Exercise and the heart: the good, the bad and the ugly.

What is it about?

This review provides information about the electrical and structural changes that take place within the heart as a result of intensive physical training. In some athletes such changes may overlap with those seen in patients with serious heart muscle diseases, known as the cardiomyopathies. The differentiation between changes due to athletic training and the cardiomyopathies is crucial because the cardiomyopathies are considered among the common causes of sudden death in young athletes. This paper provides practical methods including a beautifully illustrated Venn diagram to help differentiate cardiac adaptation occurring as a result of exercise and the cardiomyopathies.

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Why is it important?

This article is unique because it is written by world leaders and based on excellent research and personal experience. The paper comes from a unit that serves most athletes in the United Kingdom. The topic is important because sudden death in a young athlete is a very visible event and many sporting organisations have started to mandate cardiovascular screening to identify young individuals who may be at risk of sudden death. In such cases up to 10% of young athletes reveal cardiac findings that may overlap with disease. This review aids the differentiation between the two entities and will reduce the number of athletes who are subject to unnecessary investigations or even erroneously disqualified from sport.

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