Prepared National recommendations for admission to sports and participation in competitions for athletes with abnormalities of the cardiovascular system. This was announced yesterday by the director of the State Research Center for Preventive Medicine, prof. Sergei Anatolyevich Boytsov at the Sportmed-2011 conference, taking place these days at the Expocenter (Moscow).

The recommendations were developed by specialists from the All-Russian Scientific Society of Cardiologists (VNOK), the Russian Association for Sports Medicine and Rehabilitation of the Sick and Disabled (RASMIRBI), the Russian Society of Holter Monitoring and Non-Invasive Electrophysiology (ROHMINE), and the All-Russian Public Organization "Association of Pediatric Cardiologists of Russia". Work on the document began about a year and a half ago.

The recommendations highlight the relevance of the problem of sudden cardiac death in athletes, discuss issues of adaptation to physical activity and classification of sports, preliminary screening and diagnosis of cardiovascular abnormalities in athletes, birth defects heart and acquired valvular heart defects, hypertrophic and other cardiomypathies, prolapse

mitral valve, myocarditis and Marfan syndrome, arterial hypertension , coronary disease heart disease, syncope and cardiac arrhythmias, the use of automatic external defibrillators, and the problem of concussion (commotio cordis) during sports

The prerequisites for creating these recommendations were the special attention of the public to the facts of sudden cardiac death among athletes. On the one side cardiovascular diseases in athletes they are often asymptomatic and therefore often unrecognized. On the other hand, in the structure of sudden cardiac death in athletes, more than 50% are due to previously recognized cardiovascular diseases. As a result, the risk of sudden cardiac death among athletes is 2 times increased compared to untrained people with the same cardiovascular pathology. Career, economic and other motives of professional athletes who have achieved high achievements play a significant role, which can significantly influence the decision to continue sports career, including in the presence of cardiovascular risks established and recognized by the athletes themselves. All this necessitates the need for recommendations at the national level, which clearly define the criteria for the admission of athletes with deviations from the cardiovascular system to the training and competitive process.

Of course, Russian recommendations were not created from scratch - they were based on the recommendations of the European Society of Cardiology in 2005, the recommendations of the American College of Cardiology adopted at the 36th Conference in Bethesda in 2005 and the Order of the Ministry of Health and Social Development of the Russian Federation dated 08/09/2010 N 613n “On approval of the procedure for providing medical care during physical education and sports events.”

“Unfortunately, many doctors, and even cardiologists, do not know the cardiological criteria for an athletic heart,” Prof. noted in his report. Boytsov S.A. “For example, disorders such as sinus bradycardia

, 1st degree AV block, incomplete block right leg His bundle, early repolarization syndrome and isolated voltage criteria for myocardial hypertrophy of the left ventricle puts some cardiologists into a stupor and they prohibit athletes from intense physical exercise. Although all of the listed signs are due to the training process and are not contraindications to playing sports.”

Thus, a heart rate (HR) of up to 25 beats per minute (the norm for an ordinary person is about 70 beats/min) or pauses in sinus rhythm for more than two seconds can be a common finding when conducting 24-hour Holter ECG monitoring in highly qualified athletes. Also, 2nd degree AV block (Mobitz 1) is often observed in athletes, and single monomorphic ventricular extrasystoles can occur in approximately 40% of athletes.

At the same time, a sports doctor should be alert to sinus pauses of more than 3 seconds. Periods of SA blockade accompanied by symptoms may be a manifestation of weakness syndrome sinus node, which requires additional examination. Athletes with bradycardia without structural abnormalities of the heart and an adequate increase in heart rate during physical activity, they can be allowed to engage in any kind of sports. Periodic examination is necessary to dynamically assess the effect of physical activity on the severity of bradycardia..

Athletes with fainting and pre-fainting conditions should be excluded from sports activities until adequate treatment is provided due to the risk of falling and injury due to short-term loss of consciousness. Athletes with symptoms such as momentary loss of consciousness or increased fatigue that are strongly associated with arrhythmias

, should receive adequate treatment and provided that during treatment of arrhythmia and the associated symptoms upon re-examination are not detected within 2-3 months, they can be allowed to play any kind of sport.

Potentially dangerous arrhythmias are any arrhythmias with very high and very low heart rates, accompanied by a significant decrease in cardiac output, coronary/cerebral blood flow and blood pressure, namely ventricular tachyarrhythmias, atrial fibrillation/flutter with a high (200 to 300) ventricular rate, often with concomitant WPW syndrome, AV block/sick sinus syndrome with a very low heart rate.

• Search for and removal from sports of athletes with hidden cardiovascular abnormalities – effective method risk reduction sudden death
• A physical therapy doctor and a sports medicine doctor have the right to remove an athlete from sports if there is a high risk of sudden death
• Preliminary screening is the basis for searching for cardiovascular abnormalities in athletes
• Dividing ECG changes into two groups allows you to increase the effectiveness of preliminary screening
• Most often, a differential diagnosis must be made between sports heart and such cardiomyopathies such as HCM, DCM and ARVD.

Professor Boytsov S.A. headed the working group for the preparation of recommendations, which included Professor Smolensky A.V., Professor Zemtsovsky E.V., Ph.D. Kolos I.P. and Ph.D. Lidov P.I. Expert recommendations: Professor Ardashev A.V. (Moscow), professor Balykova L.A. (Saransk), Doctor of Medical Sciences Barbuhatti K.O. (Krasnodar), professor Belichenko O.I. (Moscow), professor Boytsov S.A. (Moscow), professor Vasyuk Yu.A. (Moscow), Doctor of Medical Sciences Gabrusenko S.A. (Moscow), professor Gavrilova E.A. (Moscow), professor Golitsyn S.P. (Moscow), professor Dzemeshkevich S.L. (Moscow), Academician of the Russian Academy of Natural Sciences Degtyareva E.A. (Moscow), corresponding member. RAMS Karaskov A.M. (Novosibirsk), Professor Kislyak O.A. (Moscow), Ph.D. Kolos I.P. (Moscow), Ph.D. Komolyatova V.N. (Moscow), Doctor of Medical Sciences Kryzhanovsky S.A. (Moscow), Ph.D. Lidov P.I. (Moscow), professor Makarov L.M. (Moscow), Ph.D. Mikhailova A.V. (Moscow), professor Makarova G.A. (St. Petersburg), Ph.D. Nikulina N.N. (Ryazan), academician of the Russian Academy of Medical Sciences Paleev N.R. (Moscow), professor Paleev F.N. (Moscow), professor Polyaev B.A. (Moscow), professor Polyakov S.D. (Moscow), professor Revishvili A.Sh. (Moscow), Professor Rogoza A.N. (Moscow), Doctor of Medical Sciences Sadykova D.I. (Kazan), academician of the Russian Academy of Medical Sciences Storozhakov G.I. (Moscow), Ph.D. Sokolov S.F. (Moscow), professor Smolensky A.V. (Moscow), professor Sulimov V.A. (Moscow), professor Tereshchenko S.N. (Moscow), Doctor of Medical Sciences Sharykin A.S. (Moscow), professor Shkolnikova M.A. (Moscow), Ph.D. Kharlap M.S. (Moscow), professor Yakushin S.S. (Ryazan).

Year of manufacture: 1995

Genre: Cardiology

Format: DjVu

Quality: Scanned pages

Description: Problems of sports cardiology cannot but worry specialists working in the field of sports physiology and cardiologists, since millions of people of various ages are involved in physical training and sports. The beneficial effects of physical training on the body and its cardiovascular system is well known and today no longer requires special evidence.
At the same time, irrational physical training can also negatively affect the circulatory system. This means that adaptive changes that occur in the cardiovascular system during physical training should be under constant medical supervision, and deviations in health status and diseases that arise during such training should become the object of close attention of specialists to develop methods early diagnosis, correct clinical assessment of certain deviations, selection of rational and effective measures for the prevention and treatment of pathological sports heart.
The difficulties in studying heart lesions in athletes are caused by the fact that little attention has been paid to the problems of the pathophysiology of sports for a long time. Even cases of sudden death of athletes, which, unfortunately, are not uncommon, have not been subjected to systematic analysis in our country.
The reason for this was largely the politicization of sport in the USSR and the official attitude that existed for many years towards thoughtless propaganda of sports as a panacea for all diseases, as well as the hushing up of cases of sudden death of athletes.
And yet, it was during these years that domestic researchers made a huge contribution to the development of ideas about the danger of excessive physical activity for the development of adaptation disorders of the cardiovascular system and the formation of a pathological sports heart.
Among many names, the contribution of F.Z. should be especially highlighted. Meyerson and the laboratory of cardiac pathophysiology headed by him in the development of ideas about the pathophysiology of the heart in hyperfunction and A.G. Dembo and his colleagues, who created the clinical direction in sports cardiology. First formulated by A.G. Dembo's idea of ​​myocardial dystrophy due to physical overexertion (MSOS) is today widely recognized in all countries of the former USSR.
At the same time, the unconditional successes of domestic sports cardiology remain little known and not recognized abroad to this day, and the approaches to solving the problems of sports cardiology among Russian and their foreign colleagues remain very different.
There are several reasons behind the differences in approaches to solving a number of issues in sports cardiology, among which, first of all, significant differences in the existing systems of medical support for sports training should be mentioned.
Being aware of all the shortcomings and vices of the healthcare system that has developed in the former USSR as a whole and sports medicine, in particular, one cannot fail to note those positive aspects of the medical control system, which made it possible to achieve certain successes both in the development of sports medical science, and in the development of sports and the health of athletes.
The basis of this, today, unfortunately, collapsing system of medical control over athletes, was the training of specialist doctors in the field of sports medicine who work in clinics, sports societies, higher and secondary educational institutions and outpatient clinics. In their professional activities, these specialists are closely associated with medical and physical education clinics (until recently there were about 300 of them in the country). There were dispensaries in all major cities and regions and provided a unified approach to solving basic issues of medical care for people involved in physical training and sports.
Thanks to the network of medical and physical education clinics, all athletes who achieved noticeable results underwent mandatory training twice a year. medical examination. This organization of the matter contributed to the formation of sports medicine as a clinical discipline, requiring from the doctor not only knowledge of sports traumatology, but also the ability to identify the features of physiological processes and pathological condition internal organs, often formed under the influence of large training loads.
Another reason for differences in approaches to solving sports medical problems is a different approach to the object of study itself - the athlete. While proclaiming in words the rejection of the professionalization of sports in the USSR, in reality a coherent system was created for the selection and training of professional athletes who began training with childhood and training almost daily, or even 3-4 times a day. It was the “active” athletes who trained a lot and regularly, who achieved certain sports results at the time of the examination, who were mainly the object of our observations.
When discussing the differences between the health status of athletes from the countries of the former USSR and European countries, we should not forget that the conditions for playing sports, the nature of nutrition, household and, finally, environmental conditions are largely different.
Finally, the third reason underlying the different understanding of some problems in sports cardiology is the well-known disunity between sports doctors working on both sides of the Iron Curtain.
We hope that the attempt made in this monograph to modernly understand the problems facing sports cardiology will contribute to the convergence of different points of view on the issues of physiological and pathological sports heart.
The book “Sports Cardiology” does not pretend to be a complete presentation of all the problems of sports cardiology. We paid special attention to highlighting the problems of adaptation of the cardiovascular system to physical activity, the use of clinical and instrumental methods research in sports cardiology and discussion of clinical problems of this discipline
The author expresses sincere gratitude to all employees of the laboratory of functional diagnostics of the institute physical culture them. P.F. Lesgaft, who worked under the direction of A.G. Dembo during its 25 years of existence.
The author also thanks Professor V.M. Pinchuk, who kindly provided materials on experimental cardiology of physical activity, and Professor V.F. Antyufyev, whose valuable experience in the treatment of cardiac arrhythmias is used in this book.
Special gratitude goes to my students E.A. Gavrilova and S.A. Bondarev for assistance in working on the monograph.
The book “Sports Cardiology” is intended for cardiologists, occupational and sports physiologists, specialists working in the field of sports, military, transport and aviation medicine.

"Sports Cardiology" Sports and the circulatory system

General issues of sports cardiology

Regulation of the circulatory apparatus

Physiological sports heart

Pathophysiological basis of disorders of adaptation of the circulatory apparatus to physical activity

Methods for studying the sports heart

Peculiarities clinical trial athlete's cardiovascular system

Instrumental methods for studying the heart

Functional tests

Prepathological conditions and pathological changes in the cardiovascular system during sports

Causes of damage to the cardiovascular system in athletes

Damages of the cardiovascular system and foci of chronic infection

Arterial hypo- and hypertension

Myocardial dystrophy in athletes

Heart rhythm disturbances

Cardiomyopathy

Anomalies in the development of the valvular apparatus and subvalvular structures of the heart

Idiopathic intracardiac calcifications

Cardiac ischemia

Vascular diseases

Causes of death of athletes

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SPORTS CARDIOLOGY

Goals

Coordination of the activities of specialists - cardiologists, sports doctors, therapists, functional diagnostic doctors to solve the following problems:

Development of standards for cardiac monitoring during in-depth examination of athletes

Creation of a working group to develop a national registry of sudden death in sports

Tasks

Educational - holding educational symposiums, seminars, conferences

Scientific - coordination of scientific research and contacts of specialists in the field of sports medicine and sports cardiology

Cooperation with medical and physical education clinics and centers physical therapy and sports medicine of the Russian Federation.

Section Chairman:

Smolensky Andrey Vadimovich - Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Natural Sciences, Head of the Department of Sports Medicine of the Russian State University of Physical Culture, Sports, Youth and Tourism (GTSOLIFK)

Scientific secretary of the section:

Mikhailova Anastasia Vladimirovna - Candidate of Medical Sciences, Associate Professor of the Department of Sports Medicine of the Russian State University of Physical Culture, Sports, Youth and Tourism (GTSOLIFK)

Section members:

Bondarev Sergey Anatolyevich - Doctor of Medical Sciences, Associate Professor of the Department of Hospital Therapy of the Federal State Budgetary Educational Institution of Higher Education "St. Petersburg State Pediatric Medical University" of the Ministry of Health of the Russian Federation

Gurevich Tatyana Stanislavovna - Doctor of Medical Sciences, Professor of the Department physical methods Treatment and Sports Medicine Faculty of Postgraduate Education

Kryzhanovsky Sergey Aleksandrovich - Doctor of Medical Sciences, Head of the Pharmacological Screening Laboratory of the Federal State Budgetary Institution "Research Institute of Pharmacology named after V.V. Zakusov"

Leonova Natalya Maksimovna - candidate of medical sciences, cardiologist of the Moscow Scientific and Practical Center for Medical Rehabilitation, Rehabilitation and Sports Medicine

A conference “Sports Cardiology” is planned for 2013.

Conferences 2006 - Sports cardiology and circulatory physiology; 2009 - Sports cardiology (in memory of Professor N.D. Graevka) In 2011, on May 18-19, the All-Russian conference with the participation of the CIS countries “Sports Cardiology” was held, as well as a round table “Cardiovascular interface in sports and clinical medicine”. More than 80 specialists in the field of sports medicine and physical therapy took part in the conference, incl. employees of medical and physical education clinics, clinics and rehabilitation treatment centers, the Federal Medical Biophysical Center named after. A.I. Burnazyan FMBA of Russia, FSI “Russian Cardiology Research and Production Complex”, as well as representatives of various regions of Russia. In December 2010, a thematic issue of the Therapist magazine was published, dedicated to sports cardiology.

Sports cardiology, which studies changes that occur in the circulatory system under the influence of intense physical activity, as well as, for example, space cardiology, is part of general cardiology. Sports cardiology studies positive and negative changes in the circulatory system that occur under the influence of both acute and chronic physical activity of varying degrees, and resolves issues of diagnosis, treatment and prevention of pathological changes resulting from excessive physical activity.

The cardiovascular system of an athlete has been the object of study by both domestic and foreign authors for many years. Nevertheless, many questions still remain unclear and await solutions.

The term “athletic heart” was introduced into medicine by the German scientist Henschen. He called the athletic heart the physiological enlargement of the heart that develops as a result of exercise.

In the extensive literature devoted to this issue, one can find various, sometimes diametrically opposed, assessments of the athlete’s heart, either as certainly pathological, or as always physiological. In particular, there is no single point of view on the possibility of pathological changes in the cardiovascular system of an athlete under the influence of sports activities and on the clinical assessment of such changes.

A number of works by both pathologists and clinicians, published mainly at the end of the 19th and beginning of the 20th centuries, demonstrated the unconditional negative impact of sports on the cardiovascular system. In these works, the “athletic heart” was regarded as pathological, an increase in its size, detected in a number of athletes, was considered an unfavorable sign, and even the increase in the number of diseases in a number of countries was explained by a passion for playing sports (J. Corvisar). On the other hand, many authors insisted on the undoubted positive impact of sports on health and the cardiovascular system and believed that the athlete has a significant ability to adapt to heavy physical activity. Among these authors, the extreme position is taken by a number of German authors (N. Reindell, N. Krehl, etc.), who claim that a healthy heart can painlessly endure physical activity of any intensity, and the sometimes detected pathological changes in an athlete’s heart always indicate that it was damaged before playing sports. These extreme points of view on the “sports heart”, as always pathological or as always physiological, cannot be accepted, and the truth, as usual, lies in the middle.

The basis of modern sports cardiology is the concept clearly formulated by the largest Soviet cardiologist G. F. Lang in 1936 about the existence of both physiological and pathological sports heart or, as he said, the sports circulatory apparatus. This understanding of the “athletic heart” significantly expanded the previously existing ideas and brought complete clarity to the concept of “sports cardiology”.

G. F. Lang wrote that any increase in the function of the circulatory apparatus with a “sports heart” is determined, of course, by the performance of not only the heart, but also the blood vessels, and especially the neurohumoral apparatus that regulates.