Cardiac Adaptations and Cardiovascular Risks in Athletes

Physiological Responses and Adaptation to Exercise

Exercising muscles require a significant increase in oxygen delivery. As an adaptive response to aerobic exercise, the left ventricle mass and volume increase.

Signs and Symptoms of Cardiac Distress

• Chest Pain: Angina
• Dyspnea: Shortness of breath
• Fatigue: Unusual exhaustion
• Palpitations: Irregular heartbeats
• Syncope: Fainting
• Claudication: Limping
• Dermatological Indicators: Changes in skin and nail temperature, color, or appearance
• Edema: Swelling

Minimum Components for Preparticipation Physicals

Screening should include a review of family history regarding premature death of a relative younger than 50 years diagnosed with heart disease. Clinical indicators include:

• Heart murmur
• Hypertension
• Unusual fatigue
• Exertional syncope
• Excessive exertional dyspnea
• Exertional chest pain

Physical Examination Protocols

• Resting heart rate and blood pressure measurement
• Auscultation of the heart in supine and standing positions
• Assessment of femoral pulses
• Observation for signs of Marfan Syndrome

Hypertrophic Cardiomyopathy

While rare, this is a leading cause of sudden cardiac death (SCD) in young athletes, often presenting with no prior symptoms. Risk factors include a family history of SCD under 50 or a history of syncope, angina, or dyspnea.

Management and Intervention

• Treatment: Medications (beta-blockers), activity restriction, and occasionally surgery.
• Return to Play (RTP): Limited to low-intensity sports.
• Intervention: Informing athletes and parents of the risks associated with sports participation.

Coronary Artery Anomalies

Occurs when the left main coronary artery is abnormally positioned between the aortic and pulmonary trunks. Malpositioning and acute angles can lead to impingement. Participation in sports is generally contraindicated.

Coronary Artery Disease (CAD)

A condition involving the narrowing or blockage of coronary arteries.

Valvular Dysfunctions

• Mitral Valve Prolapse: Common (5%); rarely associated with SCD in sports.
• Aortic Valve Stenosis: A progressive narrowing of the valve resulting in an audible murmur.

Ruptured Aortic Aneurysm and Marfan Syndrome

Marfan Syndrome is characterized by an ectomorphic build, ocular dysfunction, long appendages, thoracic excavatum, and kyphoscoliosis. Athletes are typically restricted to static or low-dynamic sports.

Dysrhythmia

Common conditions include:

• Wolff-Parkinson-White Syndrome
• Long QT Syndrome
• Atrial Fibrillation

Myocardial Ischemia

Occurs when the oxygen demand of the myocardium exceeds the supply delivered by the coronary arteries. This causes angina, fatigue, dyspnea, dizziness, and syncope.