240:
621:(ECHO) are still not considered routine in these contexts. Widespread routine ECGs for all potential athletes during initial screening and then during the yearly physical assessment could well be too expensive to implement on a wide scale, especially in the face of the potentially very large demand. In some places, a shortage of funds, portable ECG machines, or qualified personnel to administer and interpret them (medical technicians, paramedics, nurses trained in cardiac monitoring, advanced practice nurses or nurse practitioners, physician assistants, and physicians in internal or
738:
with AHS lived shorter lives than those who did not acquire the syndrome. Because his research occurred throughout the 19th century, technology was limited, and it became difficult to devise appropriate ways to measure the hearts of athletes. Few believed in
Henschen's theory about athletes having larger hearts than those who did not participate in sports. The latter, however, in addition to Henschen's belief of an enlargement of the entire heart among athletes is in agreement with the four-chamber dilation seen with modern imaging modalities in individuals with athlete's heart.
77:
60:
335:). Dynamic exercises include running, swimming, skiing, rowing, and cycling, which rely on oxygen from the body. This type of exercise also increases both heart rate and stroke volume of the heart. Both static and dynamic exercises involve the thickening of the left ventricular wall due to increased cardiac output, which leads to physiologic hypertrophy of the heart. Once athletes stop training, the heart returns to its normal size.
152:
292:, the amount of blood that leaves the heart in a given time period (i.e. liters per minute), is proportional to both the chamber sizes of the heart and the rate at which the heart beats. With a larger left ventricle, the heart rate can decrease and still maintain a level of cardiac output necessary for the body. Therefore, athletes with AHS commonly have lower
617:(ECG) is a relatively straightforward procedure to administer and interpret, compared to more invasive or sophisticated tests; it can reveal or hint at many circulatory disorders and arrhythmias. Part of the cost of an ECG may be covered by some insurance companies, though routine use of ECGs or other similar procedures such as
737:
lives. He noticed that those who participated in competitive sports displayed symptoms of athlete's heart syndrome. Henschen believed the symptoms were a normal adjustment to exercise, and felt concern was not needed. Henschen believed that the entire heart became enlarged. He also believed athletes
628:
If sudden cardiac death occurs, it is usually because of pathological hypertrophic enlargement of the heart that went undetected or was incorrectly attributed to the benign "athletic" cases. Among the many alternative causes are episodes of isolated arrhythmias which degenerated into lethal VF and
1384:
Maron BJ, Thompson PD, Puffer JC, McGrew CA, Strong WB, Douglas PS, et al. (August 1996). "Cardiovascular preparticipation screening of competitive athletes. A statement for health professionals from the Sudden Death
Committee (clinical cardiology) and Congenital Cardiac Defects Committee
720:
from exercise for a period of three months allows the heart to return to its regular size. However, one long-term study of elite-trained athletes found that dilation of the left ventricle was only partially reversible after a long period of deconditioning. This deconditioning is often met with
715:
might conceivably predispose for serious arrhythmias, no evidence has been found of any increased risk of long-term events. Athletes should see a physician and receive a clearance to be sure their symptoms are due to athlete's heart and not another heart disease, such as cardiomyopathy. If the
699:
Athlete's heart is not dangerous for athletes (though if a nonathlete has symptoms of bradycardia, cardiomegaly, and cardiac hypertrophy, another illness may be present). Athlete's heart is not the cause of sudden cardiac death during or shortly after a workout, which mainly occurs due to
594:, a growing movement is making an effort to have both professional and school-based athletes screened for cardiac and other related conditions, usually through a careful medical and health history, a good family history, a comprehensive physical examination including
549:– differentiation between physiological and pathological increases of the heart's size is possible, especially by estimating the mass of the wall (not over 130 g/m) and its end diastolic diameter (not much less 60 mm) of the left ventricle.
278:. Enlargement of the heart is a natural physical adaptation of the body to deal with the high pressures and large amounts of blood that can affect the heart during these periods of time. Over time, the body will increase both the chamber size of the
322:
The level of physical activity in a person determines what physiological changes the heart makes. The two types of exercise are static (strength-training) and dynamic (endurance-training). Static exercise consists of weight lifting and is mostly
721:
resistance to the accompanying lifestyle changes. The real risk attached to athlete's heart is if athletes or nonathletes simply assume they have the condition, instead of making sure they do not have a life-threatening heart illness.
1200:
198:
Bradycardia is a slower than normal heartbeat, at around 40–60 beats per minute. Cardiomegaly is the state of an enlarged heart, and cardiac hypertrophy the thickening of the muscular wall of the heart, specifically the
389:(HCM), a serious cardiovascular disease characterized by thickening of the heart's walls, which produces a similar ECG pattern at rest. This genetic disorder is found in one of 500 Americans and is a leading cause of
163:, although an indicator would be a consistently low resting heart rate. Athletes with AHS often do not realize they have the condition unless they undergo specific medical tests, because athlete's heart is a normal,
230:
is heard, the patient should be given immediate attention. An S4 gallop is a stronger and louder sound created by the heart, if diseased in any way, and is typically a sign of a serious medical condition.
207:. Especially during an intensive workout, more blood and oxygen are required to the peripheral tissues of the arms and legs in highly trained athletes' bodies. A larger heart results in higher
393:
in young athletes (although only about 8% of all cases of sudden death are actually exercise-related). The following table shows some key distinguishing characteristics of the two conditions.
1192:
188:
262:
Athlete's heart is a result of dynamic physical activity, such as aerobic training more than 5 hours a week rather than static training such as weightlifting. During intensive prolonged
1428:
307:), and a decrease in resting heart rate along with irregular rhythms. The wall of the left ventricle increases in size by about 15–20% of its normal capacity. No decrease of the
900:
Ellison GM, Waring CD, Vicinanza C, Torella D (January 2012). "Physiological cardiac remodelling in response to endurance exercise training: cellular and molecular mechanisms".
239:
711:
No treatment is required for people with athletic heart syndrome; it does not pose any physical threats to the athlete, and despite some theoretical concerns that the
1619:
De
Innocentiis C, Ricci F, Khanji MY, Aung N, Tana C, Verrengia E, et al. (November 2018). "Athlete's Heart: Diagnostic Challenges and Future Perspectives".
189:
826:"Left Ventricular Speckle Tracking-Derived Cardiac Strain and Cardiac Twist Mechanics in Athletes: A Systematic Review and Meta-Analysis of Controlled Studies"
1527:
135:
as a consequence of repetitive cardiac loading. Athlete's heart is common in athletes who routinely exercise more than an hour a day, and occurs primarily in
629:
asystole, and various unnoticed, possibly asymptomatic cardiac congenital defects of the vessels, chambers, or valves of the heart. Other causes include
708:(ARVC), two genetic disorders. Although a link between intensive exercise and exercise-induced arrhythmogenic right ventricular cardiomyopathy exists.
167:
adaptation of the body to the stresses of physical conditioning and aerobic exercise. People diagnosed with athlete's heart commonly display three
1863:
332:
271:
1030:
778:
581:
371:. The pulse of a person with athlete's heart can sometimes be irregular while at rest, but usually returns to normal after exercise begins.
1420:
143:. The condition is generally considered benign, but may occasionally hide a serious medical condition, or may even be mistaken for one.
564:
563:
Cardiac MRI - In athlete's heart, there is balanced atrioventricular remodeling, reduced thickening of the heart after detraining, no
795:
586:
Because of several well-known and high-profile cases of athletes experiencing sudden unexpected death due to cardiac arrest, such as
1559:
947:
805:
1491:
Sachs KV, Harnke B, Mehler PS, Krantz MJ (March 2016). "Cardiovascular complications of anorexia nervosa: A systematic review".
1107:
Pelliccia A, Di Paolo FM, Maron BJ (2002). "The athlete's heart: remodeling, electrocardiogram and preparticipation screening".
1803:
187:
1273:"Distinguishing hypertrophic cardiomyopathy from athlete's heart: a clinical problem of increasing magnitude and significance"
1598:
874:
705:
684:
653:
379:
648:
The normal treatments for episodes due to the pathological look-alikes are the same mainstays for any other episode of
701:
386:
190:
1542:
382:
is usually indistinguishable from athlete's heart and at ECG, but can usually be discounted in the young and fit.
1057:
730:
540:
404:, which involve slowing of metabolic rate and sometimes shrinkage of the heart muscle and reduced heart volume.
1918:
1886:
676:
299:
The heart becomes enlarged, or hypertrophic, due to intense cardiovascular workouts, creating an increase in
1913:
672:
422:
1452:"The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S)"
355:. Similarities at presentation between athlete's heart and clinically relevant cardiac problems may prompt
712:
536:
375:
255:
132:
59:
1662:
Rowland T (May 2011). "Is the 'athlete's heart' arrhythmogenic? Implications for sudden cardiac death".
747:
283:
1322:"Abnormal electrocardiographic findings in athletes: recognising changes suggestive of cardiomyopathy"
1222:
Drezner JA, Fischbach P, Froelicher V, Marek J, Pelliccia A, Prutkin JM, et al. (February 2013).
347:
during a routine screening or during tests for other medical issues. An enlarged heart can be seen at
517:
397:
390:
1825:
Rost R (August 1997). "The athlete's heart. Historical perspectives--solved and unsolved problems".
1450:
Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, et al. (April 2014).
1707:"The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death"
734:
532:
360:
356:
180:
716:
athlete is uncomfortable with having athlete's heart or if a differential diagnosis is difficult,
1923:
1777:
1687:
1644:
1351:
1320:
Drezner JA, Ashley E, Baggish AL, Börjesson M, Corrado D, Owens DS, et al. (February 2013).
1253:
1132:
925:
525:
344:
324:
308:
263:
247:
227:
223:
1152:"The athlete's heart is a proarrhythmic heart, and what that means for clinical decision making"
591:
1842:
1769:
1728:
1679:
1636:
1590:
1508:
1473:
1402:
1343:
1302:
1245:
1173:
1124:
1089:
1026:
1003:
917:
855:
801:
774:
768:
614:
521:
364:
304:
279:
267:
251:
215:
211:, which may allow it to beat more slowly at rest, as more blood is pumped out with each beat.
89:
84:
1748:"Remodeling of left ventricular hypertrophy in elite athletes after long-term deconditioning"
1834:
1759:
1718:
1671:
1628:
1500:
1463:
1394:
1333:
1292:
1284:
1235:
1163:
1116:
1081:
993:
983:
909:
845:
837:
618:
546:
401:
368:
348:
243:
622:
513:
275:
140:
109:
1567:
1224:"Normal electrocardiographic findings: recognising physiological adaptations in athletes"
955:
1297:
1272:
998:
971:
850:
825:
717:
649:
607:
486:
367:, a resting heart rate of fewer than 60 beats per minute. This is often accompanied by
289:
208:
200:
1838:
1723:
1706:
797:
Der grosse Reuter: Springer
Universalwörterbuch Medizin, Pharmakologie und Zahnmedizin
1907:
1746:
Pelliccia A, Maron BJ, De Luca R, Di Paolo FM, Spataro A, Culasso F (February 2002).
1675:
1120:
1085:
657:
312:
300:
164:
1795:
1691:
1648:
1136:
929:
1781:
1355:
1257:
688:
642:
634:
610:, and increasingly, for better efforts at detection, such as an electrocardiogram.
595:
587:
568:
557:
553:
270:, the body signals the heart to pump more blood through the body to counteract the
194:
Resting heart rate recorded in an elite athlete demonstrating bradycardia at 42 bpm
176:
168:
117:
76:
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1468:
1451:
1338:
1321:
1240:
1223:
913:
824:
Beaumont A, Grace F, Richards J, Hough J, Oxborough D, Sculthorpe N (June 2017).
671:. The goal is avoidance of infarction, heart failure, and/or lethal arrhythmias (
396:
Athlete's heart should not be confused with bradycardia that occurs secondary to
878:
664:
661:
638:
599:
352:
226:
of the irregularly shaped heart creates a disordered blood flow. However, if an
219:
172:
125:
68:
1582:
1632:
1168:
1151:
841:
668:
603:
293:
121:
17:
171:
that would usually indicate a heart condition when seen in a regular person:
1398:
1288:
988:
535:– typical findings in resting position are, for example, sinus bradycardia,
456:
331:
for performance. It also moderately increases heart rate and stroke volume (
136:
1773:
1732:
1683:
1640:
1594:
1512:
1477:
1347:
1306:
1249:
1177:
1128:
1093:
1007:
921:
859:
311:
of the left ventricle occurs. The athlete may also experience an irregular
151:
1846:
1764:
1747:
1406:
1056:. In: Deutsche Zeitschrift für Sportmedizin. 51, Nr. 9, 2000, S. 307–308,
680:
630:
446:
733:. He compared the heart size of cross-country skiers to those who lived
160:
105:
1878:
1504:
328:
1385:(cardiovascular disease in the young), American Heart Association".
770:
Fachlexikon
Sportmedizin: Bewegung, Fitness und Ernährung von A - Z
316:
204:
185:
150:
113:
1072:
Rich BS, Havens SA (April 2004). "The athletic heart syndrome".
972:"Metabolic Mechanisms of Exercise-Induced Cardiac Remodeling"
645:
whose symptoms were slight or ignored, or were asymptomatic.
729:
The athlete's heart syndrome was first described in 1899 by
539:(primary and secondary) and incomplete (IRBBB) or complete
385:
It is important to distinguish between athlete's heart and
1528:"Der Vater des Sportherzens – Herbert Reindell 100 Jahre"
660:, and if initial defibrillation fails, administration of
543:(RBBB) – all those findings normalize during exercise.
159:
Athlete's heart most often does not have any physical
131:
The athlete's heart is associated with physiological
1868:
625:
or in some area of cardiopulmonary medicine) exist.
139:
athletes, though it can occasionally arise in heavy
1872:
83:
39:
34:
319:between 40 and 60 beats per minute (bradycardia).
1369:Alexander RW, Schlant RC, Fuster V, eds. (1998).
877:. CVS Caremark Health Information. Archived from
875:"Ills & Conditions – Athletic Heart Syndrome"
1589:, Treasure Island (FL): StatPearls Publishing,
214:Another sign of athlete's heart syndrome is an
1493:The International Journal of Eating Disorders
8:
470:Asymmetric (in hypertrophic cardiomyopathy)
1193:"Electrocardiographic findings in athletes"
1021:Lohr JT (1999). "Athletic Heart Syndrome".
506:No left ventricular hypertrophy regression
1869:
1054:Standards der Sportmedizin - Das Sportherz
598:of heart and lung sounds and recording of
75:
58:
31:
1763:
1722:
1467:
1337:
1296:
1239:
1167:
997:
987:
849:
1800:The Merck Manuals Online Medical Library
552:X-ray examination of the chest may show
503:Left ventricular hypertrophy regression
435:Left ventricular end-diastolic diameter
406:
238:
1581:Amin, Hina; Siddiqui, Waqas J. (2022),
759:
495:Normal or reduced systolic BP response
1705:Maron BJ, Pelliccia A (October 2006).
1373:(9th ed.). New York: McGraw-Hill.
773:. Deutscher Ärzteverlag. p. 221.
516:of the patient (endurance sports) and
203:, which pumps oxygenated blood to the
1560:"Chapter 27: Athletic Heart Syndrome"
1535:Deutsche Zeitschrift für Sportmedizin
1067:
1065:
582:Hypertrophic cardiomyopathy screening
7:
1806:from the original on 7 November 2007
1601:from the original on 16 October 2022
1048:
1046:
1044:
1042:
976:Frontiers in Cardiovascular Medicine
941:
939:
819:
817:
800:. Birkhäuser Verlang. p. 1300.
556:(mimicking other possible causes of
327:, meaning the body does not rely on
687:), so ultimately to restore normal
398:relative energy deficiency in sport
1456:British Journal of Sports Medicine
1326:British Journal of Sports Medicine
1228:British Journal of Sports Medicine
571:, and normal extracellular volume.
303:, an enlarged left ventricle (and
25:
1864:Merck Manual Professional Version
1724:10.1161/CIRCULATIONAHA.106.613562
286:and wall thickness of the heart.
222:. This sound can be heard as the
1676:10.2165/11583940-000000000-00000
1431:from the original on 15 May 2015
1203:from the original on 5 July 2022
1121:10.1097/00045415-200203000-00006
1086:10.1249/00149619-200404000-00006
155:Example ultrasound of an athlete
1150:Heidbuchel H (September 2018).
1074:Current Sports Medicine Reports
455:Abnormal (E/A ratio < 1; or
218:, which can be heard through a
1566:. January 2008. Archived from
1025:. Detroit, MI: Gale Research.
873:Woolston C (17 January 2007).
343:Athlete's heart is usually an
1:
1839:10.1016/s0733-8651(05)70355-6
1023:Gale Encyclopedia of Medicine
706:arrhythmogenic cardiomyopathy
685:pulseless electrical activity
654:cardiopulmonary resuscitation
528:), can give important hints.
52:Exercise-induced cardiomegaly
1541:(3): m 73-75. Archived from
1469:10.1136/bjsports-2014-093502
1339:10.1136/bjsports-2012-092069
1241:10.1136/bjsports-2012-092068
914:10.1136/heartjnl-2011-300639
576:Screening related conditions
380:left ventricular hypertrophy
252:Resistance/Strength exercise
970:Fulghum K, Hill BG (2018).
702:hypertrophic cardiomyopathy
658:restore normal sinus rhythm
565:late gadolinium enhancement
387:hypertrophic cardiomyopathy
108:condition commonly seen in
1940:
1271:Maron BJ (November 2005).
579:
520:(bradycardia, and maybe a
452:Normal (E/A ratio > 1)
1796:"Athletic Heart Syndrome"
1633:10.1007/s40279-018-0985-2
1425:Merck Manual Professional
1421:"Athletic Heart Syndrome"
948:"Athletic Heart Syndrome"
842:10.1007/s40279-016-0644-4
541:right bundle branch block
74:
66:
57:
952:Family Practice Notebook
767:Graf C, Höher J (2009).
677:ventricular fibrillation
1564:Cardiovascular Medicine
1399:10.1161/01.CIR.94.4.850
1289:10.1136/hrt.2005.060962
1169:10.1093/europace/eux294
989:10.3389/fcvm.2018.00127
673:ventricular tachycardia
423:ventricular hypertrophy
413:Athletic heart syndrome
98:Athletic heart syndrome
713:ventricular remodeling
537:atrioventricular block
376:differential diagnosis
259:
195:
156:
1765:10.1161/hc0802.104534
1526:Kindermann W (2008).
1191:Brugada J, Benito B.
748:Exercise hypertension
489:response to exercise
363:. The ECG can detect
242:
193:
154:
1109:Cardiology in Review
656:, defibrillation to
554:increased heart size
518:physical examination
391:sudden cardiac death
361:cardiac stress tests
48:Athletic bradycardia
1548:on 3 December 2008.
464:Septal hypertrophy
359:(ECG) and exercise
357:electrocardiography
294:resting heart rates
181:cardiac hypertrophy
112:in which the human
1827:Cardiology Clinics
526:fourth heart sound
351:or sometimes on a
345:incidental finding
309:diastolic function
296:than nonathletes.
260:
256:cardiac remodeling
224:diastolic pressure
196:
157:
147:Signs and symptoms
133:cardiac remodeling
120:, and the resting
1901:
1900:
1802:. November 2005.
1717:(15): 1633–1644.
1627:(11): 2463–2477.
1505:10.1002/eat.22481
1283:(11): 1380–1382.
1058:Das Sportherz pdf
1032:978-0-7876-1868-1
794:Reuter P (2005).
780:978-3-7691-1223-8
615:electrocardiogram
510:
509:
365:sinus bradycardia
268:strength training
191:
95:
94:
90:Sports cardiology
29:Medical condition
16:(Redirected from
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1197:www.escardio.org
1188:
1182:
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1171:
1162:(9): 1401–1411.
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1141:
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1069:
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1037:
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967:
961:
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954:. Archived from
946:Moses S (2008).
943:
934:
933:
897:
891:
890:
888:
886:
881:on 4 August 2007
870:
864:
863:
853:
836:(6): 1145–1170.
821:
812:
811:
791:
785:
784:
764:
731:Salomon Henschen
619:echocardiography
567:, low to normal
547:Echocardiography
457:pseudonormal E/A
441:> 70 mm
438:< 60 mm
430:> 15 mm
427:< 13 mm
407:
402:anorexia nervosa
369:sinus arrhythmia
349:echocardiography
276:skeletal muscles
274:building in the
192:
79:
62:
32:
21:
1939:
1938:
1934:
1933:
1932:
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1919:Sports medicine
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1664:Sports Medicine
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1621:Sports Medicine
1618:
1617:
1613:
1604:
1602:
1580:
1579:
1575:
1570:on 26 May 2008.
1558:
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1052:Kindermann W.:
1051:
1040:
1033:
1020:
1019:
1015:
969:
968:
964:
958:on 26 May 2008.
945:
944:
937:
899:
898:
894:
884:
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872:
871:
867:
830:Sports Medicine
823:
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781:
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761:
756:
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727:
697:
623:family medicine
592:Marc-Vivien Foé
584:
578:
514:medical history
500:Deconditioning
481:May be present
475:Family history
416:Cardiomyopathy
341:
305:right ventricle
237:
186:
149:
141:weight trainers
110:sports medicine
44:Athlete's heart
35:Athlete's heart
30:
23:
22:
15:
12:
11:
5:
1937:
1935:
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1914:Heart diseases
1906:
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1873:Classification
1867:
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1859:
1858:External links
1856:
1853:
1852:
1833:(3): 493–512.
1817:
1787:
1738:
1697:
1670:(5): 401–411.
1654:
1611:
1583:"Cardiomegaly"
1573:
1551:
1518:
1499:(3): 238–248.
1483:
1462:(7): 491–497.
1442:
1412:
1393:(4): 850–856.
1376:
1361:
1332:(3): 137–152.
1312:
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1234:(3): 125–136.
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650:cardiac arrest
608:blood pressure
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290:Cardiac output
280:left ventricle
272:oxygen deficit
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201:left ventricle
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1810:24 September
1808:. Retrieved
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1538:
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879:the original
868:
833:
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796:
789:
769:
762:
728:
710:
698:
689:sinus rhythm
647:
643:pericarditis
635:endocarditis
627:
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596:auscultation
588:Reggie White
585:
511:
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384:
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177:cardiomegaly
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106:pathological
101:
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1752:Circulation
1711:Circulation
1387:Circulation
1080:(2): 84–8.
908:(1): 5–10.
665:epinephrine
662:intravenous
639:myocarditis
600:vital signs
558:enlargement
353:chest X-ray
333:oxygen debt
284:muscle mass
220:stethoscope
173:bradycardia
104:) is a non-
69:human heart
40:Other names
1908:Categories
1587:StatPearls
885:11 January
754:References
695:Management
669:amiodarone
604:heart rate
580:See also:
467:Symmetric
374:Regarding
317:pulse rate
282:, and the
258:and growth
254:impact on
122:heart rate
1924:Syndromes
1371:The Heart
735:sedentary
569:T1 signal
449:function
447:Diastolic
339:Diagnosis
325:anaerobic
313:heartbeat
264:endurance
248:Endurance
228:S4 gallop
216:S3 gallop
137:endurance
85:Specialty
1804:Archived
1774:11864923
1733:17030703
1692:11022550
1684:21510716
1649:52813585
1641:30251086
1605:3 August
1599:archived
1595:31194436
1513:26710932
1478:24620037
1435:30 April
1429:Archived
1427:. 2005.
1348:23303760
1307:16230430
1250:23303759
1201:Archived
1178:29244075
1156:Europace
1137:24094793
1129:11895574
1094:14980136
1008:30255026
930:19630545
922:21880653
860:27889869
742:See also
681:asystole
631:carditis
602:such as
161:symptoms
118:enlarged
1892:D059267
1847:9276172
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492:Normal
410:Feature
244:Aerobic
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329:oxygen
179:, and
1778:S2CID
1688:S2CID
1645:S2CID
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1352:S2CID
1277:Heart
1254:S2CID
1133:S2CID
926:S2CID
902:Heart
683:, or
522:third
478:None
421:Left
235:Cause
205:aorta
169:signs
126:lower
114:heart
50:, or
1887:MeSH
1843:PMID
1812:2007
1770:PMID
1729:PMID
1680:PMID
1637:PMID
1607:2022
1591:PMID
1509:PMID
1474:PMID
1437:2015
1403:PMID
1344:PMID
1303:PMID
1246:PMID
1209:2022
1174:PMID
1125:PMID
1090:PMID
1027:ISBN
1004:PMID
918:PMID
887:2012
856:PMID
802:ISBN
775:ISBN
704:and
606:and
590:and
512:The
250:and
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1835:doi
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1464:doi
1395:doi
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1293:PMC
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994:PMC
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846:PMC
838:doi
667:or
613:An
533:ECG
524:or
400:or
266:or
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116:is
102:AHS
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