Cardiopulmonary Assessment

Heart of theValley Young Athlete

Heart of theValley
Young Athlete Cardiopulmonary Assessment

Young Athlete Assessment
Main Clinic: Pleasanton Clinic 5933 Coronado Lane, Suite 1 F Pleasanton, CA 94588

Information for Athlete, Family and Provider

Don’t let unidentified asthma slow your athlete down!

Our Cardiopulmonary Assessment Services:
* Assessment of pulmonary function. * Assessment of exercise capacity (physical fitness) as measured by maximal oxygen consumption (VO2max) and other metabolic parameters. * Detection of exercise-induced asthma and assessment of response to medications * Detection of vocal cord dysfunction syndrome * Education and counseling for families

Satellite Clinics: Fremont, Tracy, Brentwood, San Mateo

Please visit our website for locations of satellite clinics at www.heartofthevalley.us

Metabolic Testing during bicycle ergometry. Parameters tested include Maximal Oxygen Consumption, Work, Anaerobic Threshold, Heart Rate Rise

Cardiopulmonary Assessments are performed only in our Pleasanton Clinic.

Andrew J. Maxwell, MD, FACC
Dr. Maxwell is a Board Certified Pediatric Cardiologist and Pediatrician. He received his medical degree from Johns Hopkins Medical School, completed a Residency in Pediatrics at UCSF and Fellowships in Pediatric Cardiology at Packard Children’s Hospital at Stanford and Children’s Hospital of Philadelphia. He has been in private practice since 2002.

APPTS. AND REFERRALS:
Contact us at 925-416-0100 MORE INFORMATION: visit www.heartofthevalley.us

Heart of the Valley Pediatric Cardiology
is a full-service pediatric cardiology clinic serving expecting parents, infants, children and young adults.

HEART OF THE VALLEY - Young Athlete Assessment
Why assess cardiac and pulmonary fitness in young athletes? Top athletic performance requires perfect cardiac and pulmonary function. Two of the most common limitations to athletic performance is under-conditioning (inadequate training) and unrecognized, untreated asthma. There are other cardiac and pulmonary problems that are less common that go unrecognized as well. All of these issues can be detected by cardiopulmonary athletic assessment. Asthma About 1 in 5 young athletes have some form and degree of asthma and most of these athletes manifest worse asthma during exercise. Unrecognized asthma is the single most common cause of exertional chest pain, shortness of breath and dizziness in young people. Alternatively, these symptoms can also be caused by serious cardiac problems. Inadequate Training Under-conditioning can also explain athletic underperformance. For athletes who have demonstrated no other underlying cause, parameters of physical fitness may point to a lack of sufficient training. Other Causes of Limitations Another limitation to performance that is less common is dysfunction of the vocal cords leading to sudden breathing difficulty at peak-intensity performance. Unrecognized cardiac defects also occasionally interfere with performance. What tests are used to assess cardiopulmonary fitness? Physical fitness and conditioning is best measured using bicycle or treadmill testing with metabolic analysis. These methods measure different parameters of physical fitness such as maximal oxygen consumption, maximal work performed, anaerobic threshold, and heart rate rise. Unrecognized asthma and vocal cord dysfunction may be detected from a combination of pulmonary function testing and exercise stress testing with treadmill or bicycle. Abnormalities found by these assessments may be followed by additional studies such as an ultrasound or an ECG. Are there limitations of this assessment? Not all asthma is reproducible in the clinic setting and so may not be detected even though it exists. Not all cardiac and pulmonary problems can be detected by these non-invasive tests.

Pulmonary Function Testing: Produces Flow-Volume Loops. Normal healthy lungs produce loops that touch the black dots. This athlete demonstrated very mild asthma at baseline (red line in left panel), Following treadmill running to exhaustion the athlete demonatrated a marked reduction in lung function or exercise-induced asthma (blue line in left panel). Twenty minutes after inhaling albuterol, the athlete demonstrated supra-normal lung function (right). Other medications may improve lung function further. Assessing pulmonary function: an athlete breaths through the apparatus first slowly and then with as much force as possible. This is done before exercise to obtain a baseline assessment. It is repeated after exercise to determine the presence of exercise-induced asthma. It may then be repeated a third time, after a pulmonary bronchodilator is inhaled, to determine if lung function can be corrected to normal.

Who might benefit from a cardiopulmonary assessment? All participants in competitive sports should consider this assessment and particularly those who feel their athletic performance is hampered and certainly anyone who has the following symptoms in the table below:

Athlete History Questions: Has your athlete ever...
..had extreme fatigue associated with exercise (different from peers)? ..had unusual or extreme shortness of breath during exercise? ..had discomfort, pain, or pressure in his/her chest during exercise? ..complained of his/her heart “racing or skipping beats? ..passed out during or after exercise? How is an assessment paid for? If an athlete has none of the symptoms above then the expense is usually paid out-of-pocket. If symptoms are present or a medical abnormality is detected, insurance usually covers the evaluation.

Assessing Exercise Functional Capacity: This can be done with either Treadmill Testing or Bicycle Ergometry. In either case, an athlete is asked to perform to exhaustion while being monitored with ECG.

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