Biomedical subjects
Publications and source records attributed to S P Van Camp.
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This study was conducted to better define the pathophysiology, risk factors, and therapeutic approach to exercise-associated hyponatremia. Medical records from all participants in the 1998 Suzuki Rock 'N' Roll Marathon who presented to 14 Emergency Departments (EDs) were retrospectively reviewed to identify risk factors for the development of hyponatremia. Hyponatremic patients were compared to other runners with regard to race time and to other marathon participants seen in the ED with regard to gender, clinical signs of dehydration, and use of nonsteroidal anti-inflammatory drugs (NSAIDs). An original treatment algorithm incorporating the early use of hypertonic saline (HTS) was evaluated prospectively in our own ED for participants in the 1999 marathon to evaluate improvements in sodium correction rate and incidence of complications. A total of 26 patients from the 1998 and 1999 marathons were hyponatremic [serum sodium (SNa) < or =135 mEq/L] including 15 with severe hyponatremia (SNa < or = 125 mEq/L). Three developed seizures and required intubation and admission to an intensive care unit. Hyponatremic patients were more likely to be female, use NSAIDS, and have slower finishing times. Hyponatremic runners reported drinking "as much as possible" during and after the race and were less likely to have clinical signs of dehydration. An inverse relationship between initial SNa and time of presentation was observed, with late presentation predicting lower SNa values. The use of HTS in selected 1999 patients resulted in faster SNa correction times and fewer complications than observed for 1998 patients. It is concluded that the development of exercise-associated hyponatremia is associated with excessive fluid consumption during and after extreme athletic events. Additional risk factors include female gender, slower race times, and NSAID use. The use of HTS in selected patients seems to be safe and efficacious.
Nontraumatic deaths occur each year in organized high school and college athletics, resulting in considerable public concern. We conducted a study of the frequency and causes of nontraumatic sports deaths in high school and college athletes in the USA through the National Center for Catastrophic Sports Injury Research to define the magnitude of this problem and its causes. Over a 10-yr period, July 1983-June 1993, nontraumatic sports deaths were reported in 126 high school athletes (115 males and 11 females) and 34 college athletes (31 males and 3 females). Estimated death rates in male athletes were fivefold higher than in female athletes (7.47 vs 1.33 per million athletes per year, P < 0.0001), and twofold higher in male college athletes than in male high school athletes (14.50 vs 6.60 per million athletes per year, P < 0.0001). Cardiovascular conditions were more common causes of death than noncardiovascular conditions. Hypertrophic cardiomyopathy and congenital coronary artery anomalies were the most common causes of death. In high school and college athletes, males are at increased risk for nontraumatic sports deaths compared with females even after adjustment for participation frequency; college males are at greater risk than high school males. In all groups the deaths were primarily due to cardiovascular conditions.
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Ageing of the cardiovascular system presents several costly public health problems, loss of quality of life, dependency, and other various health hazards. Large declines of 0-24% per decade in cardiovascular function have been cited in the literature but no long-term longitudinal studies have been reported. Serially measured cardiovascular function was performed on 12 normal men, aged 44-79 years, at 0, 10, 15, 20 and 25 years. Over the same time period, daily exercise training data were reported monthly including mode, frequency, intensity, and duration. Although seven men developed some form of pathological disease, the total group's cardiovascular function remained 60% greater than the average of ten investigations. The overall decline in cardiovascular function (Vo2 max) was 13%, or 5% per decade, 45.4 ml.min-1.kg-1 to 39.5 ml.min-1.kg-1. In summary, cardiovascular function was one-half, or 0.24 ml.min-1.kg-1.year-1 of the 0.45 ml.min-1.kg-1.year-1 reported to be the average decline for ageing cited in the literature.
Sudden death in athletes is a tragic, but fortunately infrequent, event. In young athletes (30 years old and younger) structural cardiovascular disease, often congenital, is usually responsible. Athletes over 30 years old who die suddenly are most frequently found to have severe atherosclerotic coronary artery disease. This article discusses the type of cardiovascular diseases underlying sudden death in athletes and approaches to preventing these tragedies.
To determine the incidence of major cardiovascular complications in outpatient cardiac rehabilitation programs, we obtained data from 167 randomly selected cardiac rehabilitation programs via mailed questionnaires and follow-up telephone calls. These 167 programs reported that 51 303 patients exercised 2 351 916 hours from January 1980 through December 1984. Twenty-one cardiac arrests (18 in which the patient was successfully resuscitated and three fatal) and eight nonfatal myocardial infarctions were reported. The incidence rates per million patient hours of exercise were 8.9 for cardiac arrests (one per 111 996 patient-hours), 3.4 for myocardial infarctions (one per 293 990 patient-hours), and 1.3 for fatalities (one per 783 972 patient-hours). There was no statistically significant difference in frequency of these events among programs of varying size or extent of electrocardiographic monitoring. These data indicate that current cardiac rehabilitation practice allows for prescribed supervised exercise by patients with cardiovascular disease to be performed at a low risk of major cardiovascular complications.
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