Throat and Thoracic Conditions: Chapter 13
The anatomy of the throat includes the pharynx,
larynx, trachea, and esophagus.
The pharynx is a membrane- lined cavity behind
the nose and mouth, connecting them to the
esophagus.
The larynx is a hollow muscular organ forming
an air passage to the lungs and holding the
vocal cords in humans.
The trachea is commonly known as the windpipe,
it is a tube of about 4 inches long and less
than an inch in diameter in most people.
The trachea begins just under the larynx and
runs down behind the breast bone or sternum.
The trachea then divides into two smaller
tubes called bronchi: one bronchus for each
lung.
The trachea is composed of about 20 rings
of tough cartilage.
The back part of each ring is made of muscle
and connective tissue.
Moist, smooth tissue called mucosa lines the
inside of the trachea.
The trachea widens and lengthens slightly
with each breath in, returning to its resting
shape with each breath out.
The esophagus is a tube that carries food,
liquid, and saliva from your mouth to your
stomach.
You may not be aware of your esophagus until
you swallow something too large, too hot,
or too cold.
You may also become aware of it when something
is wrong.
The ribs partially enclose and protect the
chest cavity, where many vital organs (including
the heart and lungs) are located.
The ribcage is collectively made up of long,
curved, individual bones with joint connections
to the spinal vertebrae.
At the chest, many rib bones connect to the
sternum via costal cartilage, segments of
hyaline cartilage that allow the ribcage to
expand during respiration.
Although fixed into place, these ribs do allow
for some outward movement, and this helps
stabilize the chest during inhalation and
exhalation.
The human rib cage is made up of 12 paired
rib bones; each are symmetrically paired on
a right and left side.
Of all 24 ribs, the first seven pairs are
often labeled as “true”.
These bones are connected to the costal cartilage,
while the five other “false” sets are
not.
Three of those connect to non-costal cartilage,
and two are deemed “floating” which means
they only connect to the spine.
While there are some cases of minor anatomical
variation, men and women in general have the
same amount of ribs.
A different rig count between the genders
is largely a medical myth.
The manubrium is the upper portion of the
sternum by the first rib.
The tubercle is much more prominent in the
upper than lower ribs.
The angle of the rib, or the (constalangle),
may both refer to the bending part of it,
and a prominent line in this area, a little
in front of the tubercle.
The body of the sternum commonly called the
breastbone, and the xiphoid process, or the
little projection at the bottom of the sternum.
The muscles of the thoracic region include
the superficial pectoralis major and the deeper
pectoralis minor.
We can touch and feel the pectoralis major
and it is important to movement, the pectoralis
minor is underneath the pec major and can
assist with breathing.
The rectus abdominis is superficial.
In people with low body fat, the bellies of
the rectus abdominis can be viewed externally
and are commonly referred to as a “four,
six, or eight pack” depending on how many
are visible; although six is the most common.
While it looks impressive, the rectus abdominis
does not contribute to core strength, as much
as the other muscles do.
The transverse abdominis muscle is a muscle
layer of the anterior and lateral abdominal
wall, which is deep to the internal oblique
muscle.
It is thought by most fitness instructors
to be a significant component of the core.
The internal oblique muscle is a muscle in
the abdominal wall that lies below the external
oblique and just above the transverse abdominis
muscle.
The internal oblique performs two major functions:
first, as an accessory muscle of respiration
that acts as an antagonist to the diaphragm,
helping to reduce the volume of the chest
cavity during exhalation.
When the diaphragm contracts, it pulls the
lower wall (the chest cavity) down, increasing
the volume of the lungs, which then fill with
air.
Conversely, when the internal obliques contract,
they compress the organs of the abdomen pushing
them up into the diaphragm which intruders
back into the chest cavity reducing the volume
of air filling the lungs, producing an exhalation.
The external oblique muscle is the largest
and most superficial (or outermost) layer
of the three flat muscles of the lateral anterior
abdomen.
The external oblique functions to pull the
chest downwards and compresses the abdominal
cavity, which increases the intra-abdominal
pressure, as in the valsalva maneuver.
It also has limited actions in both flexion
and rotation of the vertebral column.
One side of the obliques contracting can create
lateral flexion.
In human anatomy, the thoracic diaphragm,
or simply the diaphragm, is a sheet of internal
skeletal muscle and extends across the bottom
of the thoracic cavity.
The diaphragm separates the thoracic cavity
containing the heart and lungs from the abdominal
cavity, and performs important functions in
respiration.
During inhalation, the diaphragm contracts
and moves in the inferior direction, thus
enlarging the volume of the thoracic cavity.
This reduces the intra-thoracic pressure:
in other words, enlarging the cavity creates
a suction that draws air into the lungs.
Cavity expansion happens in two extremes,
along with intermediary forms.
When the lower ribs are stabilized and the
central tendon of the diaphragm is mobile,
a contraction brings the insertion or the
central tendon towards the origins and pushes
it lower in the cavity towards the pelvis,
allowing the thoracic cavity to expand downward.
This is often called belly breathing.
When the central tendon is stabilized and
the lower ribs are mobile, a contraction lifts
the origin, or the ribs, up towards the insertion,
or the central tendon, which works in conjunction
with other muscles to allow the ribs to slide,
and the thoracic cavity to expand laterally
and upwards.
When the diaphragm relaxes, air is exhaled
by an elastic recoil of the lungs and the
tissue lining the thoracic cavity.
Assisting this function with muscular effort
(called forced exhalation) involves the internal
intercostal muscles used in conjunction with
the abdominal muscles, which act as an antagonist
paired with the diaphragm’s contraction.
The diaphragm is also involved in non-respiratory
functions helping to expel vomit, feces, and
urine from the body by increasing the intra-abdominal
pressure, and by preventing acid reflex by
exerting pressure on the esophagus as it passes
through the esophageal hiatus.
Intercostal muscles are several groups of
muscles that run between the ribs and help
form and move the chest wall.
The intercostal muscles are mainly involved
in the mechanical aspect of breathing.
These muscles help expand and shrink the size
of the chest cavity to facilitate breathing.
There are three principal layers.
The external intercostal muscle aids in quiet
and forced inhalation.
They originate on ribs 1 through 11 and have
their insertion on ribs 2 through 12.
The external intercostals are responsible
for the elevation of the ribs and bending
them more open thus expanding the transverse
dimension of the thoracic cavity.
The internal intercostal muscles aid in forced
expiration (quiet expiration is a passive
process).
They originate on ribs 2 through 12 and have
their insertion on ribs 1 through 11.
The internal intercostals are responsible
for the depression of the ribs and bending
them inwards, thus decreasing the transverse
dimension of the thoracic cavity.
The innermost intercostal muscle, the deep
layer of the internal intercostal muscle which
are separated from them by a neurovascular
bundle.
This is then in turn composed of: the transversus
thoracic muscle, the sternalcostal muscle,
and the subcostalis muscle.
Superficial muscles have a slightly different
function then do deep muscles.
In general superficial muscles are visible,
bulky, and provide dynamic movement.
In contrast deep muscles are usually much
less visible, much less bulky, and provide
stability to the joints and/or the core.
The heart is located under the sternum and
ribcage, slightly to the left.
The purpose of the heart is to pump blood
through the blood vessels to the circulatory
system.
Blood provides the body with oxygen and nutrients,
and also assists in the removal of metabolic
wastes.
The heart is made up of cardiac muscle.
The heart has four chambers, to upper atria,
or receiving chambers, and to lower ventricles,
the discharging chambers.
The atria open into the ventricles via the
atrioventricular valves.
The heart pumps blood through the body.
Blood low in oxygen from the systemic circulation
enters the right atrium from the superior
and inferior vena cava and passes to the right
ventricle.
From here it is pumped into the pulmonary
circulation, through the lungs where it receives
oxygen and gives off carbon dioxide.
Oxygenated blood then returns to the left
atrium, passes through the left ventricle,
and is pumped out through the aorta to the
systemic circulation, where the oxygen is
used and metabolize to carbon dioxide.
In addition, the blood carries nutrients from
the digestive tract to various organs of the
body, while transporting waste to the liver
and kidneys.
Normally with each heartbeat the right ventricle
pumps the same amount of blood into the lungs
as the left ventricle pumps into the body.
Veins transport blood to the heart and carry
deoxygenated blood, except for the pulmonary
and portal veins.
Arteries transport blood away from the heart,
and apart from the pulmonary vein, holds oxygenated
blood.
Their increased distance from the heart causes
veins to have a lower pressure than arteries.
The heart contracts at a resting rate close
to 72 beats per minute.
Exercise temporarily increases the rate, but
lowers the overall resting heart rate in the
long term, which makes it good for heart health.
Cardiovascular disease is the most common
cause of death globally, and accounts for
30% of all deaths.
Risk factors include: smoking, being overweight,
poor exercise routines, high cholesterol,
high blood pressure and poorly controlled
diabetes, among other conditions.
The lungs are the primary organ of respiration
in humans.
Their function in the respiratory system is
to extract oxygen from the atmosphere and
transfer it to the bloodstream, and then release
carbon dioxide from the bloodstream into the
atmosphere in a process of gas exchange.
In humans the primary muscle that drives breathing
is the diaphragm.
The lungs also provide air flows that make
vocal sounds (including human speech) possible.
Humans have two lungs: a right lung and a
left lung.
They are situated within the thoracic cavity
of the chest.
The right lung is bigger than the left, which
share space in the chest with the heart.
The lungs together weigh approximately two
point nine pounds, and the right is heavier.
The lungs are part of the lower respiratory
tract that begins at the trachea and branches
into the bronchi and bronchioles, which receives
air breathed in via the conducting zone.
These divided until the air reaches the microscopic
alveoli where the process of gas exchange
takes place.
Together, the lungs contain approximately
1,500 miles of airways and 300 to 500 million
alveoli.
The lungs are enclosed within a sac called
the pleural sac, which allows the inner and
outer walls to slide over each other whilst
breathing takes place without much friction.
This sac encloses each lung and also divides
each long into sections called lobes.
The right lung has three lobes and the left
lung has two.
The lobes are further divided into bronchopulmonary
segments and lobules.
The lungs have a unique blood supply, receiving
deoxygenated blood sent from the heart for
the purposes of receiving oxygen, also known
as the pulmonary circulation, and a separate
supply of oxygenated blood called the bronchial
circulation.
The tissue of the lungs can be affected by
a number of diseases, including pneumonia
and lung cancer.
Chronic diseases such as chronic obstructive
pulmonary disease and emphysema can be related
to smoking or exposure to harmful substances.
Diseases such as bronchitis can also affect
the respiratory tract.
Lung cancer can either arise directly from
lung tissue or as a result from metastases
from another body part.
The major risk factor for cancer is smoking.
Throat conditions include: contusions and
fractures.
The most common mechanism of injury for a
throat contusion or fracture is having the
head extended and then receiving a direct
impact.
In rare cases, swelling or fluid accumulation
could obstruct the airway and become fatal.
Signs and symptoms include: hoarseness, dyspnea
(which is shortness of breath or difficulty
breathing), coughing, difficulty swallowing,
inability to say high-pitched “E” sounds,
and in severe cases, laryngospasm and respiratory
distress may occur.
The best way to prevent throat contusions
and fractures is to wear the proper protective
equipment.
If an injury occurs, management of throat
contusions and fractures starts by trying
to calm the person.
Try to diminish panic and anxiety.
Monitor the person and refer if necessary.
Stafon Johnson is a former University of Southern
California football player.
He was bench pressing 275 pounds on September
28, 2009 when the weight slipped out of his
hand the barbell hit him in the throat.
The weight crushed his larynx, and it was
split into two parts.
He had emergency surgery to repair the larynx,
but it was believed that he would not be able
to talk or play football again.
He has had several additional surgeries after
that initial emergency surgery.
He declared for the 2010 NFL Draft after recovering
from the injury, but went unselected.
He signed with the Tennessee Titans as an
undrafted free agent, but dislocated his ankle
in a pre-season game, and spent his rookie
season on injured reserve.
In 2012, he sued the University of Southern
California for an unspecified damage greater
than $25,000.
In the lawsuit, Johnson alleged that the former
USC assistant strength and conditioning coach
was “negligently and carelessly inattentive”
in placing the bench press bar back into the
player’s hands after an exercise, causing
the bar to fall on Johnson and rupture his
larynx; this case is still ongoing.
Thoracic conditions include: a stitch in the
side, pectoralis major strain, sternal fractures,
Costochondral injury, rib contusions and fractures.
A stitch in the side is also called a side
ache, a side cramp, a side crampie, a side
sticker, or simply a stitch.
This is an intense stabbing pain under the
lower edge of the rib cage that occurs while
exercising.
It is also referred to as exercise-related
transient abdominal pain.
Some people think that this abdominal pain
may be caused by the intestinal organs like
the liver and the stomach pulling downward
on the diaphragm, but that theory is inconsistent
with its frequency of occurrence during swimming,
which involves almost no downward force on
these organs.
If the pain is present only when exercising
and is completely absent at rest, in an otherwise
normally healthy person, it is benign and
does not require further investigation.
Conservative management can include stretching,
deep breaths, and rest.
The pectoralis major muscle is a large powerful
muscle in the front of the chest.
It is used to rotate the arm inward, pull
a horizontal arm across the body, pull the
arm from above the head down, and pull the
arm from the side upwards.
It is most likely to rupture at the point
where it inserts on the humerus.
It is more common in weight training, especially
when performing a bench press.
The symptoms of a pec major sprain will include
a sudden sharp pain in the front of the upper
arm near the shoulder where the pectoralis
major tendon attaches.
There is likely to be rapid swelling in the
front of the shoulder and arm.
Muscle tests can help reproduce pain and confirm
the diagnosis.
A visible gap or lump in the muscle may appear,
this is commonly known as “popeye” sign.
What can an athlete do?
They can apply RICE (rest, ice, compression,
and elevation) for at least the first two
days.
They can also see a sports injury specialist
doctor.
A surgeon will operate if it is a total rupture
of the tendon.
A long rest period followed by a full rehabilitation
program is essential.
Sports massage may be applied to aid healing
after the acute stage.
Sternal fracture is a fracture to the sternum,
located in the center of the chest.
The injury, which occurs in 5-8% of people
who experienced significant blunt chest trauma,
may occur in vehicle accidents when the still-moving
chest strikes the steering wheel or dashboard,
or is injured by the seat belt.
Cardiopulmonary resuscitation, commonly known
as CPR, has also been known to cause thoracic
injury including sternum and ribs fractures.
Sternal fractures may also occur as a pathological
fracture in people who have weakened bones
in their sternum, due to another disease process.
Sternal fractures can interfere with breathing
by making it more painful; however, its primary
significance is that it can indicate the presence
of a serious associated internal injury, especially
to the heart and lungs.
If a person is injured with enough force to
fracture the sternum, injury such as myocardial
and pulmonary contusions are likely.
Other associated injuries that may occur include
damage to blood vessels in the chest, myocardial
rupture, head and abdominal injuries, failed
chest, and vertebral fracture.
Sternal fractures may also accompany rib fractures,
and are high-energy enough injuries to cause
bronchial tears or ruptures of the bronchioles.
They may hinder breathing.
Due to associated injuries, the mortality
rate for people with the sternal fracture
is high, estimated somewhere between 25-45%;
however, when sternal fractures occur in isolation,
their outcome is very good.
Signs and symptoms include crepitus (a crunching
sound made when the broken bone ends rub together),
pain, tenderness, bruising, and swelling over
the fracture site.
The fracture may visibly move when the person
breathes, and it may be bent or deformed,
potentially forming a “step” at the junction
of the broken bone ends.
If you suspect a sternal fracture, immediate
referral to an emergency department is warranted.
It is important to rule out associated intrathoracic
trauma.
The costochondral joints are the joints formed
by the ribs and the cartilage, which attaches
them to the breastbone or the sternum.
A separation of the bone from the cartilage
is similar to a joint dislocation.
This injury may also be known as a separated
rib.
A separation of one of the costochondral joints
usually occurs after an impact, such as a
fall onto the side of the body or being hit
by something.
Violent twisting movements can also result
in costochondral separation, and it can also
happen from coughing violently.
The symptoms of costochondral separation includes
sudden point tenderness at the point where
the rib meets the chest bone or the sternum.
Patients often described a popping sensation.
The initial pain may subside, only to get
gradually worse again.
Pain is acute with deep breaths, coughing,
and sneezing.
Treatment for costochondral injuries is typically
rest.
Seek medical attention to rule out any complications
from fractured ribs or pneumothorax.
Your doctor may prescribe painkillers to ease
your discomfort and allow you to breathe more
normally.
This injury will usually take around two to
three months to fully heal.
A rib contusion is a bruise to one or more
ribs.
It may cause pain, tenderness, swelling and
a purplish tint on the skin.
There may be a sharp pain with each breath.
A rib contusion can take anywhere from a few
days to a few weeks to heal.
A minor rib fracture or break may cause the
same symptoms as a rib contusion.
The small crack may not be seen on regular
chest x-rays.
Treatments for both problems is the same:
you may use over-the-counter pain medications
to control pain.
Rest; do not lift anything heavy and do not
do any activity that causes pain.
You can also apply ice to the injured area
every day.
The first three to four weeks of healing will
be the most painful.
A broken rib can injure blood vessels and
internal organs.
The risk increases with the number of ribs
broken.
Complications vary depending on which ribs
break.
Possible complications include: a torn punctured
aorta: a sharp end of a break in one of the
first three ribs at the top of your ribcage
could rupture your aorta or other major blood
vessels.
A punctured lung: the jagged end of a broken
middle rib could puncture a lung and cause
it to collapse.
Lacerated spleen, liver, and kidneys: the
bottom two ribs rarely fracture because they
have more flexibility than do the upper and
middle ribs, which are anchored to the breastbone,
but if you break a lower rib the broken ends
can cause serious damage to your spleen, liver,
or kidney.
The internal complications which will be discussed
include: hyperventilation, pneumothorax, hemothorax,
commotion cordis, heart contusion, sudden
death in the athlete, hypertrophic cardiomyopathy,
Marfan’s Syndrome, and athletic heart syndrome.
Hyperventilation is rapid or deep breathing
that can occur with anxiety or panic.
It is also called overbreathing, and may leave
you feeling breathless.
You breathe in oxygen and you breathe out
carbon dioxide.
Excessive breathing creates low levels of
carbon dioxide in your blood.
This causes many of the symptoms of hyperventilation.
Feeling very anxious or having a panic attack
are the usual reasons that you might hyperventilate,
but rapid breathing can be a symptom of a
disease such as bleeding, heart or lung disorder,
or infection.
It is important to determine the cause of
your hyperventilation.
Rapid breathing maybe a medical emergency
that you need to get treated.
Often panic and hyperventilation become a
vicious cycle.
Panic leads to rapid breathing, and rapid
breathing can make you feel more panicked.
If you frequently overbreathe, you may have
hyperventilation syndrome that is triggered
by emotions stress, anxiety, depression, and
anger.
Hyperventilation from panic may be related
to a specific fear or phobia, such as the
fear of heights, dying, or being in closed
spaces also known as claustrophobia.
It is important to try to stay calm in acute
cases of hyperventilation.
It may be helpful to have someone with you
to help coach you through the episode.
The goal of the treatment of the episode is
to increase carbon dioxide levels in your
body and to work to slow your breathing rate.
You can try some immediate techniques to help
acute hyperventilation: breathe through pursed
lips, breathe into a paper bag or cupped hand
(but only do this for a short period of time),
attempt to breathe into your belly rather
than your chest, cover your mouth and try
alternate nostril breathing, hold your breath.
The symptoms should resolve within one to
two minutes; if they have not, activate EMS.
A pneumothorax is a collection of free air
in the chest space that causes the lung to
collapse.
Pneumothorax may occur on its own in the absence
of underlying disease; this is termed as spontaneous
pneumothorax.
Pneumothorax may also occur as a consequence
of an injury or underlying lung disease.
A small spontaneous pneumothorax may resolve
without treatment; a pneumothorax arising
as a result of lung disease or injury requires
immediate treatment.
Treatment may include the insertion of a chest
tube or aspiration of the free air in the
chest cavity.
A spontaneous pneumothorax is also referred
to as a primary pneumothorax.
It occurs in the absence of traumatic injury
to the chest or a known lung disease.
Spontaneous pneumothorax is caused by a rupture
of a cyst or small sack or bleb on the surface
of the lung.
Pneumothorax may also occur following injury
in the chest wall, such as a fractured rib
or any penetrating injuries such as a gunshot
wound or stabbing.
In some instances, the lung continues to leak
air into the chest cavity and results in compression
of the chest structures, including vessels
that return blood to the heart.
This is referred to as attention pneumothorax,
and can be potentially fatal if not treated.
Symptoms of a pneumothorax include chest pain
that usually has a sudden onset.
The pain is sharp and may lead to feelings
of tightness in the chest, shortness of breath
or dyspnea, rapid heart rate, rapid breathing,
cough, and fatigue.
The skin may develop a bluish color (termed
cyanosis) due to decreases in blood oxygen
levels.
Control the patient's breathing and activate
EMS as soon as possible.
The usual cause of hemothorax is laceration
of the lung, intercostal vessel, or an internal
mammary artery.
It can result from a penetrating or blunt
trauma.
Hemothorax is often accompanied by a pneumothorax
sometimes called a hemopneumothorax.
Hemorrhage volumes range from minimal to massive.
Massive hemothorax is most often defined as
the rapid accumulation of greater than a thousand
milliliters of blood.
Shock is common.
Patients with large hemorrhage volumes are
often dyspneic or have trouble breathing,
and have a decreased breath sound.
They may also have rapid breathing rate or
tachypnea, pain, and maybe turning blue from
hypoxia or the lack of oxygen reaching tissue.
Control breathing treat for shock and activate
EMS as soon as possible if a hemothorax is
suspected.
Commotio cordis is an often lethal disruption
of the heart rhythm that occurs as a result
of a blow to the area directly over the heart
at a critical time during the heartbeat, causing
cardiac arrest.
It is a form of ventricular fibrillation not
mechanical damage to the heart muscle or surrounding
organs, and is not the result of heart disease.
The fatality rate is about 65%.
It can sometimes, but not always, be reversed
with defibrillation.
Commotio cordis occurs most frequently in
boys and young men the average age of 15,
usually during sports, most often baseball,
often despite chest protectors.
It is most often caused by a projectile but
can also be caused by a blow of an elbow or
other body parts such as a fist.
Being less developed, the thorax of an adolescent
is more likely prone to this injury, given
the circumstances.
Commotio cordis is a very rare event, but
nonetheless is often considered when an athlete
presents with sudden cardiac death.
Some of the sports which have the risk that
causes trauma are baseball, association football,
ice hockey, polo, rugby, football, cricket,
softball, pelota, fencing, lacrosse, boxing,
karate, kung fu, and other martial arts.
Children are especially vulnerable, possibly
due to the mechanical properties of their
thoracic skeleton.
Look for athletes who were hit in the chest
by an object such as a baseball, baseball
bat, lacrosse ball, or a fist.
There should be no apparent trauma; the athlete
will typically stumble forward for a few seconds
which is followed by unconsciousness, no breathing,
and no pulse.
An AED will indicate that the athlete is in
ventricular fibrillation.
Factors leading to commotio cordis include
the “timing of impact”, which refers to
the timing of the object hitting the chest
during the cardiac cycle.
The heart is most vulnerable when it's struck
at the beginning of the T-wave.
This part of the cycle indicates the refilling
of the hearts ventricles.
Use an AED and defibrillate as quickly as
possible.
For every one minute delayed in getting shocked
by the AED, there is a 10% decline in survival
rate.
Using the AED is the best practice and gives
the athlete the greatest chance of survival.
Immediately activate EMS or the School's Emergency
Action Plan.
Continue AED use and CPR until EMS arrives
and takes over.
Blunt cardiac injury, a general term to describe
all non-penetrating injuries to the heart
during trauma.
It incorporates myocardial or cardiac contusion,
structural injuries such as valvular damage,
and traumatic pericardial effusion.
Blunt cardiac trauma usually results from
a high kinetic force that travels through
the thorax into the heart, most commonly high-speed
motor car accidents.
Signs and symptoms include blood and fluid
leaking into the surrounding tissues, decrease
circulation of the heart muscle, hypoxia,
and necrosis in the heart, which is cell death,
localized pain and referred pain to the left
shoulder.
They're going to exhibit symptoms similar
to a heart attack.
We need to activate emergency medical services
immediately.
Low blood flow to the heart can result in
catastrophic injury.
Hypertrophic cardiomyopathy is a disease in
which the heart muscle or myocardium becomes
abnormally thick or hypertrophied.
The thickened heart muscle can make it harder
for the heart to pump blood.
Hypertrophic cardiomyopathy often goes undiagnosed
because many people with the disease have
few, if any, symptoms and can lead typically
normal lives with no significant problems.
However, in a small number of people with
HCM, the thickened heart muscle can cause
shortness of breath, chest pain, and problems
in the heart's electrical system, resulting
in life threatening abnormal heart rhythms
or arrhythmias.
Hypertrophic cardiomyopathy is usually caused
by abnormal genes that cause the heart muscle
to grow abnormally thick.
The severity of hypertrophic cardiomyopathy
varies widely.
Most people with HCM have a form of the disease
in which the wall or the septum between the
two chambers of the heart ventricles becomes
enlarged and impedes blood flow out of the
heart.
This condition is sometimes called obstructive
hypertrophic cardiomyopathy.
Sometimes hypertrophic cardiomyopathy occurs
without a significant blocking of the blood
flow, however, the hearts main pumping chamber
(the left ventricle) may become stiff, reducing
the amount of blood that the ventricle can
hold, and the amount that gets pumped out
into the body with each heartbeat.
This condition is sometimes called non-obstructive
hypertrophic cardiomyopathy.
Patients diagnosed with hypertrophic cardiomyopathy
should be disqualified from sports participation.
Athletic heart syndrome is a heart condition
that may occur in people who exercise or train
for more than an hour a day.
Athletic heart syndrome isn't necessarily
bad for you if you are an athlete, and is
not what makes young athletes expire midcourt.
While it does lead to structural changes in
the heart, a person with this condition usually
does not notice any other symptoms.
Athletic heart syndrome does not require treatment,
and is important to diagnose only to rule
out other heart problems that may be serious.
Like other muscles, the heart gets stronger
with exercise.
Endurance exercises such as jogging, swimming,
and cycling can make the organ bigger allowing
it to pump more blood with every beat.
Short, intense workouts such as weight lifting
can further increase the pumping power by
the thickening of the walls of the heart.
Just as bodybuilders sculpt their abs and
biceps into highly defined muscles, competitive
athletes may develop extraordinary hearts
as well.
Not only is the heart extra large and thick,
it they also produce some irregular rhythms
or arrhythmias.
A person with athletic heart syndrome may
also have a markedly slow resting heart rate,
in the range of 35 to 50 beats per minute.
In addition, electrical impulses can take
strange routes across the heart causing abnormal
readings on an EKG.
Together, these changes produced by exercise
are called athletic heart syndrome.
There are no symptoms other than bradycardia
or low heart rate.
After all other heart conditions are rolled
out, no treatment is necessary for athletic
heart syndrome.
Marfan’s syndrome is a genetic disorder
of connective tissue.
The degree that people are affected varies.
People with Marfan’s tend to be tall, thin,
with long arms and legs, fingers, and toes.
They also typically have flexible joints and
scoliosis.
The most serious complication involves the
heart and aorta with an increased risk of
mitral valve prolapse and aortic aneurysm.
Other commonly affected areas include the
lungs, eyes, bones, and the covering of the
spinal cord.
There is no cure for Marfan’s syndrome.
Many people have a normal life expectancy
with proper treatment.
Surgery may be required to repair the aorta
or replace a heart valve.
It is recommended that hard exercise be avoided.
About 1 in 3,000 to 10,000 individuals have
Marfan’s syndrome.
Marfan’s syndrome occurs equally in males
and females.
Rates are similar between races and among
different regions of the world.
The signs and symptoms of Marfan’s syndrome
vary greatly, even among members of the same
family.
Some people experience only mild effects,
while others developed life-threatening complications.
In most cases, the disease tends to worsen
with age.
Marfan’s syndrome features may include:
tall and slender build; disproportionately
long arms, legs and fingers (if you stick
your thumb inside your fist, if there's a
part of your thumb that sticks out on the
other side by your pinkie, you could have
a Marfan's trait); the breastbone that protrudes
outward or dips inward; a high arch palette
or crowded teeth; heart murmurs; extremely
nearsightedness; an abnormally curved spine;
and flat feet.
Because marfan’s syndrome can affect almost
any part of your body (especially the connective
tissue) and may cause a variety of complications,
it is therefore a disqualifying condition.

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