3. DEFINITION
Athlete’s heart OR Myocardiodystrophy is physiologic adaptation
characteristic by enlargement/hypertrophy of the myocardium in
response to repeative, intensive, prolonged strength training.
The term “athlete’s heart” refers to a natural, subtle enlargement
that can happen as the heart adapts to intense athletic training.
By itself, it’s not a disease or a medical condition and doesn’t
cause harm.
Principal features of athlete’s heart
● Cardiac enlargement to allow for increased maximal stroke
volume (SV)
● Cardiac output adaptations that drive the increase in oxygen
delivery
4. PHYSIOLOGY
Athlete's heart is a result of dynamic physical activity, such as
aerobic training more than 5 hours a week.
During intensive prolonged endurance or strength training, the body
signals the heart to pump more blood through the body to counteract
the oxygen deficit building in the skeletal muscles.
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 left
ventricle, and the muscle mass and wall thickness of the heart
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10. CHAMBER MORPHOLOGY
● Training induces cardiac remodeling in 50% of trained
athletes.
● Increased LV,RV and LA size and volume.
● Normal Systolic and diastolic function
● LV remodeling may develop rapidly, or more gradually, after
the initiation of vigorous conditioning.
● Changes are reversible with cessation of training - most
impressive in endurance athletes.
● Athletes show relatively small increase 10% to 20% in wall
thickness or cavity size,and these values remain within
accepted normal limits.
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12. SYMPTOMS & SIGNS
● Cardiovascular symptoms (e.g., dyspnea, chest pain) do not occur.
● However, an enlarged heart can lead to heart problems such as
hypertrophic cardiomyopathy, dilated cardiomyopathy or
hypertension.
● Signs include:-
bradycardia
a systolic murmur
extra heart sounds [A third heart sound (S3) can be
heard due to early and rapid diastolic filling AND S4
can be heard during resting bradycardia]
13. Acute response to exercise
Increase in
● maximum oxygen consumption
● cardiac output
● stroke volume
● systolic blood pressure
● Blood Pressure
● Peripheral vascular resistance
● Heart rate
This increased stroke volume and cardiac output contribute to
a decrease in the resting heart rate; however the main cause of
the decrease in heart rate is due the increase in vagal nerve
tone which is also present in athlete’s heart.
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17. DIAGNOSIS
Clinical evaluation
● Usually ECG
● Sometimes echocardiography
● Rarely, cardiac magnetic resonance imaging
● Rarely, stress testing
Findings are typically detected during routine screening or during
evaluation of unrelated symptoms. Most athletes do not require
extensive testing, although ECG is often warranted. If symptoms
suggest a cardiac disorder (eg, palpitations, chest pain), ECG,
echocardiography, and exercise stress testing are done.
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25. Echocardiography
Echocardiography can usually distinguish athlete’s heart from cardiomyopathies, but
the distinction is not always clear because there is a continuum from physiologic to
pathologic cardiac enlargement. The zone of overlap between athlete’s heart and
cardiomyopathy is left ventricular septal thickness:
● In men, 13 to 15 mm
● In women, 11 to 13 mm
Where as in cardiomyopathy left ventricular septal thickness increase more than 15mm.
In this overlap area, the presence of mitral valve systolic anterior motion strongly
suggests hypertrophic cardiomyopathy. Also, diastolic indexes may be abnormal in
cardiomyopathy but are usually normal in athlete's heart. In general, echocardiographic
changes correlate poorly with level of training and cardiovascular performance. Trace
mitral regurgitation and tricuspid regurgitation are commonly detected. Of note,
reduction of physical training will result in regression of cardiac enlargement in patients
with athlete's heart but not in those with cardiomyopathy.
26. MANAGEMENT
● No treatment is required for people with athletic heart
syndrome, It does not pose any physical threats to the athlete.
● Only we need concerns that the ventricular remodeling might
not 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.
