294.4 📋 章末速記 Summary

294.4.1 🔑 一句話總結

Athletic heart syndrome = 規律訓練的生理性心臟適應（eccentric LVH + bradycardia + 1° AV block + Wenckebach + voltage LVH）；SCD in athletes 在年輕 < 35 多由 HCM / 異常冠脈 / ARVC / LQT / Brugada / WPW / myocarditis / commotio cordis / Marfan dissection；> 35 由 CAD 主導；Pre-participation screening：Italian 強制 ECG（↓ SCD 90%），US history + physical only；HCM athletes 2024 + LIVE-HCM：中強度運動 OK + ICD ≠ disqualification；Commotio cordis：胸前撞擊在 T wave 易感期 → VF → AED + CPR；COVID-19 myocarditis：3-6 mo exercise restriction + CMR 監測。

294.4.2 💊 治療精要

  • HCM athletes：individualized + multidisciplinary；moderate exercise OK；β-blocker + 風險分層
  • LQT1：β-blocker (nadolol, propranolol)；avoid swimming for LQT1
  • anomalous coronary：surgical re-implantation / unroofing → return to play
  • WPW：risk stratify + ablation if high-risk pathway
  • ARVC：ICD + restrict competitive sport + family screening
  • commotio cordis：AED + CPR；prevention via chest protector
  • COVID-19 myocarditis：3-6 mo restriction；CMR follow-up；individualized return

294.4.3 🎯 盧醫師的考前提醒

  1. athletic heart vs HCM 鑑別：wall thickness > 13 mm 偏 HCM；LV cavity 大 + 對稱、detraining 可逆 = athletic；family hx + symptoms + LGE on CMR → HCM
  2. SCD 年輕 athlete 在 US #1 = HCM；在 Italy #1 = anomalous coronary（解剖差異 + screening 差異）
  3. anomalous coronary risk anatomy：左 from R sinus 或 R from L sinus + interarterial course（PA + aorta 之間）— 突發 SCD
  4. Italian PPS model ↓ SCD 90%（25-year data）— ECG 強制納入是關鍵；US AHA 仍以 history + physical 為主
  5. athletic ECG 變異：bradycardia、1° AVB、Wenckebach、IRBBB、voltage LVH、early repol — 都正常
  6. athletic ECG 要警覺：T wave inversion in lateral/inferolateral leads、pathologic Q、LBBB、Mobitz II、long QTc > 460-470、Brugada、WPW、epsilon waves
  7. LIVE-HCM 2023 + 2024 ACC/AHA Sports：HCM moderate exercise OK；ICD ≠ disqualification；more individualized approach
  8. commotio cordis：vulnerable T-wave window 10-20 ms；AED 5 min 內 → 50%+ survival；chest protector 預防
  9. COVID-19 myocarditis：3-6 mo exercise restriction；diagnosis = Lake Louise CMR criteria；serial CMR + clinical follow-up
  10. 2024 sports cardiology update 趨勢：less blanket disqualification + more shared decision-making + ECG inclusion + AED placement