Sports Cardiology 101: The Porta Potty
Providing competent cardiovascular care to athletes requires two basic skill sets. The first skill set, clinical expertise in cardiovascular medicine, is unambiguous and easy to define. By way of mandatory training requirements and completion of subspecialty boards, one cannot practice sports cardiology without being a licensed and board certified cardiologist. The second skill set is a bit less clear and boils down to understanding our patients as athletes and not just as cardiac patients.
Coming to truly understand athletic patients, like any heterogeneous group of people, is a lifelong goal that by definition can and should span an entire professional career. Some element of this process occurs in the exam room. We must listen closely, listen patiently, and keep an open mind and encourage athletes to share important information, not just about symptoms and prior medical experiences, but about their lifestyles, concerns and biases. As such, each and every new athletic patient can be an educational experience if we allow him or her to be. It is important to keep in mind however, that the clinical environment may not be the best place to really learn about the people we care for. To best care for athletes, perhaps we need to immerse ourselves in their world and not simply rely on ours.
I was powerfully reminded of this concept at a recent local running race. I wasn’t there to think about medicine but rather to run, albeit a lot slower than I used to. Before the gun went off, I was with the rest of the pack, standing in line for the porta potty. The nervous pre-race bladder is ubiquitous among runners and I’d been in this line hundreds of times before. While in line I found myself listening to conversations around me. Runners talked about training plans, tapering, electrolyte repletion and all the usual important topics. But they also talked, sometimes in nervously comic ways, about lifestyle issues including eating choices, alcohol intake, family genetics, medication compliance and recent illnesses. In five minutes of waiting in line for the porta potty, I’d been privy to dialogue that addressed almost every clinical topic relevant to runners with cardiovascular disease. Embedded in this pack of regular runners were pristinely healthy people who will live to be 100 years old, and ticking time bombs with disastrous cardiac risk factor profiles. On this morning though, they were all just runners and for the interested listener, they were providing a crash course in sports cardiology.
So what’s the point? The point is that the better we know our patients the better care we will take of them. Much of the challenge in sports cardiology comes not in understanding disease pathobiology and conventional treatment options but in determining how, when, and even if one can apply principles of general cardiology to the athlete with heart disease. This process can only be navigated successfully if we know whom we are treating and come to know them not just in their hospital gowns but also in their own day-to-day elements.
To do this doesn’t require getting anywhere near a porta potty and certainly does not require one to run a race. There are countless opportunities to engage our patients in ways that will empower us to be better sports cardiologists. Volunteer to hand out water at a charity ride; observe the athletic trainer at your local high school or college; volunteer for the medical crew at a marathon or triathlon; or go watch a sport you know nothing about. Ideally, do all of these things once in a while and I suspect you’ll not only become a more competent clinician but also perhaps have a little fun along the way.
Aaron L. Baggish, MD, FACC, is a member of ACC’s Sports and Exercise Cardiology Section Leadership Council.
Learn more about the Sports and Exercise Cardiology Section at ACC.org/SportsandExercise. Visit the Sports and Exercise Clinical Topic Collection on ACC.org for the latest clinical news, patient case quizzes and more.
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