Swimming: What the Sports Cardiologist Should Know
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Sports Cardiology (M Wasfy, Section Editor)
Swimming: What the Sports Cardiologist Should Know Aubrey J. Grant, MD1 Arjun Kanwal, MD1 Ankit B. Shah, MD, MPH1,2,* Address *,1 Sports & Performance Cardiology Program, MedStar Health & Vascular Institute, 3333 N. Calvert St. Suite 500 JPB, Baltimore, MD, 21218, USA Email: [email protected] 2 Sports Medicine and Science, USA Swimming, Colorado Springs, CO, USA
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Sports Cardiology Keywords Swimming I Sports cardiology I Long QT syndrome I Swimming induced pulmonary edema I Water immersion
Abstract Purpose of review To inform the reader on the current knowledge of the cardiovascular effects of swimming and review the characteristics and treatments of unique cardiac conditions affecting the swimmer including swimming-induced pulmonary edema, long QT syndrome, troponin elevation, and sudden cardiac arrest/death. Recent findings New research has characterized swimming-induced cardiac remodeling as eccentric remodeling notable for greater left ventricular chamber dilation relative to wall thickening suggesting that swimming primarily challenges the heart with a volume load. Additionally, recent data from triathlons have shown that most sudden deaths occur during the swim segment of the race; however, our understanding of the cause of death remains incomplete. Summary Cardiovascular management of the competitive swimmer is currently based on experience and anecdotal evidence. Future studies are needed to help improve our understanding of the physiologic remodeling in response to swimming and to better understand the risks and treatment of cardiovascular diseases that are uniquely encountered by swimmers.
Introduction Swimming, a core element of the modern triathlon, has intrinsic physiologic differences that distinguish it from
land-based endurance sports such as running and cycling. Water immersion and the superimposition of
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Curr Treat Options Cardio Med
exercise in a supine position result in significant unique hemodynamic changes that may place susceptible swimmers at risk for certain forms of cardiovascular disease. The inherent differences in the training medium make it difficult to extrapolate data from land-based
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athletes to this population. Therefore, the purpose of this review is to inform the reader on the current knowledge on the cardiovascular effects of swimming and review the characteristics and treatments of unique cardiovascular conditions affecting the swimmer.
Physiology of water immersion Water immersion increases compressive forces on the body and increases pressure on the peripheral capacitance vessels. As a result, blood volume is redistributed centrally into the thoracic cavity leading to increased venous return and biventricular preload [1]. Water immersion can result in hemodynamically significant changes with increases in central venous pressure by 12– 18 mmHg and increases
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