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Competitive athletes (CA) are a rapidly growing population worldwide. Habitual vigorous exercise, a defining characteristic of this population, is a potent stimulus for adaptive structural and functional cardiac remodeling and is an effective way to reduce the risk of cardiovascular disease (CVD). Manifestations of CVD in CA are highly variable ranging from subtle findings during pre-participation cardiovascular screening (PPCS) to collapse or cardiac arrest during exercise. In general, young CA are most commonly affected by congenital and genetic conditions while older CA most commonly harbor acquired CVD. Cardiac imaging using transthoracic echocardiography (TTE), cardiac computed tomography angiography (CTA), and cardiac magnetic resonance imaging (CMR) plays a fundamental role in the care of CA. This document was created to provide clinical imaging specialists with a comprehensive guide for the performance of multimodality imaging in CA.

he central nervous sys tem uses a dynamic combination of sensory inputs from the vestibular, somatosensory, and visual svstem to control balance. Information from all three sensory systems, although somewhat redundant, enables the central nervous system's recognition and control of the body's orientation in space, relative orientation of body segments, and relative interaction of body center of gravity and center of pressure (16). The central nervous system varies the weight assigned to each sensory input according to initial conditions of the individual and the environment. The goal is central nervous system balance control to maintain upright stance (1,121.When acuity of one sensory system decreases due to disease or trauma, the other sensory systems adjust so the central nervous system receives sufficient information to make appropriate motor responses to maintain balance (16). The degree of compensation by the other sensory systems is dependent upon many factors, including the individual's capability for learning.The present study evaluates one of the sensory system's contributions to balance abilities, proprioception. Ankle injuries are common in sports

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A 13-year-old boy presented with cardiac tamponade. Echocardiography revealed a large mass extending from the right and left ventricles into a large pericardial effusion. Pathology confirmed the first reported case of a primary cardiac extraskeletal Ewing's sarcoma.

Patients with exertional dyspnea and mild mitral stenosis and regurgitation at rest demonstrate a marked increase in pulmonary artery systolic pressure and mean transmitral pressure gradient during dynamic exercise. In a subset of these patients, marked worsening of mitral regurgitation appears to be the underlying mechanism of this hemodynamic deterioration. Because of the small sample size, this novel observation must be considered preliminary with respect to the true prevalence of exercise-related development of severe mitral regurgitation. If additional studies confirm the importance of this phenomenon, it has important implications for the management of patients with rheumatic mitral valve disease.

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The last few decades have seen substantial growth in the populations of competitive athletes and highly active people (CAHAP). Although vigorous physical exercise is an effective way to reduce the risk of cardiovascular (CV) disease, CAHAP remain susceptible to inherited and acquired CV disease, and may be most at risk for adverse CV outcomes during intense physical activity. Traditionally, multidisciplinary teams comprising athletic trainers, physical therapists, primary care sports medicine physicians, and orthopedic surgeons have provided clinical care for CAHAP. However, there is increasing recognition that a care team including qualified CV specialists optimizes care delivery for CAHAP. In recognition of the increasing demand for CV specialists competent in the care of CAHAP, the American College of Cardiology has recently established a Sports and Exercise Council. An important primary objective of this council is to define the essential skills necessary to practice effective sports cardiology.