Athlete's heart changes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Athlete’s heart is a term that refers to concentric and symmetric hypertrophy of the left ventricle that occurs in some athletes. It is important to distinguish Athlete’s heart, which is not a true cardiomyopathy from hypertrophic obstructive cardiomyopathy (HOCM), which is a true cardiomyopathy and places the athlete at risk of sudden death.

Traditional Criteria for Distinguishing Athlete’s Heart from HOCM

Several criteria can be used to distinguish these two entities:

The degree of left ventricular wall thickness

In athlete’s heart the LVH is symmetric and less than or = to 12 mm
Rarely the LV thickness can be 14-16 mm and this makes it difficult to distinguish from HOCM. Athletes who engage in strength training may develop this pattern, ahtletes who engage in endurance training do not.
If the degree of thickening is out of proportion to the type and intensity of exercise, this suggests HOCM

The pattern of left ventricular wall thickness

Athleste’s heart is symmetric
HOCM is more often asymmetric, but may in some cases be symmetric

The left ventricular cavity size

HOCM has smaller LV cavitary dimensions in general

Sophisticated Criteria and Testing to Distinguish Athlete’s Heart from HOCM

Doppler mitral valve inflow patterns are diagnostic of HOCM 9prolonged isovolumic relaxation time, reduced peak E velocity, prolonged deceleration time, increased peak A velocity, and decreased E/A ratio as compared to normal controls or athletes)
Tissue doppler echocardiography
Electrocardiogram: HOCM is favored if there are prominent q waves, large increases in voltages, and deep T wave inversions
The presence of an LV outflow tract gradient favors the diagnosis of HOCM
A speckled pattern on MRI favors the diagnosis of HOCM

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