145 - EXERCISE AND CARDIOVASCULAR DISEASE: CAN THERE BE TOO MUCH OF A GOOD THING?

Thursday, October 24, 2024

2:00 PM – 3:00 PM PT

Room: 212-213

Workshop Description: Exercise is associated with a marked reduction in cardiovascular morbidity and mortality. However, the physiologic and metabolic stress of exercise may increase the risk of cardiac morbidity and mortality in patients with established cardiovascular disease, and in some instances, exercise may potentiate disease progression and/or cardiac events (myocardial infarction, arrhythmia, or sudden cardiac arrest). Exposure to high-volume and high-intensity exercise over prolonged periods may result in substantial cardiac adaptations. These adaptations assist in improving the body’s ability to achieve higher levels of cardiorespiratory fitness. Occasionally, findings of exercise induced cardiac remodeling (“Athlete’s Heart”) may overlap with possible pathologic changes, resulting in the clinical challenge of differentiating between these two entities. Furthermore, prolonged exposure to exercise may increase the risk of developing cardiac pathology, such as atrial fibrillation.

This workshop will be case-based and present three commonly encountered clinical scenarios related to sports and exercise in clinical cardiovascular care. 1) Exercise-induced cardiac remodeling versus dilated cardiomyopathy, 2) Aortic dilatation and exercise, and 3) Atrial fibrillation in an athlete. Each scenario will be presented in a clinical case format followed by a brief discussant presentation and panel discussion outlining an expert approach. Audience and panel engagement will then commence.

The workshop will provide an approach and framework for the work-up and management of active patients with cardiovascular disease, and those with borderline findings (i.e., athletic ‘grey-zone’). This will be achieved by focusing on three common conditions and scenarios encountered in clinical practice. This framework will include the principles of exercise prescription and safe exercise that can be applied to all patients with cardiovascular disease. Sex-specific considerations in cardiac adaptation to exercise and disease management will also be explored.

Interactive and Engagement Activities Description: The workshop proposal aims to provide an interactive experience for the audience. Three separate succinct 5-minute clinical cases will be presented by a trainee (EICR vs. Dilated Cardiomyopathy, Aortic Dilatation, and Atrial Fibrillation in an Athlete). Following each case, an expert discussant will provide their approach to the scenario with expert panel involvement. After the case presentation, and expert discussant and panel review, the case will be open for audience discussion to the audience. This will occur after each case and there will be additional time at the end allotted to additional audience questions on all cases.

Learning Objectives:

At the end of this session participants will be able to:

participants will become familiar with contemporary understanding of exercise-induced cardiac remodeling (EICR) i.e. “Athlete’s Heart” and how to approach differentiation of EICR from potential pathology;
participants will become familiar with the management of exercise and cardiovascular disease, including aortic dilatation and atrial fibrillation ; and
participants will gain an approach to return-to-sport for patients with a cardiovascular diagnosis, including the importance of shared-decision making.

Disclosure(s):

Nathaniel Moulson, MD, MHA, FRCPC: Amgen: Honoraria received (Ongoing); HLS Therapeutics: Honoraria received (Ongoing); Novartis: Honoraria received (Ongoing); Novo Nordisk: Advisory Board (Ongoing); Sanofi: Honoraria received (Ongoing)

James McKinney, MD, FRCP(C): No financial relationships to disclose

Paul Dorian, MD MSc: No financial relationships to disclose

Laura F. Halperin, MD: No financial relationships to disclose

Erin Karlstedt, MD, FRCPC: No financial relationships to disclose

Marie-Eve Piché, MD PhD: No financial relationships to disclose

Christina Luong, MD: No financial relationships to disclose

Chair(s)

NM

Nathaniel Moulson, MD, MHA, FRCPC

Clinical Assistant Professor
University of British Columbia
University of British Columbia

Co-Chair(s)

James McKinney, MD, FRCP(C)

Clinical Assistant Professor
UBC Cardiology
SportsCardiologyBC

Presenter(s)

Paul Dorian, MD MSc

Professor of Medicine
St Michael's Hospital , Toronto
University of Toronto
Laura F. Halperin, MD

Resident Physician
CCS Trainee
Erin Karlstedt, MD, FRCPC (she/her/hers)

Cardiologist
Libin Cardiovascular Institute
University of Calgary
Marie-Eve Piché, MD PhD

Cardiologist
Quebec Heart and Lung Institute
Laval University
Paul Poirier, MD, PhD, FRCPC, FACC, FAHA, FCCS

Cardiologist
Université Laval
Universite Laval

Trainee(s)

Laura F. Halperin, MD

Resident Physician
CCS Trainee
TP

Taylor E. Petropoulos, MD

Advanced Heart Failure, Critical Care Fellow
Trainee

Planning Committee Member(s)

NL

Noah Lewis, MD FRCPC ABIM

Cardiology Fellow
Trainee
Christina Luong, MD, MHSc, FRCPC, FASE

Clinical Associate Professor
University of British Columbia
University of British Columbia
BM

Barbara N. Morrison, PhD, MSc, ACSM-CEP

Post-doctoral research fellow
CCS
Sofiane Ouerd, MD, MSc

Cardiology Fellow
CCS trainee
BP

Bradley Petek, MD

Director of Sports Cardiology
N/A
Ryan Quinn, FRCPC (he/him/his)

Sports Cardiologist
None