Athlete's Heart and Cardiovascular Care of the Athlete

Abstract

“The physiologic capabilities of the heart are enormous, and in judging the effect of any undue exertion on it, we must not regard the murmurs of the irregularity alone, but must also consider carefully, the way in which the heart is doing its work, its strength, as shown by its ability to maintain proper arterial tension, and its recuperative power. As with other muscles, not size but quality tells in the long run.”1 Eugene Darling The heart of the athlete has intrigued clinicians and scientists for more than a century. Early investigations in the late 1800s and early 1900s documented cardiac enlargement and bradyarrhythmias in individuals with above-normal exercise capacity and no attendant signs of cardiovascular disease. Since that time, scientific understanding of the association between sport participation and specific cardiac abnormalities has paralleled advances in cardiovascular diagnostic techniques. It is now well established that repetitive participation in vigorous physical exercise results in significant changes in myocardial structure and function. Recent increases in the popularity of recreational exercise and competitive athletics have led to a growing number of individuals exhibiting this phenomenon. This review provides an up-to-date summary of the science of cardiac remodeling in athletes and an overview of common clinical issues that are encountered in the cardiovascular care of the athlete.Initial reports describing cardiac enlargement in athletes date back to the late 1890s. In Europe, the Swedish clinician Henschen2 used the rudimentary yet elegant physical examination skills of auscultation and percussion to demonstrate increased cardiac dimensions in elite Nordic skiers. Similar observations were made during the same year by Eugene Darling1 of Harvard University in university rowers. In the early 1900s, Paul Dudley White3 studied radial pulse rate and pattern among Boston Marathon competitors, and was the first to report marked resting sinus …