Sports Medicine: Just the Facts

141

25 CARDIOVASCULAR

CONSIDERATIONS

Francis G O’Connor, MD, FACSM

John P Kugler, MD, MPH

Ralph P Oriscello, MD, FACC

INTRODUCTION

• Enhanced cardiovascular health is one of the key ben-
  efits of most forms of consistent athletic endeavors
  throughout life. Regular physical activity promotes
  cardiovascular fitness and lowers the risk of disease.


• While there is generally a net cardiovascular benefit
  from athletic activity, there is also an increased car-
  diovascular risk for certain susceptible individuals.
  These individuals may be known with identified car-
  diovascular disorders or they may be unrecognized
  until the adverse event occurs.


• Cardiovascular conditions are the leading cause of
  sudden death in high school and college athletes,with
  the majority of sudden deaths occurring during or
  immediately after a training session or a formal com-
  petition.

CARDIOVASCULAR BENEFITS
OF EXERCISE

• Numerous studies (Williams, 1998; Paffenbarger et al,
  1993; Powell et al, 1987; Leon et al, 1987; Berlin and
  Colditz, 1990) have clearly identified physical inac-
  tivity and a sedentary lifestyle as significant risk fac-
  tors for the development and progression of coronary
  heart disease. Moreover, studies (Pate et al, 1995;

Williams, 1997; Villeneuve et al, 1998; Kohl et al,

1992; Blair et al, 1995) have consistently confirmed

the cardiovascular benefit of aerobic exercise with a

reduction in the number of adverse events and a

reduction in mortality.

•While there is a definite increased risk for certain sus-

ceptible individuals, particularly middle-aged persons

with coronary artery disease(CAD) and a sedentary

lifestyle, there is abundant evidence (Maron, 2000) of

net cardiovascular benefits from consistent exercise as a

primary-prevention recommendation for coronary dis-

ease in asymptomatic middle-aged and older persons.

THE ATHLETIC HEART SYNDROME

•Vigorous athletic training is associated with specific

physiologic and structural cardiovascular change

(Murkerji, Albert, and Mukerji, 1989), which com-

prises what has been termed the athletic heart syn-

drome. These changes are nonpathologic and represent

appropriate adaptations to physical training.

• It is important to remember that the adaptive struc-
  tural and physiologic response of the normal athletic
  heart do not rule out the presence of an underlying
  pathologic condition. In fact, it makes the task of
  diagnosing that condition more challenging for the
  primary care physician and cardiologist. Of note,
  detraining for 2–3 months can result in a reversal of
  athletic heart syndrome changes, which is not seen in
  pathologic conditions.


• Studies (Pluim et al, 2001) have suggested that there
  is a continuum of athletic adaptations depending on
  the training stress of the athlete.
  •For endurance-trained athletes, the heart has to
  adapt to principally a chronic volume overload that
  results in an increase in both left ventricular end-
  diastolic diameter and left ventricular wall thickness.

Section 3

MEDICAL PROBLEMS IN THE ATHLETE

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