Boulder is considered one of the fittest communities in the nation. We
have an impressive number of professional athletes from all fields and
a multitude of recreational athletes, many who train and compete at an
But demanding workouts can trigger physiologic changes in the heart that
can intensify an undetected heart problem. Without diagnosis and treatment,
certain heart problems can be life threatening.
During a free health lecture held in Boulder, Drs.
Samuel Aznaurov and
Molly Ware, experts in treating all types of cardiovascular disease, provided an
overview of how exercise can spark changes to the heart and heart-related
problems that commonly impact athletes.
Changes to the Heart in Trained Athletes
Dr. Ware spoke about how athletes’ demanding workouts can trigger
physiological changes to the heart, known as athlete’s heart, whereby
the heart grows in size and has slightly thicker muscle walls.
These changes arise from an increase in heart rate and stroke volume (the
amount of blood ejected from the heart with each heartbeat) during high-endurance
activity. The heart adapts to the intense exercise so it can pump more
blood per stroke. For the average individual, stroke volume can grow from
5 to 6 liters a minute at rest to 16 to 20 liters a minute during exercise.
By comparison, stroke volume can increase up to 35 liters in well-trained athletes.
Exercise and Heart Problem Risk
Drs. Ware and Aznaurov then discussed potential exercise-related heart
Coronary Artery Disease (CAD) - Regular exercise helps strengthen the heart and lowers the long-term
potential for cardiovascular problems. However, sudden strenuous exertion
among usually sedentary people with atherosclerotic CAD (artery-clogging
plaque buildup) can increase the immediate risk for heart attack. This
is especially true for those already at higher-than-normal risk either
because of age, genetic factors, high blood pressure and lifestyle.
The majority of sedentary individuals who experience a heart attack during
vigorous exercise are 45 to 55 years old. However, the likelihood of this
occurring can decrease with regular physical activity.
Masters endurance athletes are not immune to CAD. In fact, research shows
that, compared to sedentary men, high-intensity male athletes have a higher
level of plaque buildup in their arteries. Researchers think that different
pathophysiological mechanisms cause more abundant plaque in male athletes.
Hypertrophic cardiomyopathy (HCM) - HCM is a genetic disease that causes the heart muscle to become abnormally
thick and stiffen, making it harder for the heart to pump blood. It often
goes undiagnosed because people with the condition may have no symptoms.
However, the thickened heart muscle can lead to life-threatening complications,
Sudden cardiac arrest. People with HCM have an increased risk of sudden cardiac arrest. Although
deaths from sudden cardiac arrest are rare, HCM is thought to prompt 30
to 40 percent of such deaths in young athletes.
Abnormal heartbeat (arrhythmia). The thickened heart muscle can disrupt the normal functioning of the heart’s
electrical system, causing an irregular heartbeat called atrial fibrillation (AFib).
Outflow tract obstruction. Thickened heart muscle from HCM can many times obstruct the blood flow
leaving the heart, leading to shortness of breath with exertion, chest
pain, dizziness and fainting spells.
Arrhythmogenic (right) ventricular cardiomyopathy (ARVC) – A genetic condition, ARVC is a problem with the proteins that bind
the heart's muscle cells together. This results in accelerated “wear
and tear” of the muscle, causing the heart’s ventricles (lower
pumping chambers) to become thin. ARVC can affect the electrical activity
of the heart, leading to dangerous arrhythmias. About 20 percent of sudden
death in young athletes result from ARVC.
Other concerning heart problems in athletes include:
- Heart valve problems, which can lead to heart failure.
- Aortic problems, which are usually caused by high blood pressure or genetic
syndromes and can lead to dissection or rupture of the aorta.
Detecting — or Ruling Out — Heart Disease in Athletes
If you’re an athlete and experience any of the following symptoms,
we encourage you to make an appointment with a
Boulder Heart cardiologist:
- Chest pain or pressure
- Unusual shortness of breath
- Unusual heart racing/skipping
- Unexplained decline in exercise tolerance
Boulder Heart uses the latest heart technologies to diagnose potential
heart problems in athletes such as an ECG, imaging workups, stress testing
and echocardiogram. They can also evaluate whether your symptoms are related
to physical activity or something more serious.
To make an appointment with a
Boulder Heart cardiologist, call 303-442-2395.
PowerPoint slides from the lecture on “Recognizing and Treating Heart Problems in