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Clinics in Sports Medicine

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THE ATHLETE'S HEART - 10/09/11

Doi : 10.1016/S0278-5919(05)70050-8 
James D. Mills, MD *, Geoffrey E. Moore, MD *, Paul D. Thompson, MD *

Resumen

The development of the athlete's heart is a fascinating phenomenon produced by physiologic adaptations to the increased demands of exercise. The syndrome of the athlete's heart includes cardiac hypertrophy and bradycardia as well as other physiologic and morphologic manifestations. Our purpose is to highlight these manifestations in the young athlete and to discuss the cardiovascular complications that may arise in this patient population. Our ultimate goal is to educate the primary caregiver and thereby facilitate the appropriate evaluation and treatment of cardiovascular findings in young, athletic patients.

Henschen first described the athlete's heart in the late nineteenth century.5, 58 He compared the cardiovascular examination of competitive cross-country skiers with that of sedentary controls. Henschen hypothesized that cardiac enlargement in his cohort of skiers was a normal, beneficial response to exercise. Scientists debated this theory throughout the twentieth century, some arguing that the cardiac enlargement seen in athletes was pathologic dilatation resulting from overexertion, possibly in hearts with pre-existing disease. Henschen's original theory, however, has proved correct.

How are normal adaptations in athletes differentiated from the pathologic? Although physical activity has unquestionably been shown to decrease the risk of cardiovascular disease, there remains a small but definable cardiovascular risk with exercise.55, 65 This risk has been underscored by several recent, highly publicized deaths of nationally known athletes. Such events have sensitized physicians and other caregivers to the importance of diagnosing cardiovascular abnormalities in athletes and thereby preventing these exercise complications. The following principles can be applied to the syndrome of the athlete's heart and sudden cardiac death during exercise:

1
Atherosclerotic coronary artery disease (CAD) is the predominant cause of sudden death during exercise in adults.35, 55, 65, 66, 67, 72 The risk of acute myocardial infarction and sudden cardiac death is increased in adults during exercise, and physicians should know that athletic adults with symptoms possibly related to cardiac ischemia should be referred to a specialist for prompt evaluation. In contrast, sudden death during exercise in athletes under 30 years of age is rarely related to CAD.36, 69 Cardiac complications in young athletes will be the focus of this review.
2
The dimensions of an athlete's heart, adjusted for body size, rarely exceed the upper limits of normal.2, 5, 20, 21, 25, 33, 37, 38, 39, 51, 53, 54, 56, 68 Significant cardiac enlargement usually occurs with repetitive, endurance training. The physiologic changes that occur with this form of training have been extensively studied with echocardiography and advanced cardiac imaging techniques. In the majority of athletes and with only rare exception, changes in left ventricular wall thickness, chamber size, and function remain below the upper limits of normal.2, 25, 37, 38, 39 Hence, few athletes demonstrate cardiac dimensions in the “grey zone” between normal and pathologic cardiac physiology.37

“Abnormalities” uncovered during the routine cardiac screening of asymptomatic, healthy athletes are usually variants of normal. Identified physical findings are typically manifestations of the athletic heart syndrome. The cardiac adaptations seen with endurance training and described later produce most of the “abnormal” findings.5, 25, 28 As mentioned previously, these adaptations rarely exceed the upper limits of normal; however, caregivers of athletes should never ignore cardiac symptoms or significant findings on evaluation.

3. Cardiac symptoms and strikingly abnormal physical findings even in healthy athletes require a prompt evaluation by a cardiovascular expert.16, 35, 40, 57, 67 Undoubtedly, the most sensitive screening tool for diagnosing a cardiac abnormality in an athlete is the careful history and examination he or she receives prior to athletic participation.

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 Address reprint requests toPaul D. Thompson, MD, Preventive Cardiology Program, Hartford Hospital, 80 Seymere Street, PO Box 5037, Hartford, CT 06102–5037


© 1997  W. B. Saunders Company. Publicado por Elsevier Masson SAS. Todos los derechos reservados.© 1985  © 1992 
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Vol 16 - N° 4

P. 725-737 - octobre 1997 Regresar al número
Artículo precedente Artículo precedente
  • PRIMARY CARE OF HAND AND WRIST ATHLETIC INJURIES
  • Robert D. Mastey, Arnold-Peter C. Weiss, Edward Akelman
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  • THORACOABDOMINAL INJURIES IN THE ATHLETE
  • Joseph F. Amaral

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