Sports cardiology: what to know
Sports cardiology is an emerging field of medicine that focuses on the heart’s activity during physical stimulation. In this article, Dr Anita Arya, a consultant cardiologist, explains the parameters of sports cardiology, and how it is used to prevent and detect heart conditions that can affect athletes and physically active people.
Sports cardiology is a subspecialty of cardiology, and it uses a series of tests and exams to evaluate heart health, determining if patients are fit to participate in activities, and diagnosing cardiovascular conditions that are triggered by physical activity.
Common tests of sports cardiology
Sports cardiologists rely on a range of diagnostic tests to assess heart function and structure. Two of the most common are the electrocardiogram (ECG), which records the electrical activity of the heart, and the echocardiogram, an ultrasonic scan that visualises the heart's structure and pumping action. These are often used as part of screening or when symptoms manifest.
For more detailed evaluation, particularly in cases of unexplained symptoms or abnormal findings, exercise stress testing is employed. This involves monitoring the heart while the individual exercises on a treadmill or bike. Sometimes, a cardiac MRI or a CT coronary angiogram may be required to rule out structural abnormalities or detect coronary artery disease. In certain situations, Holter monitoring, which records ECG continuously over 24 to 48 hours or longer, is useful to detect intermittent arrhythmias.
Cardiovascular risks and conditions for active individuals
Not all heart problems are caused by lifestyle factors—some are genetic or congenital. In young athletes, structural and electrical abnormalities such as hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, or long QT syndrome are of particular concern, as these conditions can increase the risk of sudden heart failure during exercise.
In older individuals, particularly those over the age of 35, coronary artery disease is more common and can be aggravated by intense physical activity. Symptoms that should raise concern include chest pain during exertion, unexplained fainting (especially during or after exercise), palpitations, or breathlessness.
A multidisciplinary approach to care
Sports cardiology involves the collaboration between cardiologists, electrophysiologists, general practitioners, sports physicians, physiotherapists, and exercise physiologists. This multidisciplinary approach ensures that both the cardiovascular health and overall athletic goals of the patient are addressed.
For example, a cardiologist may identify a rhythm abnormality, while a sports physician helps tailor training loads and a physiotherapist supports the patient through rehabilitation. Such collaboration is particularly important when managing competitive athletes or individuals returning to sport after a cardiac event.
Treatment and rehabilitation programmes
When a cardiovascular condition is diagnosed, treatment plans are highly individualised. For many, medication such as beta-blockers, anti-arrhythmia medications, or statins may be utilised in order to optimise blood flow to and from the heart. In some cases, surgical interventions or procedures like implantable cardioverter defibrillators (ICDs) or catheter ablation for arrhythmias may be necessary.
Rehabilitation plays a vital role, and cardiac rehabilitation programmes are designed to safely reintroduce patients to physical activity. These often combine supervised exercise sessions, education on heart health, and psychological support. The ultimate goal is not only to restore fitness but to empower individuals with the confidence to return to sport.
In some cases, patients may be advised to modify the type or intensity of activity, while in others, participation may continue with close monitoring. Patients should understand their condition, the potential risks, and the options available.