Guide: Athletic Heart Syndrome

Athletes are at the top of the fitness game, training religiously daily to maintain shape. You will be appalled to know that certain adaptations and changes can occur in the hearts of individuals who engage in regular, intense physical activity.

An athletic heart syndrome is a structural and functional change in people who train for prolonged durations ( > 1 hour on most days of the week) and frequently at high intensities. Intensive, prolonged endurance and strength training cause many physiologic changes in the heart.

The changes are often asymptomatic and may look like changes similar to cardiomyopathy. It's therefore crucial to be aware of the signs and symptoms to rule out potential threats.

The below article will navigate through the causes, symptoms, diagnosis, treatment, recovery and prevention of this condition. Read on!

What is Athletic Heart Syndrome?

• Athletic heart syndrome is the changes in the heart resulting from regular, intense physical training. As a result, the volume and pressure loads in the left ventricle (LV) increase, which, over time, causes an increase in LV muscle mass, wall thickness, and chamber size.
• Athlete’s heart affects 2% of athletes and is more common in athletes who are Black than in people of other races.
• It is considered a natural phenomenon in athletes, but left ventricle hypertrophy in athletes frequently resembles pathological conditions (hypertension or hypertrophic cardiomyopathy) and differential diagnosis is essential in active athletes as pathological left ventricle hypertrophy is a risk factor for disease and death in mature age.

What are the causes of Athletic heart syndrome?

When it comes to defining an athlete, the first thing that comes to your mind is Intense endurance or strength training. But do you know, due to this, changes happen even inside the body? One such change is athletic heart syndrome.

The causes include:

• Endurance sports tend to increase the size and wall thickness of an athlete’s left ventricle.
• Typically, athletes who participate in sports like rowing, swimming, cross-country skiing, cycling etc. can get athletic heart syndrome.
• Athletes experience an increased stroke volume, which is the amount of blood ejected from the heart with each contraction due to strenuous exercise.
• It also allows the heart to pump more blood with each beat and causes a lower resting heart rate, known as bradycardia.
• The body needs more blood and oxygen while exercising, and the left ventricle gets bigger and develops thicker heart muscle.
• When not working out, the heart doesn’t pump much blood. Therefore, the athlete heart rate is lower than the heart rate at rest compared to a non-athletic heart rate.

What are the symptoms of Athletic Heart Syndrome?

There are no actual symptoms of athletic heart syndrome.

However, according to the Merck Manual, a few signs may occur in the athletic heart that the healthcare provider can recognise:

• Bradycardia: Bradycardia is a condition where the heart beats more slowly than expected, under 60 beats per minute. It happens without causing any harmful effects, especially in physically active people.
• An LV impulse that is laterally displaced, enlarged and increased in amplitude.
• Extra heartbeat sounds that aren’t normally there, like a systolic ejection (flow) murmur at the left lower sternal border, 3rd heart sound (S3) due to early, rapid diastolic ventricular filling, 4th heart sound (S4), are heard best during resting bradycardia because diastolic filling time is increased.
• Hyperdynamic carotid pulses.
• Shortness of breath, fatigue, dizziness or fainting during or after exercise, fluid retention or swelling in the legs and ankles are other signs to be watched out for.

If an athlete experiences persistent symptoms, seeking prompt medical attention for a thorough evaluation and appropriate diagnosis is essential.

How is Athletic Heart Syndrome Diagnosed?

Diagnosing Athletic Heart Syndrome involves a combination of medical history assessment, physical examination, and specific cardiac tests.

Clinical evaluation:

• A healthcare provider will take detailed notes on the exercise routine, training intensity, and any symptoms experienced during or after physical activity.
• To assess the overall health, blood pressure, heart rate, and signs of potential cardiac abnormalities are checked for.

Electrocardiogram (ECG):

• An ECG is a non-invasive test that records the electrical activity of the heart.
• It checks for abnormal heart rhythms (arrhythmias) and can provide information about the heart's structure and function.
• Unusual results happen while at rest but not during exercise in people with athlete’s heart.

Echocardiogram:

• An echocardiogram is an imaging test that uses sound waves to create detailed images of the heart's structure and function.
• An echo checks the size of the heart chambers, the thickness of the heart muscle, and the function of the heart valves.
• However, third-degree AV block is abnormal and should be investigated thoroughly.

Cardiac magnetic resonance (CMR) imaging

• It is done for a comprehensive analysis of heart structure, function and diseases.
• CMR may also help differentiate an athlete's heart from cardiomyopathy.
• It is not usually done for this, but in rare cases where detailed images of the heart and surrounding structures are required.

Exercise Stress Test

• This test involves monitoring the heart's response to physical activity, typically on a treadmill or stationary bike.
• During this, the athlete heart rate during exercise remains lower than normal at submaximal stress and increases appropriately and comparably to the heart rate in nonathletes at maximal stress; it rapidly recovers after exercise.

What are the treatments for Athletic Heart Syndrome?

• Athletic Heart Syndrome generally doesn't require specific treatment, as the physiological adaptations observed in athletes' hearts are considered normal responses to regular, intense physical training.
• No treatment is required, although 3 months of deconditioning may be needed to monitor LV regression as a way of distinguishing this syndrome from cardiomyopathy.
• That is three months without training, and then the heart will be reimaged to rule out cardiomyopathy.
• In most people, the heart returns to its original size after stopping training hard.
• Athletes should be vigilant in monitoring for unusual symptoms, such as chest pain, irregular heartbeats, excessive fatigue, or shortness of breath.
• Also, overtraining can lead to increased stress on the cardiovascular system, so taper individualistic fitness goals.
• Prioritize regular medical check-ups, proper hydration and nutrition and adequate rest and recovery for better cardiovascular health.

How to recover from Athletic heart syndrome?

Recovery from Athletic Heart Syndrome is not about reversing the physiological adaptations that occur in response to regular, intense physical training. In most cases, structural changes and bradycardia regress with detraining, but up to 20% of elite athletes have residual chamber enlargement.

Heart health is critical in the case of athletes. Numerous studies have found an increased risk of developing atrial fibrillation with endurance and mixed sports. Athletes younger than 55 years are at higher risk. The athlete also has to maintain a healthy and active lifestyle to prolong his career, so to manage and maintain heart health, the following pointers may help:

• Always do routine assessments of cardiovascular function, blood pressure, and other vitals. Modern medical equipment and scientific advancement will help monitor athlete heart rate chart.
• Adjust the intensity, duration, and frequency of workouts to avoid overstraining the body.
• The cumulative fatigue and stress can be hard on the cardiovascular system. Rest and recovery are inevitable for good heart health.
• A well-balanced diet and hydration are crucial, heart-healthy foods can benefit heart health and lower the risk of heart disease.
• Lifestyle modifications like regulating the sleep cycle, avoiding binge drinking and smoking, practising meditation etc. will support recovery and better cardiovascular health.

How to prevent Athletic Heart Syndrome?

Athletic heart syndrome is not a dangerous condition; it is a normal response of the heart to aerobic exercises one does. When the training is paused it can get reversed. Individuals engaging in athletic activities should however be careful to avoid overtraining and focus on overall health.

Below are some tips that may help to prevent it:

• Listen to your body! Not everyone can be the bodybuilder type. Introduce any new exercise form gradually so that the body can adapt. If the body signals fatigue and injury, focus on rest and recovery.
• Experienced trainers can guide you and create a long-term sustainable plan for fitness without overstraining your heart by including strength training, flexibility exercises, and cardiovascular workouts.
• Monitor your fluid intake and include a well-balanced diet in your routine by consulting a nutritionist.
• Include a cardiologist visit as a must in your itinerary.
• Stress is a silent killer. Implement stress management techniques to create an inner balance.
• Sleep cycle management is extremely important as a lot of recovery happens during sleep.

Conclusion

Athletic Heart Syndrome, also known as athlete's heart, is a term used to describe certain adaptations and changes that can occur in the hearts of individuals who engage in regular, intense physical activity. It causes an increase in the size of the left ventricle, a lower athlete resting heart rate than a non-athlete and a higher amount of blood pumped by the heart.

Persistent or severe chest pain, palpitations or arrhythmias severe shortness of breath, especially at rest, and excessive fatigue are both common in Hypertrophic Cardiomyopathy (HCM) and athlete’s heart. So, it is crucial to get it checked if you feel any of the above symptoms.

Regular check-ups, proper training balance, and listening to your body are the key components of maintaining heart health for athletes. Your body is your temple! Your inner and outer self deserve due care. Here’s to mindful and happy training.