0:02

Comprehensive, relevant, and insightful conversations

0:05

about health and medicine happen here on

0:08

Medstar health. Doc talk.

0:11

Any form of intense exercise will increase our

0:14

body's need for oxygen. With elite

0:16

athletes, the heart responds to that need, too.

0:20

It's the pump in the body's engine that supplies

0:22

oxygenated blood to muscles. Over

0:25

time, an athlete's heart can grow larger and

0:28

stronger. In a sense, it remodels itself.

0:31

Treating elite, high performance athletes

0:34

requires a highly specialized cardiology

0:37

program. Sports and performance cardiology at

0:40

Medstar Health is the first program of its kind in the

0:42

Baltimore, DC region and is one of

0:45

only a few like it in the United States.

0:48

Today, we welcome Dr. Aubrey Grant, a

0:51

graduate of the only sports cardiology fellowship in

0:53

the country who has a unique understanding of the athlete's

0:57

heart. I'm your host, Debra Schindler. Welcome to Doc

1:00

Talk. Thank you for being with us, Dr. Grant.

1:02

Happy to be here. Thank you for having me.

1:04

With only one program in the country and maybe two

1:07

graduates a year.

1:08

Yeah, just two. it actually depends on the year. Sometimes it's just one,

1:11

sometimes it's two. My year over two.

1:13

But I've heard it described, or graduates of that

1:15

program described as a unicorn, because you're so

1:18

unique.

1:19

We are certainly a small collective of general

1:21

cardiologists. the field of sports cardiology

1:24

is sort of in its infancy, and it's a new and growing

1:27

subspecialty within cardiology. I mean, in fact,

1:30

it's probably less than 20 years old, but we are

1:33

learning much, much more about what it takes to take care

1:35

of high level athletes and just highly active

1:38

individuals. And so it's a wonderful year to learn about all the things that are

1:41

involved in taking care of these individuals.

1:43

Why do you think it did form just 20 years

1:46

ago?

1:46

I think part of that is we are just starting to understand

1:50

and learn and think about all the things that go

1:52

into athletics. and we're just starting to

1:55

be on the cusp of what an understanding of

1:58

superphysiological training, what that

2:01

can do to a heart, and the adaptations that can

2:04

be seen because of the elite, athleticism and

2:06

performance that these individuals are undergoing. And so in that

2:09

time, there's been new studies. The thought process of

2:12

how we manage and take care of individuals who have

2:15

cardiovascular disease, who are athletes, has changed over

2:18

time. and this science and this understanding has been

2:21

sort of an artistic pathway in how we really creatively

2:23

think about how to keep people active over the course of a lifetime

2:26

and then manage people when they are highly active and elite

2:29

athletes.

2:30

It sounds a little bit complicated. Did you go

2:33

into this, with an interest in cardiology or

2:36

with an interest in sports medicine? Did you know that this

2:39

program existed, that you wanted to check it out?

2:41

Yeah. So I had no idea that the program existed. I

2:44

think for me, I always was thinking

2:46

general cardiology, more so on the preventative route. and

2:49

I'm an active human myself, so I'm a former division one

2:52

college soccer player, and sport has always been important

2:55

to me. and even after I finished college athletics, I

2:58

lived abroad teaching individuals on how we can

3:01

use sport for sort of development. And I did some

3:04

HIV AIDS work as well in the sports medicine type

3:06

world. so sports has always been sort of central to my understanding of

3:09

medicine, health, and sort of longevity in

3:12

life. and then to be able to blend that with my understanding

3:15

and love of cardiology, it felt like the perfect fit.

3:18

fortunately, I did my cardiology training here at

3:21

Medstar. and Medstar being one of the premier locations for

3:24

sports cardiology, it afforded me the opportunity to be

3:27

able to learn about this beautiful subspecialty during my

3:30

training. And then I was again fortunate enough to receive the opportunity

3:33

to move to Boston to complete that training. And now I'm back home,

3:35

applying everything I've learned in that year.

3:37

Excellent. We're glad that you are. how would you describe athletes heart?

3:44

So, athletes heart, it is a catch all phrase

3:47

essentially used to describe the

3:49

adaptations that we can see when individuals

3:52

engage in sort of long term

3:55

sport or high level of activity.

3:58

And it's really an interesting, nuanced, understanding of

4:01

cardiology in the sense that what we have learned is that different

4:04

activities can create different adaptations in

4:07

the heart. for instance, a long distance runner's

4:09

heart may look drastically different than an

4:12

NFL lineman's heart or someone who does

4:15

short, high intensity, starts, and stops in

4:18

activity. and so understanding the activity

4:21

that the elite athlete is engaging in certainly

4:24

has a reflection on the adaptations that we see in the

4:27

heart. and so that's a big part of what we do

4:30

in the world of sports cardiology is really sort of understanding

4:32

how the individual sport that the

4:35

person is taking part of creates these adaptations that we

4:38

then can see in the heart. additionally, we

4:41

oftentimes have to understand that

4:44

these adaptations can sometimes look like

4:47

physiological and pathological heart

4:50

disease. And so being able to differentiate between the

4:52

two, is a really big part of my job as well.

4:55

You said that the hearts look different depending on the

4:58

athlete or the sport.

4:59

Very much so.

5:00

How so? The shape of the heart is different, the size of the

5:03

valves. What do you mean by that?

5:04

For example, I took care of a weightlifter, highly

5:07

trained weightlifter, who bench presses in the

5:10

upwards of 300 pounds, lifting five to

5:13

six days a week. As someone who's doing that level

5:16

of static activity and engaging in high level,

5:19

high intensity interval type activity, their heart

5:22

can sometimes be a little bit thicker than someone who

5:25

perhaps is a marathon runner who engages in endurance

5:27

training. For that athlete, the right side of the

5:30

heart may be a little bit larger, to really sort of

5:33

adjust for the amount of work that is required to maintain

5:36

that constant level of endurance that a marathon will

5:39

require. Really, the adaptations that we see

5:42

tend to be reflective of the demands of that sport

5:45

and the, sort of central adaptations that are

5:48

required in order to sort of meet the needs of that athlete.

5:50

Do you think that you would be able to identify the

5:53

athlete if you were only looking at the

5:56

cardiac imaging, for example?

5:58

Yeah, there are a lot of

6:00

clues, that we could pick out, on someone's heart

6:03

that's actually a really good game that we should probably think about as

6:06

training our residents and fellows, being able to

6:09

guess the sport based on the heart. Yeah. But a lot of the

6:11

adaptations that we see certainly can be reflective

6:14

in the changes that we see in the heart. In particular for

6:17

athletes that have been doing it consistently for months or for years and

6:20

that are highly trained.

6:21

I remember doing a story once on a runner,

6:24

marathon runner who had a, cardiac arrest.

6:27

It turns out that his heart had rerouted itself many

6:30

times, and that had sort of what was described as almost like

6:33

a spaghetti effect around the heart because

6:35

of its own bypassing around blockages.

6:39

Is, that common for a runner?

6:40

What we see in another big part of my job

6:43

is helping people maintain activity

6:46

for a long period of time. So masters athletes,

6:49

people being able to run marathons well into their. Unfortunately,

6:53

historically, what we have seen is these people tend to

6:56

be quite healthy. and so oftentimes their previous

6:59

doctors have allowed them to exist with

7:02

cholesterol levels that are above normal, certain

7:05

biomarkers that are abnormal, just because they're kind of a highly active,

7:08

healthy individuals. But we're learning that, just because

7:11

someone is highly active and someone is an elite, perhaps

7:13

master's athlete, that doesn't mean that they don't require the same medical

7:16

therapy and the same intensity for medical options

7:19

that the general public requires. additionally, a part of that

7:22

information is, understanding that intensity really

7:25

matters when thinking about exercise. And risk of

7:28

exercise. And there was a recent study, actually a

7:31

few years ago at this point, looking at marathon

7:33

runners, and oftentimes we see a lot of sudden

7:36

cardiac arrest, while people are engaging, in this

7:39

high level of activity. And so having an understanding of

7:42

who is at risk for sudden cardiac arrest

7:45

when they're doing marathon training, understanding how to

7:48

counsel people on healthy practices when

7:51

you're engaging in that level of activity, is really a

7:54

big part of my job, too.

7:55

Is athletic heart syndrome the same as athlete's

7:58

heart?

7:59

Kind of similar. Tomato, tomato type. I think athletic,

8:02

heart, essentially is really just that

8:05

understanding that the heart is like any other muscle

8:08

that exists in the body. So if I train my

8:10

bicep, and I do bicep curls with 45 pounds

8:13

every day for the rest of the week, my bicep is going

8:16

to reflect in hypertrophy in a way that allows

8:19

me to do the work that I'm asking of my bicep. And the

8:22

heart is no different, and it's a similar muscle.

8:25

If you are asking your heart to do certain types of work,

8:28

over time, we'll be able to see and

8:30

image and reflect and see what type of adaptations that

8:33

the heart can have based off of the requirements that we're asking

8:36

of that. So, like I said, high intensity challenges

8:39

tend to present differently than sort of long

8:42

endurance, marathon type activity. NFL

8:45

players'hearts look a lot different than NHL

8:47

players'hearts. Baseball, players are kind of in the middle

8:49

somewhere. but it's a really beautiful thing to really sort of

8:52

understand how all of this activity in sport has

8:55

reflections on what people's hearts look like over

8:57

time.

8:58

So if you were looking at some of the things that you would

9:01

identify in a heart as a specific

9:04

athletes, and you were looking at that

9:07

in a non athlete image, would you

9:10

treat it differently?

9:11

I think we are learning a lot about

9:14

athletes. in particular, one, of the things that I do

9:17

a lot is learning about coronary, disease, in

9:19

particular in master's athletes. And I think

9:22

over time.

9:23

Excuse me, what do you mean by master's athletes?

9:25

Master's senior athletes?

9:27

Yeah, senior level.

9:28

Senior level athletes. Yeah. Older

9:30

athletes. So I think there was a time, like I was

9:33

mentioning, where these athletes might have had some level

9:36

of maybe perhaps low level, high level blood pressures

9:38

or high level cholesterols. And over time, people have been like, oh,

9:41

you're kind of healthy. You don't really need to manage it, and it's

9:44

okay. but what we are learning is that just because someone

9:47

engages in high level athletics, that doesn't mean that they

9:49

can't procure disease over time. and so I'm just

9:52

as intense with my master's athletes as I would be with

9:55

general population. I'm getting similar level of

9:58

testing, genetic testing, all these things in my athletes as

10:01

well, because we know that these persons can

10:03

ultimately have just as much disease as the general

10:06

population.

10:07

One thing that I kept reading about while researching this

10:10

was a thickening of the ventricle wall. Is

10:13

that a common factor involved with

10:15

athletes heart?

10:16

Yeah, we see a lot of that.

10:18

what's the consequence of that?

10:20

So, to take a step back, sometimes the

10:22

heart muscle can thicken, and sometimes it can

10:25

thicken pathologically because there's some sort of

10:28

disease that's at play, or it

10:31

can thicken because of athletic activity, and certain

10:33

types of movements can promote that level

10:36

of athletic change in the heart.

10:39

And, so a big part of my job is being able to differentiate.

10:42

Is this normal remodeling because of the sport

10:45

that, the activity that this person is doing, or is this actually

10:48

some pathological disease that we need to

10:50

manage? fortunately, at Medsar, we have a swath

10:53

of diagnostic modalities that help us

10:56

differentiate between the two. Cardiac MRI,

10:58

echocardiogram, EKG, cardiac CT, all

11:01

of the imaging, modalities we have available. and

11:04

I'm able to use even a cardiopulmonary exercise

11:07

testing in order to help gather information, to really sort of

11:10

paint a broad picture about, is this pathological,

11:13

or is this sort of just the normal changes that we expect to see

11:16

from athletics?

11:17

Who are your typical patients that you see?

11:20

So I see elite level

11:22

athletes all the way down from your

11:25

elite level pelotoner. and so people who are

11:28

highly active and encouraged,

11:30

to maintain, activity over a lifetime. I see, a

11:33

broad range of, quote unquote athletes. I think that term

11:36

athlete. Sometimes people just think it's, oh,

11:39

he just does. Professional persons. But I

11:41

work a lot of the sort of local marathoners, local

11:44

five k's, ten k's. I see people who are just

11:47

interested in, endurance training and activity and

11:50

all those sorts of things.

11:51

And are they coming to you because they've had a cardiac event

11:54

or cardiac issues, or are they just preventive, just

11:57

coming to you because they want to make sure they don't have one?

11:59

So I think that's the beautiful part of my job, too, is I

12:02

oftentimes see people, who have had a family history

12:05

of heart disease, and they're highly active, and they want sort of an

12:07

understanding of where they are in their baseline health. I

12:10

see people who are planning for a big event, a big race,

12:13

and they want to make sure that they do it in a safe way.

12:16

I oftentimes do see people, after they've had

12:19

some sort of cardiovascular event, heart attack, stroke, cardiac

12:22

arrest, et cetera, and help them understand how to

12:25

get back to training. My goal with my

12:28

practice is to keep people as active for

12:31

as long as possible. I, think what I have

12:33

learned and understood in my training is that exercise really

12:36

is medicine. and the fitter you are, the

12:39

longer you tend to live in all

12:42

aspects of even cardiovascular disease. When we think about

12:45

oncology, I mean, just all the things, the fitter that a person

12:48

is, they tend to do better in life. And so

12:50

I encouraging of all of my patients to engage

12:53

in some sort of activity. I mean, the American Heart

12:56

association recommends at least 150 minutes of activity

12:59

per week. And so that is sort of the baseline recommendation I

13:02

tend to give to people. But as active as

13:05

people can be, I tend to encourage that.

13:07

So you see a lot of athletes, and maybe they

13:10

come to you with some symptoms. Are you specifically

13:13

looking for athletes heart?

13:15

Yeah. Oh, certainly. It's always in the back of my mind.

13:18

anytime I read a study, and

13:21

then being a sports cardiologist is really

13:24

important because it's giving me that sort of clinical eye to

13:27

suspect, a lot of these adaptations that athletes

13:29

tend to have. Sometimes athletes can get

13:32

labeled as having cardiovascular disease,

13:35

but it's really just the athletic adaptation that's

13:38

causing that abnormality in the diagnostic

13:41

test.

13:41

that means they don't have any cardiac.

13:43

Yes, right. They do not have cardiac disease. However,

13:46

they might appear as though they have

13:49

cardiovascular disease to the non way on imaging,

13:52

on imaging or symptoms, et cetera. A lot of

13:55

times, for example, athletes, tend to have really

13:58

funny looking ekgs. EKG is the, way we pick

14:00

up people's electrical signature. Your heart runs on

14:03

electricity. And so we use the EKG to try to determine

14:06

what that actual signature is. but in athletes,

14:09

EKG tends to look wildly different than

14:12

the persons in the general population. In fact, we have

14:15

different guidelines for people who are highly active

14:18

and elite level athletes for how we look at their

14:21

ekgs. and for someone who's not trained in that, you

14:24

might not keep that in the top of mind, but for me,

14:27

that's kind of always what I'm thinking about.

14:28

So an athlete's heart as someone who is diagnosed with an athlete's

14:31

heart doesn't necessarily have an unhealthy heart,

14:34

am I right?

14:35

Correct, yeah, correct.

14:36

It just means that it's been remodeled because of their

14:39

athleticism.

14:39

Correct? Yeah. There are certain adaptations

14:42

that can happen over time,

14:45

with high, high level

14:47

of training activity, et cetera.

14:50

And one thing in particular, endurance

14:53

runners, long distance endurance runners, they tend to get atrial

14:55

fibrillation, at a little bit of a higher rate than others.

14:58

Atrial fibrillation is an arrhythmia of the top

15:01

chamber of the heart. Right. And so, understanding that that

15:04

tends to happen in a little bit more frequent. For

15:06

marathon runners and highly active people, I keep that in the back

15:09

of my mind, and so I'm oftentimes counseling.

15:12

but that is a condition that is concerning.

15:15

It is a condition, absolutely. And even in the

15:18

management strategy, we tend to have different management strategies

15:21

for people who are highly active than the general population.

15:24

Sometimes people who are highly active, the

15:26

management, they don't tend to tolerate it as well, as

15:29

the general public. So there are other medications that we. There are other

15:32

medications and or procedures that we can offer, in

15:35

order to, number one, help them tolerate, and then, number two,

15:38

get them back active and achieving and completing all the things

15:41

that they want to complete with their athleticism.

15:43

There really are a lot of differences between an

15:46

athlete's heart and a normal heart.

15:47

Very much so.

15:48

What are some of the symptoms, then? for athletes? Heart.

15:50

So, in particular, all the major cardiovascular

15:53

symptoms, chest pain, shortness of breath, lightheadedness, dizziness,

15:56

passing out, those are things we kind of look for. One sort of

15:59

unique symptom that I look for in athletes, that

16:02

sometimes can go undetected in

16:05

the people who are not trained in sports. Cardiology in

16:07

particular is oftentimes we see athletes that aren't able

16:10

to achieve. For example, so, if I have

16:13

an endurance runner and they're saying, oh, my times are

16:16

just a little bit slower than they were a year ago,

16:19

or I'm not able to achieve the

16:21

speeds that I previously were able to achieve,

16:24

previously. Sometimes that can be a signal and a

16:27

sign that there's something brewing and there's something at bay, and

16:30

perhaps we need to do some diagnostic testing to try to

16:33

figure that out. I found that sometimes that

16:36

main symptom, that sort of exercise decrement, can go

16:39

sort of unnoticed, in a lot of our high level athlete

16:42

populations.

16:42

Suggesting what? That there's blockage or cholesterol?

16:45

Yeah, absolutely. I mean, there's a lot of things that could be the cause of that.

16:48

poor, arrhythmias, blockages, decreased

16:51

heart function. All of these things can support that

16:53

diagnosis, but that's a symptom that oftentimes gets

16:56

missed.

16:56

Interesting. So, an athlete comes to you, what's the first appointment

17:00

look like? What does their first walk through? Are there

17:03

screenings and diagnostics? What might you do?

17:06

So, usually on all of our first visits, everyone's coming in and

17:09

getting an EKG and then having a clinical visit with me.

17:12

where we meet, we talk. I try to understand

17:14

your fitness goals, sort of where

17:17

you've been with fitness, where athleticism

17:20

and sport has taken you in your lifetime, and what are your

17:23

future goals. I think a lot of understanding,

17:26

of sports cardiologists and understanding of what are

17:29

people's goals, for the activity that

17:32

they're doing. And oftentimes, we will have different

17:35

management strategies based on people's goals.

17:37

If you tell me you want to compete in the Olympics, I might

17:40

be more intensive about a medical strategy that I would create

17:43

for you, as opposed to you're saying, hey, I just want to do

17:46

exercise for longevity. and that sort of really frames

17:49

how I think about the patient. Beyond that, we often do testing

17:52

such as echocardiogram, cardiac MRI, cardiac

17:55

cT. One of the unique testing tests that we

17:58

do for sports cardiology is we offer cardiopulmonary

18:00

exercise testing, and that is a wonderful test where

18:03

patients can exercise while they're wearing a

18:06

mask. and we're able to determine their, vo

18:09

two. and their villain.

18:11

What's vo two?

18:12

Yeah. and basically, that is a measurement of a person's

18:15

fitness, and so how fit a person is, we can

18:18

determine additionally from that, we can

18:20

determine what a person's anaerobic threshold

18:23

is to help guide how they can

18:26

improve their fitness, how they can improve their training,

18:28

and how can they become an even better

18:31

athlete, with the testing that we're able to provide.

18:34

And that testing happens on a CPET machine,

18:37

which is a rather unique piece of equipment.

18:39

Very much so, yeah. So we have a

18:41

unique protocol specifically designed in our

18:44

exercise physiology lab for athletes, using

18:47

our woodway treadmill. we also have, an agrometry

18:50

machine, and then we have a bicycle as well, if, the person

18:53

sporting is bicycling. but essentially, our unique

18:56

protocol allows us to, adapt

18:59

for highly active people that are coming for our treadmill

19:01

testing, that on a normal, protocol, they would

19:04

blow that out of the water because they're so fit. But with our

19:07

protocol, that we have, we're able to really sort of hone in

19:10

on highly active persons fitness, levels.

19:14

And is there a follow up?

19:16

Yeah, absolutely. I like to think of myself,

19:19

I'm not intuitively and by nature a data

19:22

oriented person. I'm really sort of like, I see

19:25

things, as high level and so oftentimes I'm meeting people

19:28

and we're going through the details, we're doing the sort of initial

19:30

testing, but I think of them over the course of their lifetime.

19:33

How can I be best helpful to this person, achieve

19:36

their goals, live as long as possible, and offer the sort of

19:39

the most longevity to them. so certainly, treating any sort of

19:42

acute issues in the first couple of visits, but also coming

19:45

up with a plan for how can I give this

19:48

person the things, the strategies, the techniques,

19:51

perhaps medication, perhaps procedures so that they can be as

19:54

active as possible for as long as possible throughout

19:57

their lifetime. I know prevention is a big strategy that

20:00

I incorporate and then a fitness, I, think, like I

20:03

said before, people that have higher levels of fitness, people that have

20:05

higher vo two s, tend to live a lot longer, and that's a

20:08

much better medication, in my opinion, than traditional pharmacological

20:11

medications.

20:12

So when should an athlete come to see

20:15

you? before they start training, maybe they're

20:18

not really that elite yet, or,

20:21

who's to say who's an elite athlete?

20:23

Right.

20:23

What's the right level?

20:25

I think at any point is a wonderful

20:28

opportunity and the goals can change as the

20:31

relationship goes on. I think oftentimes I see a lot

20:34

of persons prior to a marathon, or prior

20:37

to any sort of events or any sort

20:40

of competition, that they're trying to engage in. Number one, just

20:43

to make sure that they're doing it in a safe way. Oftentimes

20:46

we're able to discuss persons that perhaps might have had a family

20:49

history of heart disease. And so getting a baseline sense

20:52

of where they are in relation to the sport that they

20:55

do, can be helpful in helping them understand how can I

20:57

compete safely throughout my lifetime. Additionally, a good

21:00

time is once someone actually has had a cardiovascular

21:03

event and they would like to get back to sport. That's a great

21:06

time, to really come up with an

21:08

idiosyncratic plan for that person to really help

21:11

them recover and then improve their fitness

21:14

safely. and then certainly we see

21:17

a lot of individuals who are engaging on sport at a yearly

21:20

basis, just as do the sort of yearly check in prior

21:22

to any sort of competition that you're trying to

21:25

do.

21:26

You mentioned earlier, sudden cardiac

21:28

death, and that's a rare event, but

21:31

when it happens, it often makes the news because it is

21:34

so shocking and unexpected. And

21:37

athletes wind up dying because they didn't know of maybe

21:40

an underlying cardiac issue. Is athletes heart

21:43

something that would lead up to something like that?

21:46

sudden cardiac arrest and sudden cardiac death, is

21:48

terrifying and it is absolutely scary. I mean,

21:51

the thought of, these young tend to

21:54

be young, healthy athletes dying, as

21:57

they're competing and doing the things that they love. It shakes

22:00

communities to their core, and sort of our fundamental understanding

22:03

of health tends to get shaken as well. And that's why it's such a big

22:06

event, and I mean, there have been countless

22:09

instances, even over the last couple of years, where this

22:12

has occurred and it's made national news, and it's really sort of

22:14

highlighted the job and the role that I have, in the sports

22:18

community of getting a baseline understanding of who

22:21

is particularly at risk, and what type of person

22:25

should have a plan about how they're going to be able to compete

22:28

safely. To be clear, I think sometimes

22:30

it gets misconstrued that as sports

22:33

cardiologists, we want to pull

22:36

people out of sport, and we're really restrictive about how

22:39

we take care of people, but I think really we want people to

22:42

be able to compete in a safe way, and so we have

22:44

strategies that we utilize in

22:47

order to help us restratify persons, that

22:50

perhaps might have some level of heart disease. We have

22:52

guidelines that help us understand who, is

22:55

able to compete safely with cardiovascular

22:58

disease, and then we have certain protocols that we implore

23:01

to help understand who is really at risk,

23:04

for these sudden cardiac events. Additionally, beyond

23:07

that, what is really clear, sudden cardiac arrest

23:10

does happen. our screenings do

23:13

help, however, when it does happen,

23:16

people need to be educated, number one on

23:18

really what high quality CPR looks like

23:21

and what a concerted

23:23

resuscitation effort should look like. when Demar Hamlin

23:26

unfortunately had his son in cardiac arrest on tv, unfortunately, it

23:29

was a terrible event that most of us

23:32

witnessed. What happened afterwards was

23:35

beautiful. that concerted effort by the physical

23:38

therapist, by the medical staff in order to resuscitate, that man

23:41

and bring him back to life so quickly, was

23:43

wonderful. And that should be the standard for, obviously,

23:46

professional organizations, but obviously, colleges, high schools, et

23:49

cetera. Everyone needs to have a broad understanding of what an emergency

23:52

action plan can look like, and then dedicated CPR.

23:55

Everyone should really sort of understand how to do that properly.

23:58

And I should add that in my studies or in my

24:01

research for this podcast, I did read that

24:03

sudden cardiac death in sports has gone down. There's been

24:06

a notable decline in that. Maybe because defibrillators are

24:09

on location more often now.

24:11

Absolutely, yeah. Making defibrillators

24:13

available. Access to defibrillators was a big issue.

24:16

There was a Prague price barrier to having them

24:19

available at high school levels, lower levels, having an

24:22

understanding of cardiopulmonary resuscitation. What does

24:25

good CPR look like? having everyone in the community

24:28

feel comfortable doing CPR, making sure that

24:31

they're athletic trainers at all these events. It's not

24:34

required that every school has an athletic trainer at

24:36

their sporting events. That's certainly an area for

24:39

disparity and certainly things that we should consider,

24:42

having communities. one thing that I want

24:45

to highlight and be very clear about is there is a

24:48

big disparity between when persons do have

24:51

cardiac arrest outside the hospital, that resuscitation

24:53

event, oftentimes in communities of color, is not as

24:56

robust in majority populations. And

24:59

so why is that? I think certainly there are some issues

25:02

related to structural racism and some social determinants of

25:05

health, but also educating communities of color and empowering

25:08

them to engage in CPR, having these

25:10

afibrillators available could certainly work to reduce some of those

25:13

disparities that we see.

25:14

Important points. Thank you. Can and should athletes heart be

25:19

prevented? Should it be?

25:22

Well, I think, athletes heart in itself

25:24

is just an understanding of the adaptations that

25:27

can happen when the athlete engages in high level sport.

25:30

And that's, As someone who is highly active and a sports

25:33

person myself, I would never tell people to not be athletic

25:36

or engage in sport. and it is a wonderful thing

25:39

to see people be able to do sport for long periods of time. And

25:42

so I think that's a good thing. And the adaptations that

25:45

are, quote unquote athletes heart are really just a reflection of

25:48

highly active persons. And so I think that's great.

25:50

What we do need to understand is there's

25:53

oftentimes this gray area between what is athletes heart and

25:56

what is actually pathological cardiovascular disease. And being able

25:59

to differentiate between the two is where I come in as a sports

26:02

cardiologist, what would be next.

26:04

For our patients you were examining or you put

26:07

through on the CPET machine, and you did all these diagnostics,

26:10

and you found something. What might you find wrong?

26:13

So, one of the big things that we manage as sports

26:15

cardiologists. As I was mentioning, we discussed, sometimes the heart

26:18

can thicken, and it can thicken because of sport and

26:21

activity, or it, can thicken because of what we call

26:24

cardiomyopathy or cardiovascular disease. And

26:26

so sometimes we do pick up cardiovascular disease

26:29

in our athletes, and then what is next is

26:32

oftentimes a shared decision making conversation where we bring

26:35

all the stakeholders to the table, the athlete,

26:38

perhaps athlete's family. If a school is involved,

26:41

we bring the school involved. If it's a professional level athlete,

26:44

we bring the team in, and we really sort of have,

26:47

a unified conversation about what is the risk,

26:50

allowing people to make their own decisions about how they want

26:53

to move forward, understanding how important sport is in

26:56

their life, and then coming to a unified decision

26:59

with all the stakeholders involved about how we're going to proceed

27:02

going forward. My role in that conversation is to provide the

27:04

information to allow people to make sort of

27:07

informed decisions with their lives.

27:09

What do you hope people listening today to this podcast

27:12

will take away from this?

27:14

Yeah, I mean, I think for me, part of the biggest

27:16

message that I try to preach is that

27:19

activity, endurance sport,

27:22

it really saves lives and it changes lives. I mean, we

27:25

know about the psychological role that sport

27:28

has in increasing confidence, and changing

27:30

your mood, et cetera. But overall, people who are

27:33

active for longer, they live longer, people who have higher

27:36

level of fitness, they live longer, and they're able to stave

27:39

off a lot of these cardiovascular disease. I think what I learned in

27:42

my training, is that we know a lot about

27:45

sick hearts. We know how to manage sick hearts really,

27:48

really well. And we do an excellent job here. I mean, the cardiology team

27:51

here is beyond amazing at how they take care

27:54

of people acutely and people who are ill,

27:57

and that what has been pressed upon me

27:59

is I don't want that. I don't want heart disease,

28:02

and I don't want that for my patients. And so we try to prevent

28:05

that, as best as possible. And I truly believe that an answer

28:08

prevention really goes a long way. And so

28:10

encouraging people to be active and healthy throughout their

28:13

lifetime really is the goal. Supporting

28:16

people through endurance training, supporting people as

28:19

they do sport, into their want to keep people as active as

28:23

possible for as long as possible, because I really believe in

28:26

sport as medicine and exercise as medicine. and

28:29

so my main goal for this is really

28:32

sort of a paradigm shift in how

28:34

I think about medicine. Focusing on exercise

28:37

and endurance training is really sort of, the

28:40

bedrock of that and encouraging our society to try

28:43

to be as active as possible. It's at least 150 minutes

28:46

a week, we know, improves mortality. and so if we could do

28:49

that as a community, I think we would really sort of move the needle because

28:52

we know cardiovascular disease is one of the top killers in this country,

28:55

and working towards that, I think, can be

28:57

really beneficial.

28:59

150 minutes a week sounds like so.

29:01

Much, and that's per week. But it

29:04

doesn't have to be. I mean, you could do 30 minutes for five

29:07

days. If you're kind of a weekend warrior, you can just do

29:09

150 minutes in the morning when you wake up on Saturday.

29:13

Far more doable when you see 30 minutes a day.

29:15

Yeah, it could be broken up

29:18

for m however you want to get the work done.

29:21

As long as it gets done.

29:22

That sounds much more feasible for me. Thank you for putting it

29:25

in perspective.

29:27

30 minutes a day would do a lot for you.

29:29

Thank you.

29:30

Dr. Grant.

29:31

We've been talking with sports and performance cardiologist

29:34

Dr. Aubrey Grant at Medstar Union Memorial

29:37

Hospital. Dr. Grant, thank you for sharing your expertise with

29:40

us here on medstarhealth. Doc, talk.

29:42

Thank you so much.

29:43

For more information or to schedule an appointment with

29:46

Dr. Grant in Baltimore, call

29:48

410-3665

29:51

600. Or to see him at Medstar

29:54

Health at Lafayette center in DC, call

29:57

202416 2000

30:00

and press option one.

30:04

Close.