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Athlete's Heart

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A presentation on Athlete's Heart by Dr Abhinav Luhach BSc (Med), MBBS (Hons1), FRACP.

Published in: Health & Medicine
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Athlete's Heart

  1. 1. Athlete's Heart Abhinav Luhach BSc (Med), MBBS (Hons1), FRACP
  2. 2. Athlete's Heart • Regular physical activity leads to physiological adaptations in cardiac dimensions • This remodelling affects primarily LV wall thickness and cavity size • May be reflected on changes in ECG & echo
  3. 3. Athlete's Heart • Permits enhanced filling of the left ventricle in diastole • Augmentation of stroke volume allowing generation of a large cardiac output even at rapid heart rates • As a consequence, a diagnostic dilemma can arise when attempting to differentiate physiological adaptation with associated ECG and echo changes from true cardiac pathology
  4. 4. Dilemma • False-positive diagnoses may lead to erroneous disqualification from a sport with significant psychological distress and loss of earnings Vs • False-negative evaluations may result in devastating SCD.
  5. 5. Screening • Pre-participation cardiovascular screening of athletes is recommended by both the American Heart Association and the European Society of Cardiology • Evaluation of symptoms, family history, and physical examination is recommended • Role of ECG remains controversial
  6. 6. Role of ECG • Incorporating ECG into a screening protocol improves efficacy in identifying conditions capable of causing SCD. • Test of choice for electrical abnormalities – WPW, LQTS & Brugada syndrome – Often abnormal in cardiomyopathies (HCM, ARVC) • Some evidence supports use of ECGs
  7. 7. ECG Findings in Athletes
  8. 8. ECG of an Athlete
  9. 9. Athlete's heart vs HCM • In athlete's heart left ventricular hypertrophy is generally mild (<12mm) & is symmetrical • However in some individual’s LVWT is between 13-15mm which represents a “grey zone” for considering HCM • ECG, echo and occasionally more sophisticated investigations enable differentiating between the 2 conditions
  10. 10. Athlete's heart vs HCM • ECG changes suggestive of HCM include: – T wave inversion – Pathological Q waves – LBBB – ST segment depression
  11. 11. Echo findings in athlete's heart vs HCM Suggestive of AH • Concentric LVH • LV cavity >55mm • Normal diastolic function Suggestive of HCM • Asymmetric LVH • LV cavity <45mm • Abnormal diastolic function • Mitral valve abnormalities
  12. 12. Pattern of Left Ventricular Hypertrophy
  13. 13. Supplementary Tools • In rare cases there may be a role for more detailed testing • Cardiac MRI – More accurate assessment of wall thickness – Late gadolinium enhancement after administering contrast • Functional exercise testing • Genetic testing • Re-evaluation after a period of deconditioning
  14. 14. Athlete’s Heart vs ARVC • Challenging!! • Features suggestive of ARVC – Epsilon waves – Non-sustained VT of LBBB pattern – Abnormal regional RV motion abnormalities • Cardiac MRI can be useful
  15. 15. ARVC
  16. 16. ECG in ARVC
  17. 17. Conclusion • Morphological and electrical changes in cardiac status of athletes can appear similar to pathological entities • Using a structured approach it is often possible to distinguish between these entities

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