By Mrs. Karotsaki Theodora, Cardiologist, Scientific Head of the Cardiology Department of the ANASSA Clinic
Exercise has positive effects on heart health, but it also has limitations to prevent it from turning from a beneficial to a harmful activity. Particular care must be taken in the case of sport, especially if it involves competitive sports.
The athletic heart
Chronic involvement in sports brings about certain changes in the heart that are described as “athletic heart”. These changes include a decrease in heart rate, hypertrophy (thickening of the walls of the left ventricle and/or dilatation of the left ventricle).
With cessation of sport the changes subside, but not in everyone. It is therefore important to have a pre-sports check at the start of activities and to repeat it at regular intervals. It has been suggested every other year and more frequently in younger athletes for early recognition of the progression of certain heart conditions.
Pre-sport control protocol
1. Careful clinical examination: Taking blood pressure, palpation of peripheral vessels, careful listening (in supine and sitting position)
2. Resting electrocardiogram: This helps to detect athletes with cardiomyopathy or channelopathy who are asymptomatic
3. Family history taking: heart disease or sudden death in a family member (age 55 for a man or 65 for a woman)
4. Personal history: syncopal episodes, arrhythmias, pain and discomfort during or after exercise, use of anabolic drugs, ‘supplements’ of unknown composition or prohibited substances
Causes of sudden cardiac death in athletes
- Hypertrophic cardiomyopathy
- Congenital anomalies of the coronary vessels
- Myocarditis
- Dilated cardiomyopathy
- Marfan syndrome
- Arrhythmogenic right ventricular cardiomyopathy
- Preexcitation syndrome-canal diseases
- Valvular disease (aortic stenosis, mitral regurgitation)
In older athletes, coronary heart disease is the most common cause of sudden cardiac death during exercise.
Unfortunately, one in three cases of sudden death cannot be detected by medical monitoring of athletes’ health, even when this includes electrocardiographic monitoring.
Special diagnostic test for “pathological findings”:
In the event that “pathological” findings are found from the basic cardiological examination, the athletes should undergo:
- Echocardiographic examination
- Fatigue test – Holter rhythm
- Tilt test
In some cases, blood tests are required, such as:
- Coronography
- Coliography
- Myocardial biopsy
- Electrophysiological study
In conclusion, the cardiological control of athletes is deemed necessary, as it contributes to the prevention of unpleasant complications of exercise and to the reduction of sudden cardiac death. Its aim is not to exclude the athlete from exercise but to provide advice on the characters of the exercise so that it is appropriate, beneficial and safe.