Hay gente que todavía se cuestiona que el deporte no es beneficioso para la salud, pero tenemos que insistir que todos los datos indican que los beneficios de la actividad física regular y la participación deportiva superan con creces el riesgo de padecer un infarto de miocardio desencadenado por la actividad física aguda e intensa, aunque evidentemente no podemos generalizar, porque siempre vamos a ver casos de deportistas de élite que sufren un infarto de miocardio, y es aquí donde surge la duda…
La enfermedad coronaria (en ingles: Coronary Artery Disease; CAD) es la principal causa de isquemia miocárdica en personas con más de 35 años, y aquí también incluimos a los deportistas. Se ha comprobado que la CAD en personas con menos de 35 años es infrecuente, y habitualmente se debe a hipercolesterolemia familiar.
El entrenamiento físico regular reduce el riesgo de desarrollar CAD, así como el riesgo de muerte o paro cardíaco repentino (en ingles, sudden cardiac death or arrest: SCD/SCA) durante un esfuerzo intensivo.
Hay estudios que muestran que el entrenamiento intensivo (más de 7 veces por semana o 18 horas de ejercicio extenuante por semana) puede aumentar el riesgo de mortalidad en pacientes con CAD, aunque la incidencia real de episodios es muy baja. Se ha descrito que el riesgo de muerte súbita se puede multiplicar por 2 ó 3 en deportes como el triatlón, probablemente por el riesgo adicional de edema pulmonar por inmersión.
¿Por qué se produce un infarto durante el ejercicio?
Un infarto se produce por la existencia de isquemia miocárdica, es decir, cuando se produce una obstrucción completa o parcial de una o varias arterias coronarias que condiciona una marcada disminución de flujo sanguíneo hacia el corazón.
Durante el ejercicio esta isquemia es causada por un desajuste de la oferta y la demanda, y aquí van a tener mucha importancia un aumento en la frecuencia cardíaca, de la presión arterial y de la carga de trabajo, como ocurre típicamente durante el ejercicio.
Se cree que los eventos cardíacos durante los deportes se desencadenan por la activación neurohormonal, la ruptura precipitada de una placa de aterosclerosis, por la existencia de hipercoagulabilidad, por erosión endotelial, así como por la realización de un esfuerzo de muy alta intensidad, que supera con creces el umbral de isquemia en pacientes-atletas con CAD crónica y estable.
¿Los síntomas son similares en los deportistas?
Debemos señalar que en ocasiones la forma de presentación no es la habitual, es decir, no suelen tener el típico dolor en el pecho, falta de aire, palpitaciones, mareos o pérdida de conciencia transitoria (síncope).
Los deportistas pueden consultar por una disminución de su capacidad de ejercicio, menos rendimiento deportivo, cansancio y agotamiento más prematuro, presencia de una frecuencia cardíaca inusualmente aumentada durante el ejercicio, incluso en muchas ocasiones, no presentan ningún síntoma, ningún aviso previo, hasta que lamentablemente debutan con el infarto.
¿Qué pruebas debemos realizar en caso de sospecha de CAD en deportistas?
– Las nuevas técnicas de imagen cardíaca (sobre todo la angiografia coronaria por tomografía TC y la resonancia cardiaca) son muy útiles para el diagnóstico de CAD subclínica, aunque no aportan información sobre el flujo coronario y su reserva.
– El ecocardiograma de estrés, la cardio-resonancia con dobutamina o adenosina, la tomografía por emisión de positrones (PET)/ tomografía computarizada por emisión de fotón único (SPECT), pueden tener un papel mayor.
– Las pruebas de esfuerzo convencionales son útiles porque están ampliamente disponibles, aportan información funcional sobre la capacidad de ejercicio máximo y submáximo, respuesta de tensión arterial, detección de arritmias inducidas por el ejercicio, pero tienen el problema de su baja sensibilidad, es decir una baja capacidad para detectar CAD en sujetos asintomáticos y en aquellos con CAD menos avanzada. Por ello es muy recomendable realizar pruebas de esfuerzo con protocolos específicos, es decir, que se adapten al tipo de deporte que realizan y evaluando siempre la máxima capacidad de ejercicio.
Recomendamos la lectura de las Recomendaciones para la participación en el tiempo libre o deportes competitivos en atletas-deportistas con enfermedad coronaria, documento de la Sección de Cardiología del Deporte de la Asociación Europea de Cardiología Preventiva (EAPC), donde se realiza una actualización de las recomendaciones previas.
REFERENCIA
Mats Borjesson, Mikael Dellborg, Josef Niebauer, et al.
Recommendations for participation in leisure time or competitive sports in athletes-patients with coronary artery disease: a position statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC),
European Heart Journal, Volume 40, Issue 1, 01 January 2019, Pages 13–18,
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A number of forced exchanges later, the sport entered an reverse-colour bishop endgame the place White was a pawn up, but may make no progress.
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Each of these contracts fluctuates based upon changes in interest rates.
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If rates fall and homeowners refinance, then the security loses value.
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