Heart Problems in Athletes

Stephen. W. Parcell, ND here. I specialize in cardiovascular medicine at NatureMed, Boulder, CO. My approach is comprehensive. I spends more time learning about patients so that a holistic, patient centered model can be implemented. I work closely with athletes in both the prevention and treatment of many conditions including cardiovascular. 

Athlete’s heart is a condition that has been recognized for over 100 years but only recently has ultrasound technology improved to the point that it can be evaluated more carefully. Long-term athletic training leads to an increase in left ventricular mass. These changes in the heart muscle are relatively mild and the differences between athlete and non-athlete populations are generally small. The changes in heart size associated with long-term athletics are more pronounced in certain sports such as distance running, swimming, cycling, and rowing. 

Athlete’s heart is not a dangerous condition but one must differentiate increased heart size that is adaptive and normal versus changes in heart size and function that are abnormal, maladaptive and pathologic.

Athletes can also get plenty of plaque in their arteries, I know its not fair but it happens. This is easily seen on an ultrasound. 

Heart problems affecting athletes:

1. Electrophysiologic heart muscle problems affecting younger athletes that may cause unexpected death in a otherwise very healthy individual. Cardiomyopathy si the most common heart problem affecting athletes.There are a number of subtypes of cardiomyopathy.  Hypertrophic cardiomyopathy is the most common and needs to be differentiated from athletes’s heart, which is normal. Screening: ECG (poor), resting echocardiogram (better), stress echo (best).
2. Myocarditis: While myocarditis, (inflammation of the heart muscle).
3. Pulmonary hypertension: In this condition pulmonary arterial pressure is too high during exercise.  The blood vessels that supply the lungs constrict and their walls thicken, so they can’t carry as much blood, pressure can build up. The workload on the heart increases trying to force the blood through. If the pressure is high enough, eventually the heart can’t keep up, and less oxygenated blood is the result. Athletes can become tired, dizzy and short of breath.The main issue here is that intense exercise must be avoided. Light to moderate activity is usually OK.
4. Diastolic dysfunction: In diastolic dysfunction there is inadequate filling of blood during the relaxation phase of the heart beat. This condition may present with decreased exercise tolerance.
5. Heart valve problems. Usually the athletes will experience exercise intolerance. If the valves are leaky high intensity exercise should be avoided. 
6. In older athletes intense as well as long duration exercise may lead to abnormal changes within the structural elements of the myocardium (heart muscle). Sometimes the first symptom is irregular heart rate and rhythm. In other cases its and ER visit or sudden death. 

The goal of the visit is to show that your heart is fine and that high intensity training will cause no problems. Don’t wait until you get symptoms to get checked out.