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Morte improvvisa nello sport

Pubblicato da in News · 12/3/2018 11:28:00
Tags: DavideAstoriinfartomortecardiaca
Il caso del calciatore Davide Astori ha riacceso i riflettori sulla morte improvvisa, qualcosa che sconvolge ancora di più quando le vittime sono sportivi super controllati (in questo caso pochi giorni prima).
Il cuore del giovane calciatore durante la notte ha rallentato sempre di più, fino a fermarsi completamente.
L’autopsia ha accertato che si tratta di una morte cardiaca senza difetti macroscopici del miocardio, verosimilmente su base bradiaritmica.
 
Principali cause di morte per arresto cardiaco
Se la morte improvvisa nel 90% dei casi riconosce una causa ischemica cioè una malattia coronarica, altrettanto vero è che nei giovani la maggior parte dei casi è invece dovuta a causa congenita, solitamente aritmogena:
  • displasia aritmogena del ventricolo destro
  • sindrome di Brugada o bradiaritmia
  • sindrome del QT lungo
  • origine anomala delle coronarie dall’arteria polmonare
Dietro le morti improvvise dei giovani si nascondono dunque malattie cardiache congenite e le cause non cardiache sono rilevabili solo in una minoranza di casi.
L’autopsia
 L’autopsia aiuta poco a formulare delle statistiche, in quanto è possibile individuare delle anomalie nei difetti elettrici del cuore solo quando è in funzione e passa energia.
Nell’adulto, in caso di morte improvvisa da insufficienza coronarica acuta, l’autopsia può anche non rilevare anomalie significative in quanto il muscolo cardiaco non ha il tempo di manifestare le lesioni tipiche micro e macroscopiche dell’ischemia, che solitamente sono l’edema e l’infarcimento emorragico.
Esami di primo check-up
Tutti gli sport di fatica rappresentano un potenziale rischio per la salute, per questo a livello normativo nazionale sono necessari accurati controlli clinici e strumentali da eseguire nei centri di Medicina dello Sport.
L’elettrocardiogramma sotto sforzo e l’ecografia cardiaca restano esami strumentali essenziali per determinare lo stato di salute del cuore.
Esami specifici
Nel caso dei soggetti al di sotto dei 35 anni viene effettuato un particolare elettrocardiogramma non invasivo, ad alta risoluzione e senza filtri.
In caso di positività, essa è predittiva di aritmie maggiori e può consigliare un più approfondito studio elettrofisiologico intracavitario cardiaco.
Nel caso degli adulti, è stata introdotta da alcuni anni una metodica ambulatoriale rapida e non invasiva per lo studio delle coronarie: la Tomografia Computerizzata chiamata Coronaro TC.
Indicazioni fondamentali di prevenzione
Certamente è difficile, se non impossibile, prevenire in modo assoluto questi tragici episodi, in cui vi è una componente decisiva di ineluttabilità.
Esistono, però, alcune indicazioni fondamentali che ci possono aiutare nella prevenzione:
  • Sforzi estremi sono potenzialmente rischiosi.
  • L’intensità dello sforzo deve sempre essere proporzionata alle capacità individuali,
  • Mai andare oltre le proprie possibilità.
  • Non fare sforzi intensi se non si è adeguatamente allenati.
  • Evitare di fare sforzi intensi in condizioni climatiche particolarmente avverse (sotto il sole cocente, con caldo torrido e umidità molto elevata). In questi casi è più facile incorrere nel cosiddetto colpo di calore, spesso responsabile di gravi aritmie anche mortali.
  • Eseguire adeguati controlli medici e strumentali che evidenzino la piena integrità fisica e l’idoneità alla pratica sportiva.
Conclusioni
Nell’attività quotidiana non è raro trovare soggetti con test da sforzo normale e concomitante malattia coronarica, anche severa e sub occlusiva. Questo significa che alcune patologie potenzialmente gravi e rischiose possono sfuggire anche ai più severi controlli.
Resta il problema di chi sottoporre a queste sofisticate indagini che ovviamente non possono e non devono essere estese a tutti.

Alberto Bozzolan



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dfgsyu
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dfgsyu
2025-07-16 21:04:46
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