Member Case Study: Athlete's Heart

author : AMSSM

comments : 0

Upon releasing me from the ER, the cardiologists said that I have an athlete's heart - enlarged chambers and thickening of the walls. Should I be concerned?

Member Question from mcbill98

Well, some background is needed. I passed out the other night at a professional baseball game for no apparent reason. I felt dizzy one second, and the next I was kissing the concrete. I broke three front teeth and needed eight stitches to close the wound on the inside of my lower lip. This has never happened to me before. The only other time I have fainted was donating blood. Well, after 21 hours in the ER with 2 EKG's, repeated blood work, chest x-ray, CAT scan of the head, cardiac enzyme test, and an echocardiogram, there was nothing to explain why I fainted.

I wore a holter monitor for 24 hours to record electronic heart activity and follow up with the cardiologists on Friday to find out the results. Upon releasing me from the ER, the cardiologists said that I have an athlete's heart - enlarged chambers and thickening of the walls (he also said that I have minor valve leakage but not enough to cause concern, apparently very common).

I am 5'7", 145 lbs, solid muscle, been an athlete my whole life, a runner for 13 years and a triathlete for 13 months (3 races to date). I feel that the fainting is a freak occurrence and most likely will never occur again. No cause has been found so far. I am holding off on training till I get clearance but the cardiologist did tell me that I can do anything that I did before. My next race is on 7/15.

Anyway, two questions:

1) Should I be concerned?
2) Can this cause fainting with no apparent reason?
 

Answer by Jeffrey Rosenberg, MD

Member AMSSM

The term ”athlete’s heart” denotes the normal physiologic changes in the heart that occurs in response to regular exercise and was first discovered in 1935. When we exercise, the heart needs to move more blood around the body to deliver oxygen to the muscles. The heart adapts to the increased blood flow through it by dilating (getting wider) so it can push more blood out of the chambers with each contraction.

If one performs static exercises (i.e. weight lifting), the walls will also thicken because the heart must push the blood against increased resistance. Other adaptations of the heart to exercise include slowing of the heart rate and short pauses in the electrical rhythm within the heart. With detraining, all of these adaptations reverse themselves: heart rate increases to normal, the electrical pauses disappear, and the heart wall thickness returns to normal. Because of this, detraining for eight to twelve weeks is often recommended to differentiate this normal enlargement of the heart from other more worrisome pathologic conditions.

Therefore, these adaptations of the heart to regular exercise are considered normal and should not be worrisome. Syncope (passing out) has a multitude of causes including cardiovascular, neurological, and emotional. Syncope often occurs because of decreased blood flow into the brain. The body’s response to this low blood flow is to cause us to fall down, thereby taking gravity away and improving blood flow into the brain.

If your baseline heart rate is too low, or you had a long pause in between heartbeats, the “athlete’s heart” could be the cause. A thorough history, physical exam, and blood work in the ER would have picked up many of the more common causes of syncope. Continued recording of the electrical activity of the heart should be performed to rule out other cardiovascular causes of passing out. Lastly, if you should pass out again, a tilt table test should be performed to evaluate the autonomic nervous system. In this test, the blood pressure and heart rate are regularly monitored as your body moves from horizontal to vertical and maintains a vertical position for 30 minutes.

Jeffrey Rosenberg, MD

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date: July 11, 2007