Athlete's heart

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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