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Cardiac damage in athlete's heart: When the “supernormal” heart fails!

World Journal of Cardiology 2017年第6期9卷 470-480页

作者： Andreina Carbone Antonello D’Andrea Lucia Riegler Raffaella Scarafile enrica pezzullo Francesca Martone Raffaella America Biagio Liccardo Maurizio Galderisi Eduardo Bossone Raffaele Calabrò Second University of Naples Monaldi HospitalAORN Ospedali dei Colli Department of Advanced Biomedical Sciences FedericoⅡUniversity Hospital Department of Cardiology and Cardiac Surgery University Hospital San Giovanni di Dio

Intense exercise may cause heart remodeling to compensate increases in blood pressure or volume by increasing muscle mass. Cardiac changes do not involve only the left ventricle, but all heart chambers. Physiological cardiac modeling in athletes is associated with normal or enhanced cardiac function, but recent studies have documented decrements in left ventricular function during intense exercise and the release of cardiac markers of necrosis in athlete's blood of uncertain significance. Furthermore, cardiac remodeling may predispose athletes to heart disease and result in electrical remodeling, responsible for arrhythmias. Athlete's heart is a physiological condition and does not require a specific treatment. In some conditions, it is important to differentiate the physiological adaptations from pathological conditions, such as hypertrophic cardiomyopathy, arrhythmogenic dysplasia of the right ventricle, and non-compaction myocardium, for the greater risk of sudden cardiac death of these conditions. Moreover, some drugs and performance-enhancing drugs can cause structural alterations and arrhythmias, therefore, their use should be excluded.

关键词： Athlete’s heart Cardiac damage Fibrosis Intense exercise Arrhythmogenic dysplasia of the right ventricle Atrial fibrillation Doping Anabolic-androgenic steroids Hypertrophic cardiomyopathy

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Transcranial Doppler ultrasonography: From methodology to major clinical applications

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World Journal of Cardiology 2016年第7期8卷 383-400页

作者： Antonello D'Andrea Marianna Conte Massimo Cavallaro Raffaella Scarafile Lucia Riegler Rosangela Cocchia enrica pezzullo Andreina Carbone Francesco Natale Giuseppe Santoro Pio Caso Maria Giovanna Russo Eduardo Bossone Raffaele Calabrò Integrated Diagnostic Cardiology Second University of NaplesAORN "dei Colli"Monaldi Hospital Department of Cardiology and Cardiac Surgery University Hospital

Non-invasive Doppler ultrasonographic study of cerebral arteries [transcranial Doppler(TCD)] has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency(≤ 2 MHz) transducer on the scalp of the patient over specific acoustic windows, in order to visualize the intracranial arterial vessels and to evaluate the cerebral blood flow velocity and its alteration in many different conditions. Nowadays the most widespread indication for TCD in outpatient setting is the research of right to left shunting, responsable of so called "paradoxical embolism", most often due to patency of foramen ovale which is responsable of the majority of cryptogenic strokes occuring in patients younger than 55 years old. TCD also allows to classify the grade of severity of such shunts using the so called "microembolic signal grading score". In addition TCD has found many useful applications in neurocritical care practice. It is useful on both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoidal haemorrhage(caused by aneurysm rupture or traumatic injury), traumatic brain injury, brain stem death. It is used also to evaluate cerebral hemodynamic changes after stroke. It also allows to investigate cerebral pressure autoregulation and for the clinical evaluation of cerebral autoregulatory reserve.

关键词： Transcranial Doppler ultrasonography Lindegaard ratio Paradoxical embolism Microembolic signals Middle cerebral artery Patent foramen ovale Cryptogenic STroke Vasospasm Acute subarachnoid hemorrhage Ischemic stroke

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