Sports cardiology: heart conditions in athletes

Leading consultant cardiologist Dr Anita Arya takes an in-depth look at sports cardiology, more specifically cardiac evaluation of athletes. This includes potential conditions that may be identified during pre-participation screenings, how patients can participate in sport safely, or if they’ve experienced a cardiac event and what processes are involved in ensuring safe return to activities.

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

When we screen athletes for cardiac conditions, the types of conditions that we’re looking for are conditions that can be identified by the health questionnaire or ECG.
For some professional teams, they also use echocardiography:

• important cardiac conditions such as cardiomyopathy
• congenital heart disease
• electrical abnormalities of the ECG may be detected

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

We know that sport and exercise to a moderate degree is healthy for the heart and cardiovascular system in general.
 

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.

High levels of exercise such as at an elite level can result in cardiovascular changes known as Athlete's Heart. If these changes become more marked they can overlap with pathology and it is thought that particular athletes may have a genetic predisposition.

Extreme or high levels of exercise can have detrimental effects on the heart and a number of different body systems. In some cases it can lead to increased risk of arrhythmias such as atrial fibrillation, an irregular heart rhythm.

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

The prospect of returning to sport after a cardiac event like a heart attack, varies depending on the type of event and it's severity, 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. Once the evaluation is satisfactory, there’s a phased return to play with the combined help of the athlete’s team and coaches.

What are the ethical considerations in using performance-enhancing drugs?

Using performance-enhancing drugs poses significant ethical issues, alongside the most clear issue of probity, they can cause serious health and cardiovascular risks, such as hypertension, arrhythmias, and sudden cardiac death.

Athletes may not fully understand these dangers. Additionally, the pressure to succeed can lead to decisions that prioritise short-term gains over long-term health.

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