Hypertrophic cardiomyopathy (HCM) is the main cause of sudden unexpected death in the young and especially in young athletes with an incidence up to 2.3 per 100,000 athletes and year. Risk stratification models including patient history (syncope, familial risk of sudden death) and findings in noninvasive tests (nonsustained ventricular tachycardia, abnormal blood pressure response during exercise, maximum left ventricular wall thickness > or = 30 mm) have been developed in order to estimate the risk of individual patients. Echocardiographic parameters are helpful in distinguishing HCM from athlete's heart. Definitive diagnosis of HCM implicates disqualification from competitive sports resulting in a significant reduction of sudden cardiac death due to HCM during sports competition. This positive development should lead to a widespread preparticipation screening of athletes including historical, clinical, and electrocardiographic examination. At least in borderline findings and symptomatic athletes, an additional echocardiogram should be performed in order to minimize or better exclude the risk of sudden cardiac death.
Adult-onset regurgitation in two dogs with partial oesophageal constriction caused by vascular ring anomaly Two dogs-1.5 and 5 years old-each presented with a 1-month history of regurgitation and a low body condition score (3/9 and 4/9). In each dog, thoracic radiographs showed gas-dilated oesophagus cranial to the heart base (Fig 1A-D) and oesophagoscopy revealed an oesophageal diverticulum cranial to the heart base. CT angiography identified a persistent right aortic arch and aberrant left subclavian artery leading to incomplete stricture of the oesophagus (Fig 1E-G). CT angiography also revealed a bicarotid trunk, aberrant right subclavian artery and a Kommerell's diverticulum in each dog (Fig 1E-G). Although surgical intervention was recommended, medical management with elevated feedings resolved the regurgitation and surgery was not pursued in either case. Vascular ring anomalies should be considered as a potential diagnosis in adult dogs presenting with regurgitation, and CT angiography is a valuable method of diagnosing this condition and aiding in decision making for management.
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