Abstract:Cardiomyopathies are a group of heterogeneous myocardial diseases that are frequently inherited and are a recognised cause of premature sudden cardiac death in young individuals. Incomplete expressions of disease and the overlap with the physiological cardiac manifestations of regular intensive exercise create diagnostic challenges in young athletes and military recruits. Early identification is important because sudden death in the absence of prodromal symptoms is a common presentation, and there are several … Show more
“…143,144 This may include cardiac imaging following comprehensive clinical assessment. [142][143][144][145] In the UK and Germany coronary CTA is preferred to CACS due to the ability to assess for non-calcified and vulnerable plaques, anomalous coronary origins and the higher negative predictive value of CCTA that additionally reduces subsequent downstream testing. 120,142…”
Section: Cardiac Investigation For Cad In Asymptomatic Military Personnelmentioning
In response to the increasing application of cardiovascular computed tomography (cardiovascular CT), the Society of Cardiovascular Computed Tomography (SCCT) guidelines committee has produced this document to guide the use of cardiac CT in the risk assessment of coronary artery disease (CAD) in occupational health evaluation. The purpose of this document is to support quality care given to individuals who undergo occupational health evaluation for the diagnosis of CAD. This document reviews evidence regarding the prevalence of coronary artery disease (CAD), the incidence of major adverse cardiac events (MACE), and the recommendations for enhanced cardiovascular screening and investigation for CAD evaluation amongst safety sensitive occupations. This document examines occupation risk categories where cardiac CT may be appropriate to investigate for CAD and evaluates available testing strategies for risk assessment.
“…143,144 This may include cardiac imaging following comprehensive clinical assessment. [142][143][144][145] In the UK and Germany coronary CTA is preferred to CACS due to the ability to assess for non-calcified and vulnerable plaques, anomalous coronary origins and the higher negative predictive value of CCTA that additionally reduces subsequent downstream testing. 120,142…”
Section: Cardiac Investigation For Cad In Asymptomatic Military Personnelmentioning
In response to the increasing application of cardiovascular computed tomography (cardiovascular CT), the Society of Cardiovascular Computed Tomography (SCCT) guidelines committee has produced this document to guide the use of cardiac CT in the risk assessment of coronary artery disease (CAD) in occupational health evaluation. The purpose of this document is to support quality care given to individuals who undergo occupational health evaluation for the diagnosis of CAD. This document reviews evidence regarding the prevalence of coronary artery disease (CAD), the incidence of major adverse cardiac events (MACE), and the recommendations for enhanced cardiovascular screening and investigation for CAD evaluation amongst safety sensitive occupations. This document examines occupation risk categories where cardiac CT may be appropriate to investigate for CAD and evaluates available testing strategies for risk assessment.
“…In the UK, cardiomyopathies are the most common cause of sudden cardiac death (SCD) from inherited disease in young athletes,2 with hypertrophic cardiomyopathy (HCM) being the most common. ApHCM is a rare form of HCM in which hypertrophy is confined to the most distal portion of the left ventricular wall and typically has a non-obstructive physiology 3.…”
We present the case of a 50-year-old, fit, asymptomatic gurkha officer. At a routine medical, an ECG showed T-wave inversion in the chest leads V3–6. Transthoracic echo showed left ventricular apical hypertrophy and cavity obliteration consistent with apical hypertrophic cardiomyopathy (ApHCM). Cardiac magnetic resonance imaging showed apical and inferior wall hypertrophy in the left ventricle with no aneurysm or scarring. A 24-hour monitor showed normal sinus rhythm with no evidence of non-sustained ventricular tachycardia. Eighteen-panel genetic testing revealed no specific mutations. Cardiopulmonary exercise testing demonstrated a V̇O2 max, anaerobic threshold and peak V̇O2 consistent with above average cardiopulmonary capacity. There was no family history of either ApHCM or sudden cardiac death (SCD). Risk of SCD by the European Society of Cardiology’s HCM calculator was low. This case generates discussion on the prognosis of ApHCM, factors that worsen prognosis, occupational limitation considerations and appropriate monitoring in this patient group.
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