Sostanze
Una delle cause di morte improvvisa dell’atleta, in particolar modo del giovane, è legata all’utilizzo di sostanze cardio-tossiche. Tra queste ricordiamo;
1) Androgeni
L’abuso di androgeni ha un effetto diretto sul cuore, a livello del quale stimola ipertrofia miocardica e fibrosi, ed effetti indiretti legati all’ipertensione, alla dislipidemia, alle aritmie e all’infarto del miocardio.4
Uno studio ha analizzato I risultati delle autopsie di 4 body builder colpiti da SCD, alla base delle quali è stato trovato un substrato di ipertrofia cardiaca e di fibrosi
2) FANS, soprattutto i COXIB, inibitori selettivi della COX-2 3) Antistaminici
4) Integratori fitoterapici
5) Alcuni antistaminici di seconda generazione, come terfenadine e astemizole che interagendo con altri farmaci e cibo, aumentano il loro livello nel sangue e predispongono allo sviluppo di QT lungo e aritmie.4
Conclusioni
Si può osservare come alla base del rischio di morte improvvisa nell’atleta, vi sia un substrato patologico subclinico preesistente, che in determinate condizioni si manifesta; L’origine di queste anomalie è frequentemente riscontrabile la presenza di condizioni genetiche
predisponenti, che giocano il loro ruolo soprattutto nei giovani al di sotto dei 35 anni (HCM e ARVC/D); anche negli atleti maturi la genetica gioca un ruolo importante, ma in questo caso acquisiscono valore anche la dieta, lo stile di vita e il tipo di attività fisica intrapresa. Al fine di ridurre al minimo gli eventi di morte improvvisa è necessario cercare per quanto possibile di determinare un profilo di rischio prima di intraprendere uno sport, già l’anamnesi può far emergere un profilo di rischio elevato; Per questo sono disponibili screening per gli sportivi volti a rilevare i vari tipi di anomalia possibile, elettrica, morfologica, ecc. L’analisi genetica offre la possibilità di diagnosticare alcune delle mutazioni patogenetiche, risalire ai parenti a rischio e quindi estendere l’efficacia dello screening; essendo un esame costoso, non può essere utilizzato come screening di massa o come test di routine, ma è necessaria una discriminazione preventiva. Le linee guida sulle raccomandazioni ai test di screening sono soggette a piccole differenze tra i vai paesi; In Italia viene posta un discreto livello di attenzione relativo ai programmi di prevenzione in questo senso.
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