Exertion and Acute Coronary Artery Injury

Black, Asher; Mm, Black; Gensini, Goffredo G.

doi:10.1177/000331977502601101

Cited by 42 publications

(17 citation statements)

References 11 publications

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“…Descriptions of types of acute coronary lesions in SCD have been reported. '', 36,37,[40][41][42][43] The present finding of acute thrombosis without evident disruption of the intimal lining in one third of those with acute occlusion and 19% of all SCDs suggests a possible prophylactic role for platelet active substances including aspirin, clofibrate, or dipyridamole59 and the need for prospective evaluation. While it is possible that the present methodology of 1 mm sectioning of acute coronary segments may miss occasional intimal disruptions and therefore may overestimate the frequency of thrombosis in SCD, it is unlikely that large numbers of significant intimal breaks are missed.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

et al. 1974

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SUMMARYIn order to better understand the problem of prehospital sudden cardiac death (SCD) two groups of individuals were studied. One group was monitored by rescue squads during attempted rescue. These subjects were defibrillated from prehospital ventricular fibrillation (VF) and hospitalized if they survived or autopsied if they could not be resuscitated. The second group were SCDs which were witnessed and described by observers. Detailed past histories of both groups were collected, and either clinical or autopsy diagnoses were obtained.On the day of death or VF, one quarter reported new symptoms (primarily chest pain and dyspnea) preceding collapse by more than 30 minutes, one quarter reported symptoms lasting from 1 to 30 minutes, and one half collapsed instantaneously or within 1 minute of acute symptoms. A history of old myocardial infarction (MI) was present in 41% and of angina pectoris in 54%, and 27% reported new or changing symptoms within four weeks.In defibrillated survivors, "'would-be SCDs,-electrocardiographic (ECG) changes of acute myocardial infarction (AMI) or ischemia were nearly three times more frequent than changes detected histologically in SCDs, and in the former involved predominantly the anterior wall in contrast to the inferior wall in most autopsied deaths. This disparity implicates acute myocardial lesions, particularly of the anterior wall, in the majority of SCDs.Acute coronary lesions were found in 58% of SCDs autopsied. Most of these were ruptured plaquealthough almost one fifth of all autopsied SCDs had thromboses without intimal rupture. Severe chronic multivessel stenosis was present in most subjects, although 15% had only disease of a single vessel and in these, the left anterior descending (LAD) or left main coronary artery were involved in three quarters.The SCD population may be subgrouped into those with recent MI, those with only myocardial ischemia, and those with no detectable myocardial change. When rescuers were able to monitor prehospital SCDs, VF was found in the majority; however, 28% did have other terminal rhythms.

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Section: Discussionmentioning

confidence: 99%

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

et al. 1974

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“…13,14 Among previously asymptomatic adults, evidence of acute coronary artery plaque disruption, including plaque rupture or erosion, with acute thrombotic occlusion is common. 14 The mechanism by which vigorous exercise provokes such events is not defined, but suggested triggering mechanisms 15,16 include increased wall stress from increases in heart rate and blood pressure, exercise-induced coronary artery spasm in diseased artery segments, 17 and increased flexing of atherosclerotic epicardial coronary arteries, 15 leading to plaque disruption and Other congenital abnormalities 90%, 9 and 89% 25 had symptom onset during or within 1 hour of training or competition. †Total exceeds 100% because several athletes had multiple abnormalities.…”

Section: Pathological Findings In Adultsmentioning

confidence: 99%

Exercise and Acute Cardiovascular Events

Thompson

Franklin²,

Balady³

et al. 2007

Circulation

804

254

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Abstract-Habitual physical activity reduces coronary heart disease events, but vigorous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. This scientific statement discusses the potential cardiovascular complications of exercise, their pathological substrate, and their incidence and suggests strategies to reduce these complications. Exercise-associated acute cardiac events generally occur in individuals with structural cardiac disease. Hereditary or congenital cardiovascular abnormalities are predominantly responsible for cardiac events among young individuals, whereas atherosclerotic disease is primarily responsible for these events in adults. The absolute rate of exercise-related sudden cardiac death varies with the prevalence of disease in the study population. The incidence of both acute myocardial infarction and sudden death is greatest in the habitually least physically active individuals. No strategies have been adequately studied to evaluate their ability to reduce exercise-related acute cardiovascular events. Maintaining physical fitness through regular physical activity may help to reduce events because a disproportionate number of events occur in least physically active subjects performing unaccustomed physical activity. Other strategies, such as screening patients before participation in exercise, excluding high-risk patients from certain activities, promptly evaluating possible prodromal symptoms, training fitness personnel for emergencies, and encouraging patients to avoid high-risk activities, appear prudent but have not been systematically evaluated. (Circulation. 2007;115:2358-2368.)Key Words: AHA Scientific Statements Ⅲ death, sudden Ⅲ exercise Ⅲ myocardial infarction Ⅲ coronary disease R egular physical activity is widely advocated by the medical community in part because substantial epidemiological, clinical, and basic science evidence suggests that physical activity and exercise training delay the development of atherosclerosis and reduce the incidence of coronary heart disease (CHD) events. [1][2][3][4] Nevertheless, vigorous physical activity can also acutely and transiently increase the risk of acute myocardial infarction (AMI) and sudden cardiac death (SCD) in susceptible individuals. [5][6][7] This scientific statement presents the cardiovascular complications of vigorous exercise, their pathophysiological substrate, and their incidence in specific patient groups and evaluates strategies directed at reducing these complications. The goal is to provide healthcare professionals with the information they need to adviseThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that m...

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“…Numerous studies have suggested that strenuous exertion (such as snow shoveling) in the days following heavy snowfalls is associated with increased cardiac events 1,2,8,10,17–21. In fact, strenuous exercise of other types has been associated with plaque rupture and subsequent thrombosis 22,23.…”

Section: Introductionmentioning

confidence: 99%

The Snow-Shoveler's ST Elevation Myocardial Infarction

Janardhanan

Henry

Hur

et al. 2010

The American Journal of Cardiology

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Heavy snowfall, cold temperatures, and low atmospheric pressure during the winter months have been associated with increased adverse cardiovascular events. However, only a few cases of the “snow -shoveler’s infarction ” have been reported. We present our experience with 6 patients presenting with ST elevation myocardial infarction all within a 24-hour period during an unprecedented snowfall (4 of whom were shoveling snow), and provide a detailed review of previously reported cases of snow-shoveler’s infarction. Consistent with other reports, the majority of our patients had the traditional cardiac risk factors of hypertension, hyperlipidemia, diabetes mellitus, tobacco use, and were habitually sedentary. Unique to our case series, however, was that the four patients who had a history of coronary artery disease and prior coronary artery stenting, all presented with subacute stent thrombosis documented on the coronary angiography performed emergently. Moreover, these patients constituted 25% of all the subacute stent thromboses diagnosed in our cardiac catheterization laboratory over the preceding 12 months. In conclusion, our findings suggest that in typically sedentary individuals with cardiac risk factors or a history of coronary artery disease, snow shoveling may trigger ST elevation myocardial infarction and, therefore, should be avoided. This may be most critical in patients with a history of coronary stent placement since our findings suggest that snow shoveling may precipitate subacute stent thrombosis.

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Exertion and Acute Coronary Artery Injury

Cited by 42 publications

References 11 publications

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

Pathophysiologic Observations in Prehospital Ventricular Fibrillation and Sudden Cardiac Death

Exercise and Acute Cardiovascular Events

The Snow-Shoveler's ST Elevation Myocardial Infarction

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