Physiological cardiac adaptation to exercise

Case contributed by Dr Tim Luijkx

Presentation

Triathlete. Exercises for an average of 20 hours per week. Sinus bradycardia and high voltages. Upper limit of wall thickness on ultrasound.

Patient Data

Age: 45
Gender: Male

Patient characteristics:
Length 193 cm, weight 80 kg, BSA 2.10 m²

Diameters:
- LV: 53 mm
- RV: 50 mm
- Septum: 15 mm, anterior and anterolateral wall 11 mm, inferior and inferolateral wall 9 mm

Functional analyses:
Left ventricle:
- EDM: 187 g (89 mL/m²)
- EDV: 277 mL (132 mL/m²)
- ESV: 102 mL (49 mL/m²)
- SV: 175 mL (83 mL/m²)
- EF: 63%
- CO: 9.0 L/min (4.3 L/min/m²)

Right ventricle:
- EDV: 294 mL (140 mL/m²)
- ESV: 122 mL (58 mL/m²)
- SV: 172 mL (82 mL/m²)
- EF: 59%
- CO: 8.9 L/min (4.2 L/min/m²)

Dilatation of both atria and ventricles with balanced volume increase. These volumesare within the upper limits for a healthy athlete of 40-49 years old (http://referencecmr.nl/reference-cmr-values/mature-healthy-population).

Left ventricular hypertrophy, most prominent in the interventricular septum. Synchronous contraction of ventricles. No focal wall motion abnormalities. No valvular insufficiencies. 

Fibrosis at the insertion of the right ventricle on the anteroseptal and inferoseptal LV wall. No late enhancement elsewhere.

Impression:
- Dilatation of atria and ventricles with good function and volumes within normal limits for an athlete of 40-49 years old.
- Left ventricular hypertrophy (interventricular septum 15 mm). Insertional fibrosis, no late enhancement elsewhere.

Conclusion:
The hypertrophy and slight fibrosis are just within the range of findings consistent with maximum physiological cardiac adaptation to physical exercise (wall thickness maximum 15 mm). Differential diagnosis should still include hypertrophic cardiomyopathy.

Case Discussion

In order to differentiate between physiological adaptation to exercise and cardiomyopathy a repeat scan after a period of detraining (as short as 6 weeks can suffice) will demonstrate regression of the cardiac changes in the case of adaptation to exercise, whereas they will persist in the case of cardiomyopathy.

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Case information

rID: 39934
Case created: 28th Sep 2015
Last edited: 6th Dec 2016
System: Cardiac
Inclusion in quiz mode: Included

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