athlete's heart
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Pathology
- left ventricular hypertrophy -> left atrial enlargement resulting in increased risk of atrial fibrillation (RR=3)[3][4]
- coronary artery calcification with higher levels of lifelong physical exercise in men[5]
- suggested to be a benign condition[5] Special laboratoary
- electrocardiogram: common ECG findings
- increased R-wave or S-wave amplitude (> 35 m)
- concave upward anterior ST segment elevation
- terminal T-wave inversion
- anterior biphasic T-waves
- classic LVH strain pattern
- loss of R waves, or significant Q-waves suggest hypertrophic cardiomyopathy or myocardial damage
- Q waves > 4 mm
- echocardiogram
- may be normal or show a mild increase in left & right ventricular chamber size
- normal diastolic filling
- mitral valve prolapse & bicuspid aortic valve are the most common abnormalities
- exercise testing
- VO2max > 120% of predicted
Physiology
- regular endurance exercise
- increases left ventricular mass & biventricular chamber size; LV diastolic cavity diameter > 55 mm
- reduces resting heart rate
- does NOT increase left ventricular wall thickness beyond 11-12 mm
- may be physiologic S3 or S4 gallop
- systolic murmur due to turbulence in right ventricular outflow tract may be heard at left sternal border
- static exercise
- increases left ventricular mass
- does not reduce resting heart rate
- may be associated with hypertension
Differential diagnosis
- hypertrophic cardiomyopathy
- distinction of cardiac hypertrophy associated with intense exercise from hypertrophic cardiomyopathy
- factors favoring hypertrophic cardiomyopathy:
- right ventricular involvement
- wall thickness > 13 mm
- outflow obstruction
- asymmetric involvement
- LV diastolic cavity diameter < 45 mm
- marked left atrial enlargement
- abnormal left ventricular filling
- positive family history
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 17, 18. American College of Physicians, Philadelphia 1998, 2009, 2015, 2018.
- ↑ Journal Watch 20(16):127, 2000 Pelliccia A et al Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 102:278, 2000 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10899089
- ↑ 3.0 3.1 Mont L et al Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter Europace 2009 11(1):11-17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18988654
- ↑ 4.0 4.1 Mohanty S, Mohanty P, Tamaki M et al Differential Association of Exercise Intensity With Risk of Atrial Fibrillation in Men and Women: Evidence from a Meta- Analysis. J Cardiovasc Electrophysiol. 2016 Sep;27(9):1021-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27245609
- ↑ 5.0 5.1 5.2 Davenport L Coronary Plaques Common but 'Benign' in Lifelong Athletes. Medscape. May 12, 2017. http://www.medscape.com/viewarticle/879923
Aengevaeren VL, Mosterd A, Braber TL et al The Relationship Between Lifelong Exercise Volume and Coronary Atherosclerosis in Athletes. Circulation. 2017 Apr 27. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28450347