Athletes running

The Emerging World of Sports Cardiology

Globally we hold our athletes in the highest regard. Every four years, we send our greatest athletes to represent our country in the Olympic Games. For many of us, the athlete is the epitome of physical health and fitness. However, just like any of us, athletes can suffer from heart disease.

For the young athlete, typically those individuals under age 35, these diseases are most commonly congenital conditions that cause abnormalities in the thickness of the heart muscle, the origins of the heart arteries, or changes in the electrical system of the heart that predispose them to arrhythmias. In the more mature individual, heart disease comes in the form of common disorders such as coronary artery disease, high blood pressure, and arrhythmias such as atrial fibrillation

I am always surprised that many accomplished endurance athletes have stories filled with lifestyle choices that include poor diets, toxic habits like smoking, and significant family history of heart disease. In fact, studies of marathon runners find that a disproportionate number are former smokers. In fact, these underlying predispositions are often the reason that many athletes turn to endurance training in their 40s and 50s. Unfortunately, many of the lifestyle choices we make in our 20s and 30s affect our heart risk throughout life.

Meeting the Sports Cardiologist:

There are usually three important questions that patients have when meeting a sports cardiologist.

Question 1: Who is considered an athlete?

An athlete can range from the individual interested in getting into exercise to the weekend warrior to the elite competitive athlete and of course to everyone in between. The most important part is that the athlete considers exercise and sports an important part of their lives.

Question 2: Why is the athlete’s heart unique?

The athlete’s heart is unique from a physiological and philosophical perspective. Over the past several years, we have used advanced imaging and laboratory testing to define many of the physiological changes that occur in the athlete’s cardiovascular system that may otherwise be considered “abnormal” in a non-athletic individual. These may include changes such as a slightly thickened heart muscle or a slow heart rate. A sports cardiologist can help you make the distinction between changes that are benign (“physiological”) versus those that are abnormal (“pathological”).

In addition, athletes, due to their high level of activity, may not display signs and symptoms of cardiovascular disease on traditional cardiovascular testing. In many cases, marathon runners with coronary artery disease may only show evidence of heart blockage if they are pushed during a stress test to the same level of exertion that they undergo during training. In sports cardiology, we always try to reproduce the activity level of the athletes we manage rather than sticking with routine testing that may not be appropriate.

Finally, it is always important to remember that athletes often have different goals than the traditional heart patient. For instance, some medications that we routinely use to treat heart blockages, arrhythmias, and heart failure in sedentary individuals may cause muscle aches and decreased exercise performance in the athlete.

Managing medications to protect the athlete from a cardiovascular perspective while maintaining their lifestyle is an important job of the sports cardiologist. In rare cases, restriction from sports may be necessary. It is important to see a sports cardiologist in these instances. While we may ultimately agree with the importance of sports restriction, sports cardiologist will not only look at the impact of restriction on your cardiovascular health but also on your quality of life and help you navigate these new challenges.

3. Who should see a sports cardiologist?

A sports cardiologist sees three primary types of athletes.

  1. The athlete with no known cardiovascular disease who develops cardiovascular symptoms or abnormal findings on routine testing.
  2. The athlete with known cardiovascular disease who wants to continue participating safely in sports and exercise.
  3. The future athlete who is interested in starting an exercise program and wants to make sure they are safe from a cardiovascular perspective. This often includes patients who have had a cardiovascular procedure and are interested in improving their cardiac risk through exercise.

Stepping up to the Starting Line:

Whether you are a weekend warrior or a high level competitive athlete, know that sports cardiologists are always available to help keep your heart safe while helping you maintain the active lifestyle that you enjoy. Step up to the starting line with confidence and keep running, swimming, cycling or dancing, towards a healthy heart. I look forward to seeing you out there hitting the pavement!

Jeffrey Lin

For more information on Dr. Jeffery Lin, please click HERE

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