Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2024, 33(4):226-239

Cardiological problems during physical exertion

Martin Studenčan, Marta Jakubová, Daniel Pella
II. Kardiologická klinika UPJŠ LF a VÚSCH, a. s., Centrum preventívnej a športovej kardiológie, Košice, Slovenská republika

The physical load in the training process of some athletes goes up to the limit of health suitability. Cardiac causes are the most common cause of sudden death in athletes, while ordinary health examination cannot detect several hidden cardiac diseases. The authors present an overview of the most common cardiology diseases that can be detected during a comprehensive in-depth preventive cardiology examination if the most modern available examination technologies are used. For individual diseases, the relationship and risk of higher physical load is described.

Keywords: heart disease and physical effort; cardiological problems of sportsmen; diagnostics of heart diseases

Published: April 1, 2024  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Studenčan M, Jakubová M, Pella D. Cardiological problems during physical exertion. Cardiology Letters. 2024;33(4):226-239.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Harmon KG, Drezner JA, Wilson MG, Sharma S. Incidence of sudden cardiac death in athletes: a state-of-the-art review. Heart. 2014;100:1227-1234. doi: 10.1136/heartjnl-2014-093872.rep. PubMed PMID: 25049314. Go to original source...
    2. Finocchiaro G, Papadakis M, Robertus JL, Dhutia H, Steriotis AK, Tome M, et al. Etiology of Sudden Death in Sports: Insights From a United Kingdom Regional Registry. J Am Coll Cardiol. 2016;67:2108-2115. doi: 10.1016/j.jacc.2016.02.062. PubMed PMID: 27151341. Go to original source...
    3. McKinney J, Velghe J, Fee J, Isserow S, Drezner JA. Defining Athletes and Exercisers. Am J Cardiol. 2019;123:532-535. Epub 20181106. doi: 10.1016/j.amjcard.2018.11.001. PubMed PMID: 30503799. Go to original source...
    4. Pelliccia A, Sharma S, Gati S, Back M, Borjesson M, Caselli S, et al. 2020 ESC Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease. Rev Esp Cardiol (Engl Ed). 2021;74(6):545. doi: 10.1016/j.rec.2021.05.003. PubMed PMID: 34020769. Go to original source...
    5. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Rev Esp Cardiol (Engl Ed). 2016;69:939. doi: 10.1016/j.rec.2016.09.009. PubMed PMID: 27692125. Go to original source...
    6. Vanhees L, De Sutter J, Gelada SN, Doyle F, Prescott E, Cornelissen V, et al. Importance of characteristics and modalities of physical activity and exercise in defining the benefits to cardiovascular health within the general population: recommendations from the EACPR (Part I). Eur J Prev Cardiol. 2012;19:670-686. doi: 10.1177/2047487312437059. PubMed PMID: 22637742. Go to original source...
    7. Vanhees L, Geladas N, Hansen D, Kouidi E, Niebauer J, Reiner Z, et al. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR. Part II. Eur J Prev Cardiol. 2012;19:1005-1033. doi: 10.1177/1741826711430926. PubMed PMID: 22637741. Go to original source...
    8. Lisman PJ, de la Motte SJ, Gribbin TC, Jaffin DP, Murphy K, Deuster PA. A Systematic Review of the Association Between Physical Fitness and Musculoskeletal Injury Risk: Part 1-Cardiorespiratory Endurance. J Strength Cond Res. 2017;31:1744-1757. doi Go to original source...
    9. 1519/JSC.0000000000001855. PubMed PMID: 28538328. 9. Caselli S, Serdoz A, Mango F, Lemme E, Vaquer Segui A, Milan A, et al. High blood pressure response to exercise predicts future development of hypertension in young athletes. Eur Heart J. 2019;40:62-68. doi: 10.1093/eurheartj/ehy810. PubMed PMID: 30590485. Go to original source...
    10. Sluik D, Buijsse B, Muckelbauer R, Kaaks R, Teucher B, Johnsen NF, et al. Physical Activity and Mortality in Individuals With Diabetes Mellitus: A Prospective Study and Meta-analysis. Arch Intern Med. 2012;172:1285-1295. doi: 10.1001/archinternmed.2012.3130. PubMed PMID: 22868663. Go to original source...
    11. Gill TM, Pahor M, Guralnik JM, McDermott MM, King AC, Buford TW, et al. Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study). BMJ. 2016;352:i245. Epub 20160203. doi: 10.1136/bmj.i245. PubMed PMID: 26842425; PubMed Central PMCID: PMCPMC4772786. Go to original source...
    12. Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med. 2000;343:1355-1361. doi: 10.1056/NEJM200011093431902. PubMed PMID: 11070099. Go to original source...
    13. Taylor RS, Walker S, Smart NA, Piepoli MF, Warren FC, Ciani O, et al. Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant MetaAnalysis. J Am Coll Cardiol. 2019;73:1430-1443. doi: 10.1016/j.jacc.2018.12.072. PubMed PMID: 30922474; PubMed Central PMCID: PMCPMC8351793. Go to original source...
    14. Giuliano C, Karahalios A, Neil C, Allen J, Levinger I. The effects of resistance training on muscle strength, quality of life and aerobic capacity in patients with chronic heart failure - A meta-analysis. Int J Cardiol. 2017;227:413-423. Epub 20161107. doi: 10.1016/j.ijcard.2016.11.023. PubMed PMID: 27843045. Go to original source...
    15. Michelena HI, Khanna AD, Mahoney D, Margaryan E, Topilsky Y, Suri RM, et al. Incidence of aortic complications in patients with bicuspid aortic valves. JAMA. 2011;306:1104-1112. doi: 10.1001/jama.2011.1286. PubMed PMID: 21917581. Go to original source...
    16. Caselli S, Mango F, Clark J, Pandian NG, Corrado D, Autore C, et al. Prevalence and Clinical Outcome of Athletes With Mitral Valve Prolapse. Circulation. 2018;137:2080-2082. doi: 10.1161/CIRCULATIONAHA.117.033395. PubMed PMID: 29735594. Go to original source...
    17. Ermakov S, Gulhar R, Lim L, Bibby D, Fang Q, Nah G, et al. Left ventricular mechanical dispersion predicts arrhythmic risk in mitral valve prolapse. Heart. 2019;105:1063-1069. Epub 20190212. doi: 10.1136/heartjnl-2018-314269. PubMed PMID: 30755467; PubMed Central PMCID: PMCPMC6658737. Go to original source...
    18. Boraita A, Heras ME, Morales F, Marina-Breysse M, Canda A, Rabadan M, et al. Reference Values of Aortic Root in Male and Female White Elite Athletes According to Sport. Circ Cardiovasc Imaging. 2016;9. doi: 10.1161/CIRCIMAGING.116.005292. PubMed PMID: 27729365. Go to original source...
    19. Gati S, Malhotra A, Sedgwick C, Papamichael N, Dhutia H, Sharma R, et al. Prevalence and progression of aortic root dilatation in highly trained young athletes. Heart. 2019;105:920-925. Epub 20190325. doi: 10.1136/heartjnl-2018-314288. PubMed PMID: 30910821. Go to original source...
    20. Itagaki R, Kimura N, Itoh S, Yamaguchi A, Adachi H. Acute type a aortic dissection associated with a sporting activity. Surg Today. 2017;47:1163-1171. Epub 20170228. doi: 10.1007/s00595-017-1492-z. PubMed PMID: 28247104. Go to original source...
    21. Harmon KG, Asif IM, Maleszewski JJ, Owens DS, Prutkin JM, Salerno JC, et al. Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review. Circulation. 2015;132:10-19. Epub 20150514. doi: 10.1161/CIRCULATIONAHA.115.015431. PubMed PMID: 25977310; PubMed Central PMCID: PMCPMC4496313. Go to original source...
    22. Kebed KY, Bos JM, Anavekar NS, Mulvagh SL, Ackerman MJ, Ommen SR. Hypertrophic Cardiomyopathy, Athlete's Heart, or Both: A Case of Hypertrophic Cardiomyopathy Regression. Circ Cardiovasc Imaging. 2015;8:e003312. doi: 10.1161/CIRCIMAGING.115.003312. PubMed PMID: 26162782. Go to original source...
    23. Dejgaard LA, Haland TF, Lie OH, Ribe M, Bjune T, Leren IS, et al. Vigorous exercise in patients with hypertrophic cardiomyopathy. Int J Cardiol. 2018;250:157-163. doi: 10.1016/j.ijcard.2017.07.015. PubMed PMID: 29169752. Go to original source...
    24. Lampert R, Olshansky B, Heidbuchel H, Lawless C, Saarel E, Ackerman M, et al. Safety of Sports for Athletes With Implantable Cardioverter-Defibrillators: Long-Term Results of a Prospective Multinational Registry. Circulation. 2017;135:2310-2312. doi: 10.1161/CIRCULATIONAHA.117.027828. PubMed PMID: 28584032. Go to original source...
    25. Pelliccia A, Solberg EE, Papadakis M, Adami PE, Biffi A, Caselli S, et al. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J. 2019;40:19-33. doi: 10.1093/eurheartj/ehy730. PubMed PMID: 30561613. Go to original source...
    26. Calkins H, Corrado D, Marcus F. Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy. Circulation. 2017;136:2068-2082. doi: 10.1161/CIRCULATIONAHA.117.030792. PubMed PMID: 29158215; PubMed Central PMCID: PMCPMC5777304. Go to original source...
    27. Rigato I, Bauce B, Rampazzo A, Zorzi A, Pilichou K, Mazzotti E, et al. Compound and digenic heterozygosity predicts lifetime arrhythmic outcome and sudden cardiac death in desmosomal gene-related arrhythmogenic right ventricular cardiomyopathy. Circ Cardiovasc Genet. 2013;6:533-542. Epub 20130926. doi: 10.1161/CIRCGENETICS.113.000288. PubMed PMID: 24070718. Go to original source...
    28. Zemrak F, Ahlman MA, Captur G, Mohiddin SA, Kawel-Boehm N, Prince MR, et al. The relationship of left ventricular trabeculation to ventricular function and structure over a 9.5-year follow-up: the MESA study. J Am Coll Cardiol. 2014;64:19711980. Epub 20141103. doi: 10.1016/j.jacc.2014.08.035. PubMed PMID: 25440091; PubMed Central PMCID: PMCPMC4610345. Go to original source...
    29. Caselli S, Ferreira D, Kanawati E, Di Paolo F, Pisicchio C, Attenhofer Jost C, et al. Prominent left ventricular trabeculations in competitive athletes: A proposal for risk stratification and management. Int J Cardiol. 2016;223:590-595. Epub 20160817. doi: 10.1016/j.ijcard.2016.08.272. PubMed PMID: 27561165. Go to original source...
    30. Caselli S, Attenhofer Jost CH, Jenni R, Pelliccia A. Left Ventricular Noncompaction Diagnosis and Management Relevant to Pre-participation Screening of Athletes. Am J Cardiol. 2015;116:801-808. Epub 20150604. doi: 10.1016/j.amjcard.2015.05.055. PubMed PMID: 26141199. Go to original source...
    31. Pinto YM, Elliott PM, Arbustini E, Adler Y, Anastasakis A, Bohm M, et al. Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases. Eur Heart J. 2016;37:1850-1858. Epub 20160119. doi: 10.1093/eurheartj/ehv727. PubMed PMID: 26792875. Go to original source...
    32. Halliday BP, Cleland JGF, Goldberger JJ, Prasad SK. Personalizing Risk Stratification for Sudden Death in Dilated Cardiomyopathy: The Past, Present, and Future. Circulation. 2017;136:215-231. doi: 10.1161/CIRCULATIONAHA.116.027134. PubMed PMID: 28696268; PubMed Central PMCID: PMCPMC5516909. Go to original source...
    33. Pelliccia A, Caselli S, Sharma S, Basso C, Bax JJ, Corrado D, et al. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete's heart. Eur Heart J. 2018;39:1949-1969. doi: 10.1093/eurheartj/ehx532. PubMed PMID: 29029207. Go to original source...
    34. Breinholt JP, Moulik M, Dreyer WJ, Denfield SW, Kim JJ, Jefferies JL, et al. Viral epidemiologic shift in inflammatory heart disease: the increasing involvement of parvovirus B19 in the myocardium of pediatric cardiac transplant patients. J Heart Lung Transplant. 2010;29:739-746. Epub 20100424. doi: 10.1016/j.healun.2010.03.003. PubMed PMID: 20456978; PubMed Central PMCID: PMCPMC2902647. Go to original source...
    35. Yilmaz A, Klingel K, Kandolf R, Sechtem U. A geographical mystery: do cardiotropic viruses respect national borders? J Am Coll Cardiol. 2008;52:82; author reply -3. doi: 10.1016/j.jacc.2008.01.072. PubMed PMID: 18582640. Go to original source...
    36. Magnani JW, Danik HJ, Dec GW, Jr., DiSalvo TG. Survival in biopsyproven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors. Am Heart J. 2006;151:463-470. doi: 10.1016/j.ahj.2005.03.037. PubMed PMID: 16442915. Go to original source...
    37. Schnell F, Claessen G, La Gerche A, Bogaert J, Lentz PA, Claus P, et al. Subepicardial delayed gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie? Br J Sports Med. 2016;50:111-117. Epub 20150729. doi: 10.1136/bjsports-2014-094546. PubMed PMID: 26224114. Go to original source...
    38. Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA. 2015;314:1498-1506. doi: 10.1001/jama.2015.12763. PubMed PMID: 26461998. Go to original source...
    39. Pelliccia A, Corrado D, Bjornstad HH, Panhuyzen-Goedkoop N, Urhausen A, Carre F, et al. Recommendations for participation in competitive sport and leisure-time physical activity in individuals with cardiomyopathies, myocarditis and pericarditis. Eur J Cardiovasc Prev Rehabil. 2006;13:876-885. doi: 10.1097/01.hjr.0000238393.96975.32. PubMed PMID: 17143118. Go to original source...
    40. Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NA, 3rd, et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation. 2015;132:e273-80. Epub 20151102. doi: 10.1161/CIR.0000000000000239. PubMed PMID: 26621644. Go to original source...
    41. Andersen K, Farahmand B, Ahlbom A, Held C, Ljunghall S, Michaelsson K, et al. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study. Eur Heart J. 2013;34:36243631. Epub 20130611. doi: 10.1093/eurheartj/eht188. PubMed PMID: 23756332. Go to original source...
    42. Sorbo MD, Buja GF, Miorelli M, Nistri S, Perrone C, Manca S, et al. [The prevalence of the Wolff-Parkinson-White syndrome in a population of 116,542 young males]. G Ital Cardiol. 1995;25:681-687. PubMed PMID: 7649416.
    43. Sano S, Komori S, Amano T, Kohno I, Ishihara T, Sawanobori T, et al. Prevalence of ventricular preexcitation in Japanese schoolchildren. Heart. 1998;79:374-378. doi: 10.1136/hrt.79.4.374. PubMed PMID: 9616346; PubMed Central PMCID: PMCPMC1728669. Go to original source...
    44. Obeyesekere MN, Leong-Sit P, Massel D, Manlucu J, Modi S, Krahn AD, et al. Risk of arrhythmia and sudden death in patients with asymptomatic preexcitation: a meta-analysis. Circulation. 2012;125:2308-2315. Epub 20120424. doi: 10.1161/CIRCULATIONAHA.111.055350. PubMed PMID: 22532593. Go to original source...
    45. Haugaa KH, Leren IS, Berge KE, Bathen J, Loennechen JP, Anfinsen OG, et al. High prevalence of exercise-induced arrhythmias in catecholaminergic polymorphic ventricular tachycardia mutation-positive family members diagnosed by cascade genetic screening. Europace. 2010;12:417-423. Epub 20100126. doi: 10.1093/europace/eup448. PubMed PMID: 20106799. Go to original source...
    46. Basavarajaiah S, Wilson M, Whyte G, Shah A, Behr E, Sharma S. Prevalence and significance of an isolated long QT interval in elite athletes. Eur Heart J. 2007;28:2944-2949. Epub 20071018. doi: 10.1093/eurheartj/ehm404. PubMed PMID: 17947213. Go to original source...
    47. Haissaguerre M, Nademanee K, Hocini M, Cheniti G, Duchateau J, Frontera A, et al. Depolarization versus repolarization abnormality underlying inferolateral J-wave syndromes: New concepts in sudden cardiac death with apparently normal hearts. Heart Rhythm. 2019;16:781-790. Epub 20181102. doi: 10.1016/j.hrthm.2018.10.040. PubMed PMID: 30391571; PubMed Central PMCID: PMCPMC6486498. Go to original source...
    48. Bayes de Luna A, Brugada J, Baranchuk A, Borggrefe M, Breithardt G, Goldwasser D, et al. Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report. J Electrocardiol. 2012;45:433-442. doi: 10.1016/j.jelectrocard.2012.06.004. PubMed PMID: 22920782. Go to original source...
    49. Pelliccia A, Adami PE, Quattrini F, Squeo MR, Caselli S, Verdile L, et al. Are Olympic athletes free from cardiovascular diseases? Systematic investigation in 2352 participants from Athens 2004 to Sochi 2014. Br J Sports Med. 2017;51:238-243. Epub 20161230. doi: 10.1136/bjsports-2016-096961. PubMed PMID: 28039126. Go to original source...

    Return to the content