From the pros to weekend warriors, we tend to admire athletes as examples of superior health and physical fitness. But, just like the rest of us, athletes can suffer from heart disease and cardiac complications. And when athletes do have heart issues, diagnosis and treatments are not necessarily straightforward.
Now, the connection between the novel Coronavirus and myocarditis (heart inflammation) is making headlines and causing increasing concern about long-term heart damage. What do those recovering from COVID-19, or any virus, need to know about the dangers of returning to training too quickly?
In this episode, host, Dr. Jonathan Fialkow welcomes Eli Friedman, M.D., medical director of sports cardiology at Miami Cardiac & Vascular Institute, to talk about the special needs of professional and amateur competitors when it comes to caring for their hearts.
For more information, visit BaptistHealth.net/CardiologyGroup
For more information about COVID-19 please visit BaptistHealth-coronavirus.com
From the pros to weekend warriors, we tend to admire athletes as examples of superior health and physical fitness. But, just like the rest of us, athletes can suffer from heart disease and cardiac complications. And when athletes do have heart issues, diagnosis and treatments are not necessarily straightforward.
Now, the connection between the novel Coronavirus and myocarditis (heart inflammation) is making headlines and causing increasing concern about long-term heart damage. What do those recovering from COVID-19, or any virus, need to know about the dangers of returning to training too quickly?
In this episode, host, Dr. Jonathan Fialkow welcomes Eli Friedman, M.D., medical director of sports cardiology at Miami Cardiac & Vascular Institute, to talk about the special needs of professional and amateur competitors when it comes to caring for their hearts.
For more information, visit BaptistHealth.net/CardiologyGroup
For more information about COVID-19 please visit BaptistHealth-coronavirus.com
Announcer:
At Baptist Health South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist HealthTalk Podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life.
Dr. Jonathan Fialkow:
Hello, Baptist HealthTalk Podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a practicing preventative cardiologist and lipidologist at the Miami Cardiac and Vascular Institute at Baptist Health South Florida, as well as chief population health officer at Baptist Health. We tend to admire athletes as examples of superior health and physical fitness, but just like the rest of us, athletes can suffer from heart disease and cardiac complications. When athletes do have heart issues, diagnosis and treatments are not necessarily straightforward, and that's where the specialty of sports cardiology comes into play. For today's podcast, I'm pleased to welcome Dr. Eli Friedman, medical director of sports cardiology with the Miami Cardiac & Vascular Institute. Welcome him to our program. Today, we're going to be talking about this emerging specialty of sports cardiology, which of course is relevant for professional athletes, but those of us that just consider ourselves athletic as well in our regular lives. This isn't just limited to the treatment of professional athletes. Welcome to the podcast, Eli.
Dr. Eli Friedman:
Dr. Fialkow, thank you so much. It's really such an honor to be here and to be a part of the Baptist family now.
Dr. Jonathan Fialkow:
Eli, if you don't know about our podcast, it's very informal, so for the purposes, I'm Jon.
Dr. Eli Friedman:
You got it. Easy.
Dr. Jonathan Fialkow:
This is what you call me anyway. So Eli, sports cardiology, we know there's a lot of specialties in medicine, cardiology being one. We know there's lots of sub specialties within cardiology like arrhythmia specialist and interventionalists and heart failure specialist. Where does sports cardiology sit in our cardiology armamentarium, and how did you first become interested in developing your leadership and knowledge in sports cardiology?
Dr. Eli Friedman:
I think sports cardiology, let's use a sports analogy, is sort of like the quarterback of cardiovascular care for an athlete. So an athlete, if he or she has cardiac complaints or cardiac concerns, maybe it's due to a family history. We'll maybe seek out someone who's familiar with that. Now specifically, when it comes to athletes, we think those of us who practice sports cardiology and do it as a passion really can be the introduction to the cardiovascular world there. We can be the quarterback of the medical home for cardiac care for athletes. Now personally, my father was a cardiologist, I was born into this field, and I've been a lifelong athlete. So as I matriculated through my medical career, I've merged these two fields together, and fortunately there's been a wealth of data out there more recently that has supported the field and obviously Baptist supports it as well, which is why I'm here and why we're talking right now.
Dr. Jonathan Fialkow:
That's interesting, and I appreciate that. So let's break it down a little bit. So specifically, let's speak about athletes who have true cardiac conditions. What makes them unique? What would make them specifically seek you out based on your knowledge, and what happens to real, heavily athletic people, professional or otherwise?
Dr. Eli Friedman:
When we look at athletes, there's certainly a spectrum of athlete, whether it's an Olympic or professional level athlete, all the way through a weekend warrior. But when someone uses their body to exercise, whether it's at high intensities or just meeting the guidelines of exercise, he or she might experience symptoms in a different way than someone who who's not exercising as much will experience them, and how we look into those symptoms, how we work them up, how we do our testing, how we treat them can oftentimes be different than somebody who isn't exercising very much. So it really takes someone who understands what an athlete is, how he or she exercises, how those symptoms might manifest and then understanding what type of tests are going to be most beneficial in an athlete, and then understanding what types of medications that we should use, or maybe even we shouldn't use in athletes, because medications can have a significant impact on the performance of an athlete as well.
Dr. Jonathan Fialkow:
There are nuances to a person who's very athletic in terms of maybe not getting the same exact approach and treatment, if you will, as someone who doesn't have those specific concerns. Is that-
Dr. Eli Friedman:
Exactly, yeah. I mean, take an athlete who says he or she is short of breath. Now that shortness of breath could be related to multiple different factors, as it could be for any type of patient. But with an athlete, there's specific conditions that we need to look into, but we also really need to spend a significant amount of time discussing that shortness of breath, how the athlete experiences it, which will then inform how we move forward.
Dr. Jonathan Fialkow:
So what are the more common medical complaints an athlete may have that would direct them to you, and then of course, we'll talk about obviously real medical disorders and stuff like that.
Dr. Eli Friedman:
So some of them are very typical, much like our general cardiac world. So chest pain, shortness of breath, palpitations, skipping or racing heartbeats. But how an athlete might describe those symptoms can sometimes be different. So it's not uncommon for us to see athletes who say their performance has decreased, they're not getting their times in the miles, the way that they want to, they're not able to cycle at the same powers that they want to. When they're on their rowing ergometer, they're not able to develop all of the power that he or she wants. So those complaints are often similar, but again, it takes someone who understands the language of an athlete to then be able to delve into them and understand how we move.
Dr. Jonathan Fialkow:
So to reiterate, the approach to the athlete with a complaint should be, and is different than an average person who might have those same complaints.
Dr. Eli Friedman:
Very much so. Much like we learn a language in medicine that we're able to communicate to our patients, we should understand the language that our athletes use. I'm always tickled by the story that Aaron Baggish tells, which is an athlete discussed with his cardiologist that he wanted to PR in his next race, and his physician took that as we use PR in the medical world, which is PRN as needed. So again, understanding the language that our patient speaks, understanding the language that our athletes speak is imperative to them being able to treat.
Dr. Jonathan Fialkow:
And that speaks to something, maybe we'll take it to this direction, which I wanted to bring up, and you and I have had private conversations about that. What about the psychological impact to an athlete? Let's say there's an athlete who really has a true medical problem, they develop an arrhythmia, or they have a heart attack, what are the nuances that you bring to the table in conversations with them about resuming activities?
Dr. Eli Friedman:
Well, they're significant. I'm often reminded, when this comes up with one of my patients who was told by another cardiologist after he explained that he wasn't riding the way he wants to, or after a condition that he was told, "Well, at least you're not dead yet." And his response to that was, "Well, if you take away my bike, I might as well be dead because I can't perform and do what I want to do and what I love." So the psychological impact of cardiovascular disease, of decreased performance is really significant to an athlete, and when someone who is dedicated to exercise, is passionate about exercise can't perform at those levels, or has a cardiac condition that they now feel vulnerable with in their exercise, it's quite significant.
Dr. Eli Friedman:
So we spend a lot of time with our testing, with our talking, with our treatment plans, to then help coach that athlete back into the exercise that he or she does, and then be able to perform at the levels that he or she can. And this is not true only of people who participate in sport. This is also true with our performance artists, so dancers. This is true with our tactical or occupational athletes, first responders, EMS, fire, police officers. We even think of nontraditional athletes now, so Amazon has athletic trainers at their facility. So everybody who uses their body as part of their occupation, it's really important that we're able to address that as well in the same light.
Dr. Jonathan Fialkow:
You had mentioned earlier that some of the medications we might routinely use in treating our cardiovascular patients, whether it be for prevention or for disorders, can have more significant negative impacts in athletes and you try to avoid those and work around those or give alternatives. Can you elaborate on that a little bit?
Dr. Eli Friedman:
Absolutely. I'm going to use just two technical terms briefly, but I'll explain what they mean. So things like beta blockers or the non-dihydropyridine calcium channel blockers. So these are things like metoprolol, atenolol, or diltiazem, verapamil, these are medications which are very good and they work and they do the job they're supposed to. But if an athlete is prescribed these as a first line agent without necessarily a clear indication for that versus another choice, we may find that the athlete has had significant impacts to their performance. They do what's called negative ionotrope negative chronotropic drugs, which can decrease the performance of the heart. So we have to be careful with those. But then again, as we get into our sanctioned athletes, Olympic level, professional level, we always have to be careful with things like diuretics, because they can show up in urine testing, so that could render the athlete potentially liable in a drug test. So again, just understanding what goes into an athlete and then what comes out in terms of the medications that we use and how they impact performance and wellbeing.
Dr. Jonathan Fialkow:
Eli, let's talk about supplements. We know it's a multibillion dollar industry. A lot of it is geared towards the idea of improving athletic performance. What do you see as concerns for athletes, and your patients take supplements? Where do you think they're okay? What's your usual engagement and discussion with patients who come to see you?
Dr. Eli Friedman:
Great question. So oftentimes athletes will be asked about their medications and they say they're taking no medicines, but then you have to go that next step further, which is what supplements are you doing? Because a lot of people who take their athletics seriously are using supplements. So I am always careful with this because what you think goes into supplements may not be there. What doesn't go into supplements may be there actually. And again, going into drug testing. So I tend to individualize this and have a discussion with each individual. We'll hear things like beet root juice, citrulline, arginine. So a lot of these things can be beneficial, but it is a detailed discussion and you want to make sure that the athlete understands why he or she is doing it, and what the desired outcome is, while being wary of the fact that there can sometimes be things in them that we're not expecting and that can hurt us.
Dr. Jonathan Fialkow:
And it becomes a critical part of your evaluation of the patient, of your treatment plan and recommendations.
Dr. Eli Friedman:
100%. I spend a significant amount of time talking not only about the symptoms or the reason that the athlete comes in, but we talk about sleep, we talk about nutrition, we talk about hydration, because these are really important holistic items that go into the care of an athlete.
Dr. Jonathan Fialkow:
Let's switch gears a little bit and talk about COVID-19. I know you've brought a lot to the table in the Baptist Health system regarding your connections with various athletic programs. What are we seeing in the athletic world in terms of its impact of COVID-19
Dr. Eli Friedman:
First and foremost, I hope all of the listeners are safe and that nobody in their family have been impacted by this or worse. So certainly anybody who has, our sympathies go out to, and we hope that they're doing well and kudos to Baptist for just doing a phenomenal job and all health care workers for their care. This has been a very challenging time. For those of us in the sports cardiology world, the last several months have just been all COVID all the time. And this virus, for whatever reason, seems to have just an increased risk of causing cardiac effects. Now whether that's blood clots, whether that's arrhythmias, dangerous heart rhythms, or whether we're actually seeing that this virus is showing up in the autopsies of people who have unfortunately passed away from this, this virus has significant cardiac effects.
Dr. Eli Friedman:
And when we think of athletes, they're people who exercise at very high, intense levels, so we do have concerns with that. And specifically it relates to this condition called myocarditis, and when people have inflammation or infection of the heart and they exercise at high levels, there's pretty good data out there that suggests that it could lead to a risk of sudden cardiac arrest. So we're being very diligent, we're being very careful in how we are triaging our athletes and their return to sport. Most of this is focusing on our higher level athletes, so college, professional, Olympic level, but I think we still need to have the same care with our athletes who have been infected by this and then want to get back into their sports. So a slow resumption of activity, being mindful of any symptoms they had or are still having, and then triaging and dedicating our testing based on that.
Dr. Eli Friedman:
Now what we do for a professional team or an Olympic level athlete may be different than a weekend warrior, but I think that the important information is you need to listen to your body and you need to pay attention to it. If your body is telling you something, that's not a day to go out and do high intensity interval training. Slow resumption of activity after COVID. And again, if you're one of those higher level athletes, we do have treatment algorithms that have been developed to help get the athlete back into sport.
Dr. Jonathan Fialkow:
Do you have any general recommendations you would make to athletes if they are recovering from other medical illnesses? For example, if someone's got a bad flu and they're achy and feverish, should they go out and exercise to burn off the virus or should they rest and let the virus take its course?
Dr. Eli Friedman:
It's a phenomenal question. If you look at histories of people who've had unfortunate events during exercise, and when I say unfortunate events, I mean sudden cardiac arrest. If you go back and look, maybe some of them had a viral illness at the time or just leading up to the event that they had. I think we all need to be careful that when we don't feel well, that we need to slowly resume activity. When you've got the flu, or even if you just have a cough or a cold, maybe that's not the day to go do that high intense training. Maybe we should be a little bit mindful of going out and running a marathon. And I know that's difficult for people who have trained and have spent all this time preparing for it, but my adage is always listen to your body. It's when we don't listen to our bodies that bad things can happen. Whether that's a heart illness, whether that's respiratory illness, whether even that's a knee problem, if your body's telling you something, in my world, you're better off listening to it and getting help and then being reassured versus pushing through and maybe having something bad happen.
Dr. Jonathan Fialkow:
So basically a very athletic person whose body's at peak physical fitness is still not superhuman.
Dr. Eli Friedman:
No. If you look at Olympic level athletes and very high level athletes, respiratory illness plays a significant role in decreased performance, and there's data out there that supports that. But just coughs, colds, viral illnesses, or even pneumonias can significantly impact how an athlete then performs later on. COVID has made me wonder whether or not we should be taking these smaller viral illnesses more seriously and if we should have greater concerns. We don't have good data to support the longterm effects of that, but definitely in the short term, it reinforces my need to make sure every athlete knows, those days when you don't feel well, don't push it. Listen to your body, stay hydrated, take care of yourself. There will be more days to exercise and push.
Dr. Jonathan Fialkow:
Eli. I I'm confident our listeners recognize your, your passion and your incredible knowledge regarding this rapidly developing area of sports cardiology. I can't thank you enough for joining our Baptist system and our MCI cardiology group and space, and I really look forward to working with you on many of these and future endeavors as we go forward. Any final comments you'd like to bring up to our listeners or anything that's of more importance than others that you want to reiterate before we close up?
Dr. Eli Friedman:
That was very formal for an informal podcast, but I'm humbled by that. I really appreciate it.
Dr. Jonathan Fialkow:
I love when I podcast and I learn from it. We're talking of hours without this, but there's always a pearl in there.
Dr. Eli Friedman:
This is truly unique in certainly the South Florida, and I would argue that the state in general, and we're privileged to be able to provide that and I'm privileged to be a part of it. The one thing I definitely want to leave listeners with is everything we've talked about is really important, but despite our best efforts, despite trying to be able to get to every athlete out there, cardiac arrest will happen. And that's what we care about. That that's what we're trying to prevent by being accessible to our athletes. So what I always encourage everybody to do is to learn CPR, learn how to use an AED, be ready to respond if something really bad happens. We're far more likely to do CPR and need an AED inside of our homes with our family.
Dr. Eli Friedman:
So I think it's an important skill that we all should have. It's something we should practice. I know it's going to be a big part of what we're trying to develop at Baptist, making CPR and AED usage accessible to everybody. So especially for those who are engaged with athletes, know CPR, know how to recognize a cardiac arrest, and then know how to use an AED, because if you can respond to somebody quickly, you're very likely to be able to save their life.
Dr. Jonathan Fialkow:
I know you've been very active in working with various organizations towards both the education and deployment of those types of methods, so maybe we'll bring you back for another podcast to talk about public and community health awareness and opportunities to prevent bad cardiac outcomes and other medical problems in the future, so I'd appreciate it.
Dr. Eli Friedman:
Anytime. We've worked with the Dolphins, we've worked with the Panthers on this, and we only look forward to furthering those relationships and making this accessible for everybody. So whenever you tell me, John, I'll be there.
Dr. Jonathan Fialkow:
Thanks. So again, to our listeners, we'll have program notes about Miami Cardiovascular Institute and certainly about Dr. Friedman and his role in sports cardiology and how you may contact him if so desired. As usual, if you have any thoughts or comments or ideas for future podcast topics, please email us baptisthealthtalk@baptisthealth.net. That's baptisthealthtalk@baptisthealth.net. Thank you very much and stay safe.
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