Friday, September 19, 2014

Spring Check-Up

by Larry Creswell, M.D.

It’s springtime and for many triathletes (at least in the northern hemisphere) this season is already underway. We’ve laid out race schedule, we’ve sketched out a training plan for the year, the bike’s been tuned up, we’ve lined up some new gear, and we’re ready to go.

I’d like you to add one more item to your early season check-list: a check-up. For you.

In my column last month, I explained that our goal here was to become better educated about the many heart-related issues that confront endurance athletes. And we’ll be doing that with the goal of helping you take charge of your own cardiovascular health. But the first order of business for taking charge is a check-up.

I firmly believe that every endurance athlete needs a doctor. Their own doctors. Many women will already have a relationship with a primary care physician or Ob-Gyn, but men in their 20s through 40s are notorious for not having a doctor. It’s easy to fall into the trap of saying, “I’m healthy, so I don’t need a doctor.” But I need to remind you about the “healthy” athletes I mentioned in my last column who die each year during training or competition and are found, at autopsy, to have a heart problem. That should be motivation enough. Your doctor will become a valuable member of your team -- just like your spouse, coach, massage therapist, etc.

For athletes who are fortunate to not have any medical problems, an annual visit to the doctor is probably sufficient. And this is the time of year to do it. If you don’t already have a doctor, ask your athlete friends who they see. Try to find a doctor who is already familiar with issues that face the endurance athlete. The very best situation might be to find a doctor who is also an athlete. That can make for a terrific working relationship.

The American Heart Association (AHA) offers some simple guidelines about what that annual visit should include -- guidelines that help to screen for the important cardiovascular conditions that cause problems in athletes. The doctor should take your medical history, focusing on:

  • Exertional chest pain
  • Unexplained light-headedness or blacking out
  • Excessive exertional shortness of breath
  • Prior recognition of a heart murmur
  • Elevated blood pressure
  • Any family history of premature death due to heart-related conditions
  • Any heart-related disability in a family member
  • Specific family history of conditions such as hypertrophic cardiomyopathy, long QT syndrome, Marfan syndrome, or arrhythmias

The doctor should also perform a complete physical exam which includes attention to:

  • Presence of a heart murmur
  • Feeling the femoral pulses (to exclude aortic coarctation)
  • Any physical signs of the Marfan syndrome
  • Measurement of the blood pressure

Although there is still some debate among cardiac specialists who care for athletes, I’d also recommend that you discuss with your doctor the possibility of getting an EKG and an echocardiogram (ultrasound pictures of the heart) to help detect any latent or congenital (acquired at birth) heart problems that might cause trouble down the line. These conditions can sometimes escape detection from the physical examination, alone. These tests can be done once as a baseline.

Print out this article or the guidelines from the AHA and take them to your doctor. Let your doctor know that these items are important to you. In many cases, you can help educate your doctor about what’s important to endurance athletes. And that’s okay; your doctor will be impressed that you care.

Remember, partnering with your doctor is the first step in taking charge of your cardiovascular health.

Larry Creswell, M.D., is a cardiac surgeon and Associate Professor of Surgery at the University of Mississippi Medical Center in Jackson, Mississippi. You can contact him at lcreswell@surgery.umsmed.edu.

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