Кардіоміопатія внаслідок фізичного перевантаження

Abstract

У роботі поданий огляд даних літератури, що відображає сучасний погляд на формування уявлень про патологію серцево-судинної системи спортсменів, що розвивається внаслідок фізичного перенапруження. Констатована необхідність виділення спортивної патології міокарда в окрему одиницю, що обумовлено як етіологічними, так і патогенетичними особливостями кардіальної патології у спортсменів. Основну увагу в роботі автор акцентує на особливостях клінічного перебігу, електрокардіографічного та ехокардіографічного проявів кардіоміопатії внаслідок фізичного перенапруження у спортсменів різної кваліфікації. Показана роль гіпертрофії міокарда в збільшенні частоти раптової кардіальної смерті спортсменів, що обумовлює необхідність регулярного медико-біологічного контролю серцево-судинної системи атлетів

В работе представлен обзор данных литературы, отображающий современный взгляд на формирование представлений о патологии сердечно-сосудистой системы спортсменов, развивающейся вследствие физического перенапряжения. Констатирована необходимость выделения спортивной патологии миокарда в отдельную нозологическую единицу, что обусловлено как этиологическими, так и патогенетическими особенностями кардиальной патологии у спортсменов. Основное внимание в работе автор акцентирует на характерных особенностях клинического течения, электрокардиографического и эхокардиографического проявления кардиомиопатии вследствие физического перенапряжения у спортсменов разной квалификации. Показана роль гипертрофии миокарда в увеличении частоты внезапной кардиальной смерти спортсменов, что обусловливает необходимость регулярного медико-биологического контроля сердечно-сосудистой системы атлетов.

Despite the successes of sports cardiology, the scientific ideas of pathologic athletic heart are in a crisis state now in the domestic (Ukrainian) athletic-medical schools. This can be explained, on the one hand, by a growth in the frequencies of cardiac pathology and cardiac death in sport and, on the other hand, by the insufficient development of the scientific conception of pathologic athletic heart. The results of analysis of literature data testify to the necessity to distinguish the specific sports pathology of cardiovascular system. This is caused not only by the statistically high part of cardiac pathology in the general structure of illness and lethality in sport, but also by a number of specific features of the course of cardiac pathology in sportsmen. In other words, the separation of pathologic athletic heart as an individual nosologic unity is extremely urgent. The rejection of such pathology would mislead practicing cardiologists, who are forced to restrict themselves by the framework of generally accepted nosologies and sometimes to consider a clear pathology of sportsman’s heart as its physiological state. The slight development of the scientific conception of pathologic athletic heart hampers the study of the pathogenesis of diseases and the development of diagnostic criteria and therapeutic and prophylactic measures, which obviously does not favor a decrease in the morbidity of cardiovascular system and in the number of sudden cardiac deaths in sport. Unfortunately, there exists no commonly accepted single term now for the definition of sports pathology of myocardium. In our opinion, in order to define the pathology of athletic heart, it is more expedient to use the words “cardiomyopathy due to physical overstress”, since this term indicates, first of all, the secondary character of damages of myocardium that arise at the noncorrespondence of the intensity and the volume of physical loads to the functional possibilities and the state of health of athletes. The clarification of etiopathogenous mechanisms of development of cardiomyopathy will favor the solution of one of the basic problems of applied sports medicine, namely, the treatment of a pathologic state of heart. Most researchers consider namely the physical overstress as the main reason for the appearance of myocardium's pathology in sportsmen. The data obtained for the last years allow us to assert that the physical loads are not the single reason, but a starting factor favoring the development of endogenous extracardiac disturbances, which favor the activation of pathologic processes in myocardium against the metabolism intensification background. A specific feature of the pathology of a cardiovascular system in skilled sportsmen consists in that the dysfunction of myocardium mostly has no symptoms or is revealed only by a decrease in the resistance to physical loads. The real existence of cardiomyopathy in sportsmen is supported by distinctive changes in electrocardiograms. The ECG-equivalent of the given pathologic state in sportsmen is considered to be a violation of the processes of repolarization (a special attention should be paid to a horizontal displacement of the segment ST below the isoline by 1.0 mm with the transition to a negative wave T), as well as the presence of clinically significant disturbances of the rhythm of heart. It is very important that the majority of tragic events in sport is caused by namely a fatal arrhythmia. In a number of cases, the cardiomyopathy due to a physical overstress can be manifested in a pathologic rearrangement of athletic hearts, which does not correspond to the directivity of the training process. First of all, this is related to the hypertrophy of myocardium, which is considered by most researchers as the necessary condition of the adaptation of sportsman’s heart. The hypertrophy of myocardium can be regarded as a version of physiological athletic heart, but only in the case where the myocardium thickness for the left ventricle is at most 12–13 mm in men and 11 mm in women. At the same time, the specific contribution of the myocardium hypertrophy to the general pattern of sudden deaths of sportsmen (with regard for the reasons concerning no heart) is already as high as 33 %. This is an indisputable proof of that the myocardium hypertrophy (of any etiology) is the direct reason for sudden deaths of sportsmen. The results of analysis of the literature data indicate that the development of a myocardium hypertrophy in sportsmen ensures, to a certain extent, an enhancement of the functional possibilities of heart as a hemodynamical pump. At the same time, the disturbances arising in this case in the humoral regulation of the metabolism of myocardium, as well as changes in its blood supply and the intracardiac hemodynamics, not only decrease the efficiency of compensatory reactions, but lead to that the hypertrophy of myocardium on the subsequent stages of its development becomes a heavy factor for the activity of heart.