Systematic training resulting in morphological, functional and electrical adaptations is referred to as Athlete's heart.

1. ATHLETE’S HEART
- Dr. Priyanka Sandeep Sagaonkar
PRIYANKA SAGAONKAR PS

2. The deaths of a number of high profile athletes within the
sporting community have focused attention on the
phenomenon of “the athlete’s heart”`
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3. • Vast majority of deaths in athletes are result of hereditary or congenital
disorders affecting the structural, functional and electrical properties of
myocardium.
• Commonest cause of sudden cardiac death in young adults worldwide:
Hypertrophic Cardiomyopathy (36%)
• Second most common underlying pathology: Coronary Artery
Anomalies (17%)
• Acquired conditions: Acute myocarditis, Commotio cordis, illicit drug
abuse
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5. DEFINITION
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Athlete’s heart is a pathologic cardiac hypertrophy, closely
resembling hypertrophic cardiomyopathy seen in those who
undergo regular, intense exercise (Pagourelias et al., 2014)
ATHLETE'S HEART

6. “Systematic training resulting in a constellation of morphological,
functional and electrical adaptions” is termed as ATHLETE’S HEART
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7. HISTORICAL OVERVIEW
1899: Initial observations by Henschen as dilatation and hypertrophy of
both sides of the heart in cross country skiers with manual chest
percussion as the only diagnostic tool.
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8. SIGNS AND SYMPTOMS
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9. Most athletes are asymptomatic. However, a variety of signs maybe
present:
• Bradycardia
• Left ventricular impulse that is out of place, large and with increased
amplitude
• Systolic flow murmur
• S3 and S4 heart sounds
• Hyperdynamic carotid pulses
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10. CHARACTERISTIC FINDING
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11. Athlete’s heart is characterized by two main findings on a
echocardiography:
1. LVH
2. INTRAVENTRICULAR SEPTUM THICKNESS (IVST)
3. OTHERS: (not necessary for diagnosis)
• Left atrial dilatation and dysfunction
• Enlarged left and right ventricles
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12. PATHOPHYSIOLOGY
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13. • Athlete’s heart is a result of reversible physiological remodeling resulting in
increased cardiac mass but normal cardiac function.
• There is slight difference in extent of remodeling based on the type of exercise.
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14. CARDIAC ADAPTATIONS TO CHRONIC EXERCISE
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16. There are 2 types of Athlete’s heart based on pathologic changes seen
in heart anatomy
ECCENTRIC MYOCARDIAL HYPERTROPHY
• Due to volume overload
• Presence of left ventricular wall
thickness and left ventricular
dilatation
• More commonly seen in
endurance athletes
CONCENTRIC MYOCARDIAL HYPERTROPHY
• Due to resistance load
• Presence of left ventricular wall
thickness but NO left ventricular
dilatation
• More commonly seen in
strength trainers
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18. Cardiovascular responses to exercise differ according to nature of the activity
1. DYNAMIC EXERCISE:
HR & SV + PVR + modest rise in BP VOLUME LOAD on LV
2. STATIC EXERCISE:
Slight rise in HR + Significant rise in BP PRESSURE LOAD ON LV
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20. Evaluation “tool kit”
• Understanding of exercise induced cardiac remodeling
• Medical history & Physical Examination
• 12 lead ECG
• 2D Echo
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Advance TTE
Imaging
Cardiac MRI
Exercise Testing Ambulatory
Rhythm
Monioring
Genetic testing
Prescribed
detraining
ATHLETE'S HEART

21. DIAGNOSIS
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22. 1. ECG
• Sinus arrhythmia
• Sinus bradycardia at rest that can lead to atrial tachycardia, non-
sustained ventricular tachycardia or pre-mature ventricular
contractions
• AV blocks : 1st degree most common
• High voltage QRS with infero-lateral T-wave changes S/O LVH
• Deep anterolateral T-wave inversion
• Incomplete RBBB
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24. 2. Echocardiography
• Left ventricular septal thickness between 13-15mm in men and 11-
13mm in women
• Left ventricular mass seen as LVH
• Left ventricular dilatation
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25. 3. Stress testing
• Submaximal heart rate response to maximal stress with a normal
blood pressure response
• Resting ECG abnormalities may disappear with exercise
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28. DISTINGUISHING FEATURES HCM FROM
ATHLETE’S HEART
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32. PRE-PARTICIPATION SCREENING
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35. THANKYOU
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