rehabilitation

27 Cardiologic rehabilitation