#16
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 ìàðòå 2005 ñîñòîÿëàñü î÷åðåäíàÿ êîíôåðåíöèÿ ïî ýòîé òåìàòèêå.
Âåñü òåêñò ïðèíÿòûõ ðóêîâîäñòâà è ðåêîìåíäàöèé ñâîáîäíî äîñòóïåí: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
#17
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Öèòàòà:
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#18
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Õîòåë ïîäåëèòüñÿ åù¸ îäíèì íàáëþäåíèåì ïî ïîâîäó ñïîðòà è çàáîëåâàíèé ñåðäöà. Íåîäíîêðàòíî ñî çíàêîìûì äîêòîðîì (çàâåäóåò ôóíêöèîíàëüíîé äèàãíîñòèêîé â ÂÑÄ ÖÑÊÀ) ëîìàëè êîïüÿ íà òåìó êòî äîëæåí ïðèíèìàòü ðåøåíèå î äîïóñêå/îòñòðàíåíèþ ñïîðòñìåíà ê òðåíèðîâêàì. Íàïðèìåð, ýêñòðàñèñòîëèÿ, WPW è ò.ä.. Ñïîðòèâíûå ìåäèêè îòïðàâëÿþò áîëüíîãî ê êàðäèîëîãàì ñ êîíêðåòíûì âîïðîñîì - à ìîæåò ÷åëîâåê çàíèìàòüñÿ ñïîðòîì èëè íåò? Êàðäèîëîãè ñòàâÿò äèàãíîç, ëå÷àò WPW, îòïðàâëÿþò áîëüíîãî ê ñïîðòèâíûì âðà÷àì ñ îòâåòîì - âîò âû è ïðèíèìà¸òå ðåøåíèå. Âðà÷ó êîìàíäû ïðîùå âñåãî îòñòðàíèòü ñïîðòñìåíà "íà âñÿêèé" ñëó÷àé, îò ãðåõà ïîäàëüøå. Ñèíäðîì âíåçàïíîé ñìåðòè è âñ¸ òàêîå. Ñïîðòñìåí íèêîãäà ê ýòèì ñîâåòàì íå ïðèñëóøèâàåòñÿ, ñïîðò - ýòî åãî áèçíåñ è ñòðàñòü. Êðîìå òîãî, îí åù¸ ñèìóëèðîâàòü áóäåò ñî ñòðàøíîé ñèëîé è ïðèêèäûâàòüñÿ "çäîðîâûì".Èñòèíà ãäå-òî ïîñåðåäèíå.
Âîçìîæíûé êîíñåíñóñ: êîìèññèÿ (íà ïîäîáèå ë¸òíîé) â ñîñòàâå ñïîðòèâíîãî âðà÷à, ïðîôèëüíîãî âðà÷à (íàïðèìåð, êàðäèîëîãà), êîòîðàÿ è áóäåò ïðèíèìàòü òàêèå ðåøåíèÿ íà îñíîâàíèè õîòÿ áû ãàéäëàéíà 36 êîíôåðåíöèè â Áàòåçäå. Ñ óâàæåíèåì, Èãîðü. |
#19
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Öèòàòà:
Ó ñòàáèëüíîãî "áîëüíîãî" ìîæíî áûëî áû ïðîâåñòè ðàçúÿñíèòåëüíóþ ðàáîòó è ïóñòü âûáèðàåò ñàì! Â êîíöå òî êîíöîâ - æèçíü åãî, åìó åé è ðàñïîðÿæàòüñÿ. Òóò ãëàâíîå îáúÿñíèòü âñå ïðàâèëüíî. |
#20
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Ðàç ïîøëà òàêàÿ ãðóñòíàÿ òåìà âîò âûëîæèë http://rusmedserv.narod.ru/SCD_AG.ppt, ïðåçåíòàöèþ "SUDDEN CARDIAC DEATHS IN YOUNG ATHLETES". ß åå ñêà÷àë åùå êîãäà ìåäñëàéäñ áûë æèâîé, ìîæåò êîìó è ïðèãîäèòñÿ...
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#21
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Öèòàòà:
Êàðäèîëîãèÿ - ýòî âçâåøèâàíèå ðèñêîâ: - ðèñê ÍÅ ëå÷åíèÿ è ðèñê ëå÷åíèÿ (òàáëåòîê, õèðóðãèè), - ðèñê óìåðåòü ðàíüøå è ðèñê æèòü äîëãî Çàäà÷à âðà÷à, ÍÅ çàïðåùàòü çàíèìàòüñÿ ñïîðòîì, ðîæàòü è æèòü, à èíôîðìèðîâàòü î ñòåïåíè ðèñêà è î ìåðàõ ïî åãî (ðèñêà) ñíèæåíèþ. [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì]
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
#22
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Öèòàòà:
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#23
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Âðà÷ - íå áîã è ðåøåíèå ÂÑÅÃÄÀ çà ñàìèì ÷åëîâåêîì!
Ïðèíóæäåíèå æå ê àáîðòó æåíùèí ñ÷èòàþ âàðâàðñòâîì. À çäîðîâûõ âûñîêîêâàëèôèöèðîâàííûõ ñïîðòñìåíîâ ÿ åùå íå âèäåë, êðîìå øàõìàòèñòîâ Äåëàë ýõîêàðäèîãðàôèè äåòÿì 10 - 12 ëåò, çàíèìàþùèìñÿ õîêêååì - ñåðäöå çàíèìàåò 1/2 ãðóäíîé êëåòêè Óðîäñòâî ýòî íàä îðãàíèçìîì...
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
#24
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Recommendations:
1. Athletes without structural heart disease, without a history of palpitations, or without tachycardia (particularly those 20 to 25 years old or more) can participate in all competitive sports. However, in younger age groups, a more in-depth evaluation including an electrophysiologic study may be ecommended before allowing participation in moderateto high-intensity competitive sports. 2. Athletes with episodes of AV reciprocating tachycardia should be treated as previously recommended (see section on Supraventricular Tachycardia). However, it should be appreciated that they can develop atrial fibrillation with rapid ventricular rates. Electrical induction of atrial fibrillation to determine the shortest QRS interval between two complexes conducted over the accessory pathway during isoproterenol administration or exercise is recommended. Those athletes in whom the shortest cycle length is less than 250 ms should undergo ablation of the accessory pathway. 3. Athletes with episodes of atrial flutter/fibrillation and syncope or near syncope whose maximal ventricular rate at rest (without therapy) as a result of conduction over the accessory pathway exceeding 240 beats/min should be considered for catheter ablation therapy of the accessory pathway prior to continuing competition. Those whose ventricular rate during isoproterenol administration is less than 240 beats/min and who have no episodes of yncope or near syncope appear to be at low risk for sudden cardiac death. 4. Athletes with no structural heart disease who have had successful catheter or surgical ablation of the accessory pathway, are asymptomatic, and have normal AV conduction and no inducible arrhythmia by follow-up electrophysiologic study can participate in all competitive sports in several days. Those without an electrophysiologic study and no spontaneous recurrence of tachycardia for two to four weeks after ablation can participate in all competitive sports. Èñòî÷íèê: 36th Bethesda Conference Eligibility Recommendations for Competitive Athletes With Cardiovascular Abnormalities. Journal of the American College of Cardiology Vol. 45, No. 8, 2005 |