Table of Contents

Part I Structure and Function of the Heart

Chapter 1 The Heart

Cardiac Anatomy

Cardiac Function

Electrical Properties of the Heart

Electrocardiography

Contractile Properties of the Heart

Exercise and the Heart

Key Points

Chapter 2 Monitoring the Electrical Activity of the Heart

Palpation

Heart Rate Monitors

Electrocardiography at Rest and During Exercise

Exercise Modalities and Protocols

Ambulatory ECG monitors

Implantable Loop Recorders

Key Points

Part II The ECG

Chapter 3 Normal ECG at Rest

Reading the ECG

Interpreting the ECG

Common Mistakes in Preparing and Placing Leads (Troubleshooting)

Key Points

Chapter 4 Abnormal ECG at Rest

Brady arrhythmias

Tachyarrhythmias

ECG Abnormalities in Diseases of the Coronary Circulation: Ischemia and Myocardial Infarction

Unusual ECG Abnormalities

Key Points

Chapter 5 ECG During Exercise

Normal ECG Responses During and Postexercise

Evaluation of Individuals with Known or Suspected Exercise- or Exertion-Related Arrhythmias

ECG Exercise Stress Testing in the Diagnosis of Coronary Artery Disease (CAD)

Key Points

Part III The Athletes’ Heart

Chapter 6 The Athlete’s Heart: Physiological Versus Pathological

Cardiac Structure and Function in Highly Trained Athletes

Electrocardiogram (ECG) of an Athlete

Arrhythmias and the Athlete

Syncope and the Athlete

Sudden Cardiac Death (SCD) in athletes

Preparticipation Screening

Key Points

Chapter 7 Athlete Case Studies

Case Study 1: Spontaneous Atrial Fibrillation in a Freestyle Skier.

Case Study 2: Exercise-Induced Vasodepressor Syncope in an Elite Rower: A Treatment Dilemma

Case Study 3: Prevalence and Significance of an Isolated Long QT Interval in Elite Athletes

Case Study 4: Differentiation of RVOT-VT and ARVC in an Elite Athlete

Case Study 5: Treat the Patient Not the Blood Test: The Implications of an Elevation in Cardiac Troponin Following Prolonged Endurance Exercise

Case Study 6: Acute Myocardial Infarction in the Presence of Normal Coronaries and the Absence of Risk Factors in a Young, Lifelong Regular Exerciser

About the Author

Greg Whyte, PhD, FACSM, is a professor of applied sport and exercise science at Liverpool John Moores University in London. As one of British sport's foremost research scientists, Whyte has worked as a consultant physiologist in a large number of Olympic and professional sports and is currently the science consultant for England FA (World Cup 2010), the Commonwealth Games Committee for England (Delhi 2010), and British Rowing. From 2001 to 2004, Whyte served as the director of research for the British Olympic Association based at the Olympic Medical Institute, where he established the Centre for Sports Cardiology, which is dedicated to the investigation and treatment of sport-related cardiac issues. Whyte is now the director of the Centre for Sports Cardiology at the Centre for Health and Human Performance.

A former international modern pentathlete, Whyte competed in two Olympic Games and won European bronze and World Championship silver medals. He studied for his BSc (hons) at Brunel University, completed his MSc in human performance at Frostburg State University in the United States, and completed his PhD at St. George’s Hospital Medical School and the University of Wolverhampton, where he was research coordinator. Whyte is a fellow of the American College of Sports Medicine (FACSM) and was chairman of the charity Cardiac Risk in the Young (CRY) from 1999 to 2009.

Sanjay Sharma, BSc (Hons), MD, FRCP (UK), FESC, was appointed consultant cardiologist and physician at University Hospital Lewisham and honorary senior lecturer in cardiology at Kings College Hospital London in 2001. In 2006 he took up the post of director of heart muscle diseases at Kings College in London and became professor of cardiology at St George’s University of London in 2009. Sharma is medical director for Virgin London Marathon, consultant cardiologist for the CRY sports cardiology clinic at St George’s Hospital, and cardiologist for the English Institute of Sport, the British Rugby League, and the British Lawn Tennis Association.

Sharma’s interests include cardiovascular adaptation in athletes, sudden cardiac death in the young, and heart muscle diseases, for which he has an international reputation and has published over 100 scientific articles, including original papers in highly rated peer-reviewed journals. Sharma was awarded the status of fellow of the European Society of Cardiology and elected as a nucleus member of the Sport Cardiology section of the European Association of Cardiovascular Disease Prevention and Rehabilitation in 2008. Sharma leads the CRY screening program, which is the largest of its kind in the UK. Sharma has an active interest in medical education and is the lead tutor for the international teaching faculty for the Royal College of Physicians.