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← Section VI · Miscellaneous Topics (Role of Echo)
VI.G

Athlete's Heart

4 cards

Notes

Physiologic athletic remodeling

  • Chronic endurance training (running, cycling): eccentric LV/RV dilation with mild wall thickening.
  • Chronic strength training (weight lifting): concentric LV hypertrophy without significant chamber dilation.
  • Mixed sports: combined remodeling.

Echo features

  • LV wall thickness usually < 12 mm in men, < 11 mm in women; rarely > 14 mm.
  • RWT < 0.6 most sensitive/specific for athletic remodeling.
  • LVEDD often mildly increased.
  • Preserved diastolic function - normal or supernormal e′.
  • Normal or supernormal GLS.
  • Bradycardia at rest (often < 50 bpm).
  • Occasional 1st-degree AV block or Wenckebach (vagal tone).

Athlete's heart vs HCM (the "grey zone")

  • Wall thickness 13–15 mm can be either.
  • Features FAVORING HCM: family history, asymmetric septal hypertrophy, dagger-shaped CW jet, wall > 15 mm, LGE on cMRI, abnormal ECG, small LV cavity, reduced e′ velocity, apical hypertrophy.
  • Features FAVORING athlete: large LV cavity, preserved e′, normal RV, absence of family history, regression with deconditioning.

Deconditioning test

  • 3–6 months of reduced training reverses athletic remodeling (walls thin, chamber normalizes).
  • HCM does not reverse.

Athletic remodeling of the right heart

  • Endurance athletes often have RV dilation.
  • Distinguish from ARVC/D by: absence of regional wall-motion abnormalities, preserved RV function, no aneurysms, no epsilon wave on ECG.

Screening

  • Preparticipation ECG + focused physical exam recommended in some countries.
  • Echo not routinely required for asymptomatic athletes.
  • Family history of SCD, syncope with exertion, or abnormal ECG → indicated.

Cards

  • basicVI.G-001
    Give three features that favor athletic remodeling over HCM in the '13–15 mm wall thickness gray zone.'
    → Normal (or larger) LV cavity size, preserved diastolic function with normal or supernormal e′, and reversal of the hypertrophy after 3–6 months of deconditioning. Also absence of family history of SCD, normal ECG, symmetric hypertrophy, no LGE on cMRI.
  • basicVI.G-002
    Give three features that favor HCM over athletic remodeling.
    → Family history of HCM or SCD, asymmetric septal hypertrophy, wall thickness > 15 mm, small LV cavity, reduced e′ velocity, abnormal ECG, and LGE on cMRI.
  • basicVI.G-003
    Relative wall thickness cutoff most sensitive/specific for athletic heart?
    → RWT < 0.6 (eccentric remodeling — chamber grows more than wall thickens). Contrasts with concentric hypertrophy of HCM.
  • basicVI.G-004
    How does an endurance athlete's right ventricle appear on echo, and how do you distinguish from ARVC?
    → Chamber dilation is common with preserved global function, no regional wall-motion abnormalities, and no aneurysms. ARVC shows regional dysfunction (RV free-wall aneurysms/microaneurysms), reduced FAC (< 33%), epsilon wave, and family history.