Sports cardiology: Heart conditions in athletes
Written by:
Published: 30/04/2024
Edited by: Karolyn Judge
Leading consultant cardiologist Dr Anita Arya takes an in-depth look at sports cardiology, more specifically heart conditions in athletes. This includes common ones 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 they can 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 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; detecting 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. They provide more detail about the pumping action, the valves and congenital abnormalities of the heart.
Does participating in endurance sports like marathons strengthen the heart or can it lead to long-term health risks?
We know that sport, done to a moderate degree, is healthy for the heart and cardiovascular system in general. Furthermore, 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.
Regarding exercise at 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. It’s thought that in these particular athletes, they may have a genetic predisposition.
It's also important to consider that 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. Once the evaluation is satisfactory, 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?
Using performance-enhancing drugs poses significant ethical issues, including serious cardiovascular risks such as:
hypertension; arrhythmias and; sudden cardiac death.Athletes may not fully understand these dangers, compromising informed consent. 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.