Member Case Study: Athlete Heart Attacks

author : AMSSM

comments : 0

Will sustained exercise at or near maximum heart rate increase the risk of heart damage, or heart failure. Is the cardiac muscle also subject to strain and damage as other muscles?

Member Question from vonschnapps
There are many reports of heart attacts after rigorous exercise. The after-the-fact answers sometimes point to an underlying heart condition, or just a guess about hydration, electrolyte imbalance, etc. Many of the athlete's who have died have been in top physical form and would have seen many of these same conditions in previous exercise encounters.

While cardiac muscle is different from other muscle, is it also subject to strain and damage as other muscle tissue? Will sustained exercise at or near maximum heart rate increase the risk of heart damage, or heart failure. Will repetitive exercise (training programs) that periodically require efforts at maximum heart rate, lead to a cumulative strain load on the heart that could eventually lead to heart failure?

Answer by Rachel Biber, MD

Member AMSSM

While athletes in endurance sports often suffer from overuse injuries such as stress fractures or tendonopathies, the healthy human heart does not "tear" like an overused muscle. High intensity training programs in which triathletes participate do not directly lead to a cumulative strain that causes heart failure in a healthy heart. If an athlete dies from sudden cardiac death (SCD) during training, it is likely that an innate unhealthy component of the heart is already present.

Many seemingly fit endurance athletes have significant risk factors for heart disease (family history, hyperlipidemia, etc) which can predispose one to an unhealthy heart, but these are often overlooked because they are so fit. There are also patients with undiscovered structural disease or arrhythmia syndromes that may lead to SCD during exercise.

For middle aged athletes, exercise decreases the overall risk of acute coronary events (possibly leading to death), but those who remain at risk are more likely to experience events during exercise. For the younger adult, competitive athletes are at increased risk as compared to non-athletes for SCD when structural heart disease and arrhythmia syndromes exist. In other words, if SCD does occur, it is likely due to an unhealthy component of the heart already present. However, when screened for these conditions (and appropriate treatment or exclusion of those with abnormalities), the risk can be reduced to below the general population. This highlights the importance of consultation with a physician prior to participating in training for athletes, especially activities that involves rigorous training.

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date: November 4, 2007