Clinical assessment of the athlete’s heart

Abstract

The electrocardiographs (ECG) of trained athletes may show changes that represent the consequence of the heart’s adaptation to physical exercise (‘athlete’s heart’) such as enlarged cardiac chamber size and increased vagal tone. Such physiological ECG changes must be differentiated from the ECG abnormalities secondary to an underlying cardiovascular disease that can cause sudden cardiac death during exercise. The ECG changes of athletes are classified according to their prevalence, relation to exercise training, association with an increased risk of cardiovascular disease, and need for further investigations: common ECG changes should be considered as a benign sign of physiological adaptation to exercise and the athlete should be allowed to participate in competitive sports without additional evaluation; on the other hand, further work-up to exclude an underlying cardiac disease should be performed in case of uncommon and training-unrelated abnormalities, which may be associated with an underlying cardiovascular disease. The present chapter reviews the abnormalities that may be found in an athlete’s ECG and proposes criteria for interpretation of such changes as normal variants or abnormal findings that need further assessment.