137. Lili Barouch, Sports Cardiologist and Triathlete

Show Notes:

Lili Barouch, a cardiologist, went to medical school at Johns Hopkins.  After moving to Baltimore, she became a cardiologist specializing in heart failure and transplant. She joined the faculty in 2003 and worked on basic science research, research lab, and inpatient and outpatient care for heart failure and transplant patients. Lili stayed in this role for about 10 years before transitioning to outpatient cardiology. She moved to Howard County, Maryland, where her children have grown up.

Founding the Sports Cardiology Program

Lili started becoming more athletic around 20 years ago. This led to her interest in sports cardiology, a field geared towards athletes. She founded the sports cardiology program at Johns Hopkins and a training program for future sports cardiologists. She talks about building a new program from scratch, how the field of sports cardiology has grown significantly.

Sports Cardiology Screening

Sports cardiology involves screening athletes, including younger athletes, high-level athletes, and masters athletes. Screening includes evaluating athletes for risk factors, symptomatic athletes, those with known cardiac diseases, and those with significant changes in the heart due to high-level exertion. Lili talks about findings through screenings in sports cardiology including congenital heart defects, a family history of cardiac death at a young age, or abnormal ECGs. She mentions that there is no single standard throughout the country for what type of screening is required for college athletics. The general Sports Med and team physician screen everyone to a certain extent. Sports cardiologists typically are involved in second-level screening, for example, high blood pressure is an area that needs to be addressed, especially in younger athletes. By understanding the specifics of each type of screening and addressing any underlying conditions, athletes can better prepare for their future athletic careers.

Stress Tests and ECG Abnormalities

The conversation turns to the importance of stress tests and ECG abnormalities in sports. Athletes often tend to be symptom minimizers, ignoring minor symptoms that don't seem to affect anything at the time. However, many athletes who develop cardiac arrests report having some symptoms before they report them later. Lili talks about finding the balance between not wanting to alarm patients and not wanting them to ignore symptoms.

Guidelines in Sports Cardiology

Sports Cardiology is its own field. New guidelines have come out this year about shared decision making, which helps athletes decide whether to continue playing or not. The previous guidelines were more paternalistic, with doctors telling athletes whether they can play or are not allowed to play. This led to many athletes hiding symptoms or being disqualified. Newer guidelines have looked at more recent research studies to determine if restricting individuals actually helps them. Many places found that it's okay for athletes to participate in ways that were not possible 10 or 15 years ago, but it also affects their psychological state severely if they get disqualified from their sport.

Changes to the Heart

Lili discusses the changes to the heart of elite athletes, including professional athletes, major sports leagues, and Olympic athletes. She explains that the higher level of an athlete, the more likely they are to have more people involved in their care. Studies on elite athletes, such as Tour de France cyclists and Olympic athletes, have shown that those who do high levels of endurance exercise, such as cycling, long-distance running, swimming, and cross-country skiing, tend to have an increase in the size of their heart chambers.

The Health Benefits of Exercise

The American Heart Association guidelines recommend a minimum of two 30 minute strength training workouts and at least three 30 to 45 minute aerobic exercise workouts of moderate intensity per week. The minimum recommended amount of exercise is two and a half hours per week, spread out throughout the week. For endurance athletes, this may be more than two hours a day. Lili talks about the benefits of exercise, highlighting that there are marginal additional gains up to three to four times the minimum recommended amount. The most significant gain is when one goes from zero hours per week to two or three hours per week of total exercise, up to about eight hours per week. This leads to greater fitness, benefits in blood pressure, cholesterol, reducing the risk of diabetes, and longevity. However, beyond eight or 10 hours per week, there are no additional health benefits.

Joining the Race

Lili started running in 2006, initially as a fitness exercise but eventually becoming an athlete due to her autoimmune disease, rheumatoid arthritis. She joined the running club and was challenged by a friend to do a triathlon. She initially struggled with swimming, but eventually learned to swim and competed in several distances, including the full Ironman. Lili has run six marathons, mostly short and medium distance triathlons, and has achieved significant accomplishments such as qualifying for the Boston Marathon in 2018 and competing in the Boston Marathon in 2018. However, she also faced joint issues due to her rheumatoid arthritis, which led her to focus more on long distance triathlons.

The Growth of the Sports Cardiology Program

Lili founded a sports cardiology program based on her clinic, which primarily focuses on athlete patients. The program is also developing a National Registry of masters athletes to study the impact of high exercise levels on athletes' health. The program involves training fellows in cardiology who are interested in sports cardiology. A fellowship program was developed for one fellow, and the first formal graduates completed the program last year. Lili  talks about an annual meeting called "The Care of the Athletic Heart" in Washington, DC, where they organize formal talks, educational symposia, and case presentations to help others get into the field. She also talks about resources and funding for the program.

Timestamps

02:19: Transition to Outpatient Cardiology and Personal Life 

06:14: Evolution and Role in Sports Cardiology 

07:05: Screening and Management of Athletes 

15:25: Elite Athletes and Cardiac Health 

27:15: Lily's Personal Athletic Journey

33:59: Founding the Sports Cardiology Program 

37:26: Administrative and Research Aspects

40:56: Memorable Courses at Harvard 

43:30: Resources and Future Plans

Links:

https://profiles.hopkinsmedicine.org/provider/lili-barouch/2705370

https://www.hopkinsmedicine.org/heart-vascular-institute/cardiology/sports-cardiology

https://www.hopkinsmedicine.org/heart-vascular-institute/education/sports-cardiology-fellowship

 

Featured Non-profit:

The featured non-profit of this episode of The 92 Report is recommended by Heather Taussig, class of ‘92, who reports: 

“Hi, I'm Heather Taussig, class of 1992. The featured nonprofit of this episode of the 92 report is Fostering Healthy Futures. Fostering Healthy Futures is an evidence based mentoring program for children and teens in foster care. I am the program developer and principal investigator of Fostering Healthy Futures, which my team and I launched in 2002. You can learn more about our work at FosteringHealthyFuturesdotorg.“

To learn more about their work, visit: https://www.fosteringhealthyfutures.org/