Is It Just Athlete’s Heart or Something Serious?

How sports cardiology can tell the difference

Athlete's Heart

Every year, about 100 U.S. athletes die from sudden cardiac death. Each tragedy reminds us how important it is to identify heart problems early.

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But diagnosing potentially lethal heart diseases in athletes isn’t so simple. An enlarged heart, detected by cardiac imaging tests, could be a life-threatening medical issue, or, it could be the normal physiological effect of intense athletic training, known as “athlete’s heart.”

Sometimes it takes a sports cardiology expert to tell the difference.

How to know if it’s heart disease

Detecting (or ruling out) heart disease in a serious athlete requires a(n):

  • Combination of tests, such as an ECG, MRI or an echocardiogram. “We are cautious in interpreting test results,” says Dermot Phelan, MD, PhD, Director of Cleveland Clinic’s Sports Cardiology Center. “Most positive findings in athletes with no heart disease symptoms are false positives. That’s why we rarely rely on a single test. We will often design individualized stress tests that are specific to the athlete and the sport.”
  • Understanding of a sport’s demands and training techniques. “Sports-related changes to the heart are often particular to age, race, sex and type of sport,” says Dr. Phelan. “All can have different ranges of ‘normal.’”

When there are symptoms

If athletes have heart disease symptoms, such as fainting, breathlessness or chest pain, sports cardiologists will evaluate whether these symptoms are benign symptoms related to the sport or something more serious.

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“A careful history will often tell us whether we should worry,” says Dr. Phelan. “Occasionally advanced testing is required.” The prevalence of heart disease in athletes is very low, he notes.

Quitting a sport is rarely necessary

When heart disease is diagnosed, it doesn’t necessarily mean the end of an athletic career.

“Detraining or quitting the sport is rarely necessary,” says Dr. Phelan. “Even athletes with a defibrillator can sometimes return to play. Sports cardiologists can discuss the pros and cons with the athlete and make a decision together.”

Many athletes are better off exercising in some capacity, even those that have heart disease or have had heart surgery, he says. That’s when a cardiac exercise physiologist, like Cleveland Clinic’s Gordon Blackburn, PhD, should design an individualized exercise program. He prescribes workouts that are safe for the athlete and effective for the sport.

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“Our goal is to protect the heart, whether the patient is cleared to return to competition and training or directed toward noncompetitive activities,” Dr. Blackburn says.

It often takes an experienced sports cardiology team to help identify who should or shouldn’t continue training. An athlete’s future — and sometimes life — can depend on the right decision.


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