Sports cardiology: Heart conditions in athletes

Leading consultant cardiologist Dr Anita Arya takes an in-depth look at sports cardiology, more specifically heart conditions in athletes including common ones identified during pre-participation screenings, how patients can participate in sport safely, or if they’ve experienced a cardiac event, what processes are involved in ensuring they can return to activities.

What are the most common heart conditions identified during pre-participation screenings for athletes?

To be honest, when we screen athletes for cardiac conditions the pick-up rate is actually very low but the types of conditions that we’re looking for are:

• conditions that affect the heart muscle, also known as cardiomyopathy;
• inherited conditions;
• abnormalities of the ECG, or;
• picking up symptoms in athletes that might require further evaluation.

How can a young athlete with a history of a heart murmur be evaluated for safe participation in competitive sports?

A young athlete that’s found to have a heart murmur, i.e. an extra sound on auscultation of the heart, would normally have an echocardiogram.

An echocardiogram is an ultrasound of the heart that would give us more detail about the pumping action of the heart, the valves and congenital abnormalities or the heart.

Does participating in endurance sports like marathons strengthen the heart or can it lead to long-term health risks?

That’s an interesting question. We know that sport to a moderate degree is healthy for the heart and cardiovascular system in general, and the European Cardiac Society guidance states that all individuals should aim to undertake 150 minutes of low intensity exercise per week or 90 minutes of high intensity exercise for optimum cardiovascular health.

When we exercise on an elite athletic level, sport can induce changes in the heart known as athletic changes and some athletes. These changes are more marked and can overlap with pathology and it’s thought that in these particular athletes, they may have a genetic predisposition.

As with everything, though, high amounts of exercise can have detrimental effects on a number of different body systems, not just the heart. In some cases it can lead to increased risk of arrhythmias such as atrial fibrillation, which is an irregular heart rhythm.

How can sports cardiologists advise athletes on returning to training after a cardiac event like a heart attack?

In terms of returning to sport after the cardiac event like a heart attack, it varies depending on the event and the severity of it, as well as the sporting activity involved.

The European and English cardiac societies produce guidance which essentially involves a thorough evaluation of the patient after a period of time convalescing. If the evaluation satisfactory then there’s a phase return to work with the combined help of the athlete’s team and coaches.

What are the ethical considerations in using performance-enhancing drugs that can put a strain on the heart?

The bottom-line is don’t use them. It’s cheating!

To arrange a comprehensive sports cardiology consultation with Dr Arya, arrange an appointment with her via her Top Doctors profile.