Athlete’s Heart

Athlete’s heart is the name given to a group of changes that occur to the heart in people who train at a high level – more than 1 hour most days.

These changes include a combination of abnormal heart rhythms, thickening of the heart muscle and increase in heart chamber size, heart murmurs and particular heart sounds detectable on physical examination.

There are no symptoms of athlete’s heart. The diagnosis is made with a combination of physical examination, ECG and echocardiography and in selected cases, stress testing.

No adverse effects of athlete’s heart are apparent. In most cases, the changes seen in athlete’s heart regress (disappear) with detraining (decreasing or ceasing the intense training regime). Many athletes find it difficult to follow the instruction form their doctor to detrain.

Although in general, cardiologists agree that regular physical exercise should be included as part of prevention of the development of heart disease, high level athletic training can pose diagnostic challenges when heart abnormalities are found. In addition, we know that athletes have a risk of sudden cardiac death, which has been estimated at around 1:40,000 to 1:80,000. 16% of deaths in athletes were caused by cardiac problems in one study, and the underlying diseases of the heart in these people can include, hypertrophic cardiomyopathy, abnormal coronary arteries, myocarditis, ruptured aortic aneurysm, and heart valve problems.

Athletes heart can mimic other, more serious and potentially life threatening disorders, such as cardiomyopathy, and that distinction is not always easy to make, as there can be an overlap between the tests showing an athletes heart and those suggesting cardiomyopathy in some people. Sometimes, the doctor will instruct the athlete to cease training for a few months, and follow up with a reassessment.

In most people, the abnormal features of athlete’s heart return to normal with detraining, helping to make the diagnosis. However about 20% of people do retain some of the abnormal appearances after detraining.

No specific treatment is required if other potentially more harmful heart conditions have been excluded.