Athlete heart syndrome refers to adaptations in both cardiac structure and function seen in people engaged in high-performance and endurance physical exercise.
The prevalence of the condition has increased due to the increased popularity of recreational exercise, approx 3.6/100,000 young athletes die per year1.
Patients are commonly asymptomatic or have rhythm disturbances (e.g. sinus bradycardia), syncope, palpitations, and/or chest pain. They will have a history of regular physical exercise often over an hour per day.
Athletic heart syndrome is due to adaptations in the cardiovascular system in order to be able to meet the physiological demands required during physical exercise. Hypertrophy and dilatation of the ventricles as a response to exercise causes enlargement of the ventricles. A larger stroke volume due to enlargement of the ventricles makes the cardiac function more efficient and demands can be met with a lower heart rate resulting in bradycardia often.
As the condition is usually asymptomatic diagnosis is usually an incidental finding on echocardiography. Echocardiography can also help to differentiate it from other forms of structural heart disease (e.g. hypertrophic cardiomyopathy).
Cardiac MRI is superior to echocardiography with a sensitivity and specificity of 80 and 90% respectively 2. It is also useful to differentiate the normal adaptation of the heart to exercise from pathological conditions and to discard acute myocarditis (seen in 5–22% of athletes’ sudden cardiac attack) 1.
Treatment and prognosis
The condition requires no treatment. There is no proven association between athlete heart syndrome and an increased risk of sudden cardiac death.
- 1. Jens Bremerich, R. S. (2018). The Heart Revealed. Radiology in the diagnosis and management of cardiac conditions. (R. S. Jens Bremerich, Ed.) (Julia Patu). Vienna, Austria: The European Society of Radiology.
- 2. Galderisi M, Cardim N, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Edvardsen T, Freitas A, Habib G, Kitsiou A, Plein S, Petersen SE, Popescu BA, Schroeder S, Burgstahler C, Lancellotti P. The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging. (2015) European heart journal cardiovascular Imaging. 16 (4): 353. doi:10.1093/ehjci/jeu323 - Pubmed
- 3. Chee, C.E., Anastassiades, C.P., Antonopoulos, A.G., Petsas, A.A., Anastassiades, L.C.. Cardiac hypertrophy and how it may break an athlete's heart – the Cypriot case. (2005) European Journal of Echocardiography. 6 (4): 301. doi:10.1016/j.euje.2004.11.009
- 4. Christian, N. O., Djeufack, T., Lionel, W., Roger, E. L., Marcel, A. K., Samuel, M., … Jérôme, F. (2018). Athlete ’ s Heart Syndrome Variability with Respect to Sporting Disciplines in Elite Cameroonian Athletes. International Journal of Internal Medicine, 7(1), 8–15. https://doi.org/10.5923/j.ijim.20180701.03
- 5. Fagard R. Athlete's heart. (2003) Heart (British Cardiac Society). 89 (12): 1455-61. Pubmed
- 6. The incognita of the known: the athlete's heart syndrome. (2011) Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology. 11 (4): 351. doi:10.5152/akd.2011.101 - Pubmed
- 7. De Castro S, Pelliccia A, Caselli S, Di Angelantonio E, Papetti F, Cavarretta E, Carbone I, Francone M, Passariello R, Pandian NG, Fedele F. Remodelling of the left ventricle in athlete's heart: a three dimensional echocardiographic and magnetic resonance imaging study. (2006) Heart (British Cardiac Society). 92 (7): 975-6. doi:10.1136/hrt.2005.069401 - Pubmed
- 8. Samad, Fatima, Harland, Daniel R., Girzadas, Mark, Jan, M. Fuad, Tajik, A. Jamil. Athlete’s heart vs. apical hypertrophic cardiomyopathy: look again!. (2017) European Heart Journal - Cardiovascular Imaging. 18 (3): 381. doi:10.1093/ehjci/jew312
- 9. Scharhag J, Schneider G, Urhausen A, Rochette V, Kramann B, Kindermann W. Athlete's heart: right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. (2002) Journal of the American College of Cardiology. 40 (10): 1856-63. Pubmed
- 10. Huston TP, Puffer JC, Rodney WM. The athletic heart syndrome. (1985) The New England journal of medicine. 313 (1): 24-32. doi:10.1056/NEJM198507043130106 - Pubmed
- 11. Bohuslav Ostadal, Naranjan S. Dhalla. Cardiac Adaptations. (2012) ISBN: 9781461452027