title: Cardiomyopathies and the Armed Forces.
abstract: Cardiomyopathies are a group of heterogeneous myocardial diseases that are frequently inherited and are a recognised cause of premature sudden cardiac death in young individuals. Incomplete expressions of disease and the overlap with the physiological cardiac manifestations of regular intensive exercise create diagnostic challenges in young athletes and military recruits. Early identification is important because sudden death in the absence of prodromal symptoms is a common presentation, and there are several therapeutic strategies to minimise this risk. This paper examines the classification and clinical features of cardiomyopathies with specific reference to a military population and provides a detailed account of the optimum strategy for diagnosis, indications for specialist referral and specific guidance on the occupational significance of cardiomyopathy. A 27-year-old Lance Corporal Signaller presents to his Regimental medical officer (RMO) after feeling 'light-headed' following an 8 mile unloaded run. While waiting to see the RMO, the medical sergeant records a 12-lead ECG. The ECG is reviewed by the RMO immediately prior to the consultation and shows voltage criteria for left ventricular (LV) hypertrophy and inverted T-waves in II, III, aVF and V1-V3 (Figure 1). This Lance Corporal is a unit physical training instructor and engages in >10 h of aerobic exercise per week. He is a non-smoker and does not have any significant medical history.
authors.affiliation: Department of Physiology Anatomy and Genetics, Oxford University, Oxford, UK Defence Medical Services, Royal Centre for Defence Medicine, Lichfield, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Holdsworth
authors.affiliation: Defence Medical Services, Royal Centre for Defence Medicine, Lichfield, UK St George's, University of London, London, UK.
authors.forename: A T
authors.initials: AT
authors.lastname: Cox
authors.affiliation: Department of Cardiology, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK Bournemouth University, Bournemouth, UK.
authors.forename: C
authors.initials: C
authors.lastname: Boos
authors.affiliation: Defence Primary Healthcare, Lichfield, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hardman
authors.affiliation: St George's, University of London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000328:Adult; D059267:Cardiomegaly, Exercise-Induced / Q000502:physiology; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008889:Military Personnel; D018570:Risk Assessment
keywords: Cardiomyopathies [C14.280.238]; Congenital Heart Defects [C14.240.400]; Hypertrophic Cardiomyopathy [C14.280.238.100]; Sudden Cardiac Death [C14.280.383.220]