Athletic heart syndrome
Syncope on exertion. Transthoracic echocardiogram reported enlarged right cardiac chambers. No personal or family history of cardiovascular disease. Intense workout, 2 hours per day, at least 5 days a week during the past 2 years. Heart rate: 45 BPM.
Loading Stack -
0 images remaining
Normal left ventricular wall motion and function, the end-diastolic volume is within the upper normal limits.
Right ventricle depicts mild dysfunction (45.3%), but the end diastolic and stroke volume is within the upper normal volume.
In the late gadolinium enhancement (LGE) images, a patchy inferoseptal enhancement is shown in the mid ventricle. This finding is common in right ventricle overload and also in athletic heart syndrome.
Left ventricular measurements:
- end diastolic diameter: 54 mm (normal, 36-56 mm)
- ejection fraction: 54.6 % (normal: male = 56-78%; female = 56-78%)
- stroke volume: 95.6 ml
- end diastolic volume: 175 mL (normal: male = 77-195 mL; female = 52-141 mL)
- indexed end diastolic volume: 94 mL/m2 (65-95 mL/m2 male)
- end systolic volume: 79.4 mL (normal: male = 19-72 mL; female = 13-51 mL)
- cardiac output: 4.3 L/min (normal: male = 2.82-8.82 L/min; female = 2.7-6.0 l/min)
Right ventricular measurements:
- end diastolic diameter: 50 mm (normal: male 25-46 mm; female 21-39)
- ejection fraction: 45.3 % (normal: male = 47-74%; female = 47-80%)
- stroke volume: 93 mL (normal: male = 52-138 mL; female = 35-98 mL)
- end diastolic volume: 205 mL (normal: male = 88-227 mL; female = 58-154 mL)
- indexed end diastolic volume: 110.2 mL/m2 (81-111 ml/m2)
- end systolic volume: 112 mL (normal: male = 23-105 mL; female = 12-68 mL)
- cardiac output: 4.18 L/min (normal: male = 2.8-8.82 L/min; female = 2.7-6.0 L/min)
Index values are normalized to body surface area (BSA) of 1.86 m2
Low heart rate, proportional enlargement of cardiac chambers, mild decrease in ejection fraction with preserved stroke volume are findings commonly seen in athletic heart syndrome. In some cases, a patchy LGE is seen in the inferoseptal and anteroseptal segments.
The athlete's heart syndrome refers to both heart enlargement and slow heart rate particularly seen in people exposed to high-performance and sustained exercise or sport (endurance sports, straight exercise, etc) that demands regular physical training program during any time of life.
It is induced by the changes the cardiovascular system has to make in order to be able to deliver the physical performance that is required. The heart tends to increase the size and strength of the ventricles (by hypertrophy and dilatation of the chambers) leading to a morphological big heart with conservated diastolic and systolic function; heart ejection fraction is sometimes mildly decreased.
The diagnosis is usually made by echocardiography which is the first line method in order to differentiate from others heart disease, but the gold standard is cardiac MR being superior to echocardiography with 80% sensitivity and 90% specificity of cine CMR 1.
- 1. Galderisi, Maurizio, Cardim, Nuno, D'Andrea, Antonello, Bruder, Oliver, Cosyns, Bernard, Davin, Laurent, Donal, Erwan, Edvardsen, Thor, Freitas, Antonio, Habib, Gilbert, Kitsiou, Anastasia, Plein, Sven, Petersen, Steffen E., Popescu, Bogdan A., Schroeder, Stephen, Burgstahler, Christof, Lancellotti, Patrizio, Sicari, Rosa, Muraru, Denisa, Lombardi, Massimo, Dulgheru, Raluca, Gerche, Andre La. The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging. (2015) European Heart Journal - Cardiovascular Imaging. 16 (4): 353. doi:10.1093/ehjci/jeu323 - Pubmed
- 2. Baggish, A. L. (2013). The Athlete’s Heart. (2018) International urogynecology journal. 27 (3): 289. doi:10.1007/978-1-4614-5203-4_15 - Pubmed
- 3. Chee, C.E., Anastassiades, C.P., Antonopoulos, A.G., Petsas, A.A., Anastassiades, L.C.. Cardiac hypertrophy and how it may break an athlete's heart – the Cypriot case. (2005) European Journal of Echocardiography. 6 (4): 301. doi:10.1016/j.euje.2004.11.009 - Pubmed
- 4. Ngongang Ouankou Christian, Tsambang Djeufack Wilfried Lionel, Eyoungou Lucien Roger, Azabji Kenfack Marcel, Mbouh Samuel, Wandji Ngamga Christiane Josée, Kuate-Mfeukeu Liliane, Mekoulou Jerson, Bitchou Marie Philomène, Tachim Ngatchouissi Kevin, Essono Naah Annabelle Clotilde, Chendjou Kapi Léana Oriane, Nganou Chris Nadege, Hamadou, Jonte Mbianda Klod Paturelle, Tikapa Joachim, Tchuisseu Larissa, Kenfack Monique, Ndongo Amougou Sylvie, Boombi Jérôme, Kaze Folefack François Jérôme, Ouankou Mérimée Débozard, Kingue Samuel, Ngu Blackett Kathleen, Mandengue Honoré Samuel. Athlete’s Heart Syndrome Variability with Respect to Sporting Disciplines in Elite Cameroonian Athletes. (2018) International Journal of Internal Medicine. 7 (1): 8.
- 5. Fagard R. Athlete's heart. (2003) Heart (British Cardiac Society). 89 (12): 1455-61. Pubmed
- 6. Kaşıkçıoğlu E. The incognita of the known: the athlete's heart syndrome. (2011) Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology. 11 (4): 351-9. doi:10.5152/akd.2011.101 - Pubmed
- 7. De Castro S, Pelliccia A, Caselli S, Di Angelantonio E, Papetti F, Cavarretta E, Carbone I, Francone M, Passariello R, Pandian NG, Fedele F. Remodelling of the left ventricle in athlete's heart: a three dimensional echocardiographic and magnetic resonance imaging study. (2006) Heart (British Cardiac Society). 92 (7): 975-6. doi:10.1136/hrt.2005.069401 - Pubmed
- 8. Samad, Fatima, Harland, Daniel R., Girzadas, Mark, Jan, M. Fuad, Tajik, A. Jamil. Athlete’s heart vs. apical hypertrophic cardiomyopathy: look again!. (2017) European Heart Journal - Cardiovascular Imaging. 18 (3): 381. doi:10.1093/ehjci/jew312 - Pubmed
- 9. Scharhag J, Schneider G, Urhausen A, Rochette V, Kramann B, Kindermann W. Athlete's heart: right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. (2002) Journal of the American College of Cardiology. 40 (10): 1856-63. Pubmed
- 10. Huston TP, Puffer JC, Rodney WM. The athletic heart syndrome. (1985) The New England journal of medicine. 313 (1): 24-32. doi:10.1056/NEJM198507043130106 - Pubmed