Athlete's Heart Blog

Dr Larry Creswell

Dr. Larry Creswell on athletes and heart health.
About Larry / Contact
  • Facebook
  • RSS
  • Twitter

Writing on…

Copyright © 2023 · Wintersong Pro Theme on Genesis Framework · WordPress · Log in

You are here: Home / Archives for Heart problems

Another Heart Transplant Triathlete

February 24, 2010 By Larry Creswell, MD 2 Comments

I came across an interesting article in the print version of Reader’s Digest and I see that the article is also available online at www.readersdigest.com.

The article profiles 4 athletes who have overcome major physical adversity. Each of the stories is heart-warming. But the first profile, that of Shannon Kelly, really captured my interest. Selfish interest, I suppose.

Shannon learned as a teenager that she had hypertophic cardiomyopathy and over the years, she became progressively more symptomatic with heart failure. By the time she was in her mid-30’s, she was short of breath with only minimal activity. Her only option for treatment was a transplant. The operation went well and she has embraced the “new” life that her transplanted heart has brought.

Two years after her transplant, she took on the challenge of a sprint distance triathlon….and she finished 93rd out of 189. Another remarkable story about a heart transplant recipient.

Filed Under: Heart problems

In the News: Atrial Fibrillation in Cross Country Skiers

February 17, 2010 By Larry Creswell, MD 2 Comments

We have talked previously here at the blog about arrhythmias….and specifically about atrial arrhthmias–those that arise in the upper chambers of the heart.

In an interesting study summarized in an article last week at ScienceDaily.com, Norwegian investigators reported on a longitudinal study of cross country skiers, focusing on the development of atrial fibrillation. Starting in 1976, a group of 122 athletes have been followed, with monitoring for the development of arrhythmias. The study is remarkable because of the length (30+ years) of follow-up.

It turns out that, among participants who were alive for the entire period, the prevalence of “lone atrial fibrillation” (that is, without other heart disease) was 12.8%. And this compares to a prevalence of ~0.5% in the general population. Among the athletes with atrial fibrillation, there was also a higher frequency of enlargement of the left atrium and bradycardia (a heart rate
Other studies have also shown an increased prevalence of atrial fibrillation among endurance athletes. It’s not entirely clear yet what the long-term implications might be. And it may well be the case that no specific treatment is needed for athletes who have “lone atrial fibrillation.”

I imagine that more information from this study (and commentary, as well) will become available, and I will share anything else I learn.

Filed Under: Exercise & the heart, Heart problems Tagged With: arrhythmia, atrial fibrillation, endurance athlete, skiing

Athletes and High Blood Pressure

February 5, 2010 By Larry Creswell, MD 167 Comments

In a previous blog post, I talked about the general problem of high blood pressure, or “hypertension.” Today, I thought I’d focus our discussion about hypertension specifically on the issues that athletes face.

Here at the blog, we’ve talked about many UNcommon cardiovascular problems that athletes might confront. But hypertension is different. In fact, high blood pressure is the MOST COMMON cardiovascular problem discovered in athletes. If you don’t have this problem, you almost certainly know fellow athletes who do. And if you don’t have high blood pressure now, you might develop high blood pressure as you age. So….this is a problem worth knowing about.

First, some definitions….and we’re talking about adults here….

The NORMAL blood pressure is 120/80.

Benefits of Exercise

Randomized clinical trials have shown that physical activity is associated with a decrease in the blood pressure for all patient groups: those who have a normal blood pressure at the outset, those with high normal blood pressure or “pre-hypertension,” and those with high blood pressure. Regular and moderate aerobic exercise can reduce the blood pressure by up to 10 mm Hg. Similarly, moderate intensity resistance training (using light weights and high number of reps) can reduce the blood pressure by 3-6 mm Hg.

Regular exercise provides a real benefit. Among the physically active, the risk of developing hypertension is 50% less than for the inactive population. Nonetheless, there will be individuals who DO develop hypertension despite engaging in a regular exercise program. Those at particular risk include: African-Americans, the elderly, the obese, those with diabetes, and those with chronic kidney disease.

Evaluation of the Blood Pressure in Athletes

I’ve talked several times here at the blog about how important it is for athletes to have a physician. The BP should be checked at every visit. For student athletes, the BP should be checked at a pre-participation physical examination. It is important to remember that the BP varies over time. No single measurement should govern treatment decisions. If the BP is elevated at the doctor’s office, it may be wise to re-check the blood pressure in a more relaxed setting such as the home. You may need to work with your physician on how best to do this.

Some behaviors are known to be associated with elevated BP: increased sodium (salt) intake, tobacco use (any form), various over-the-counter medications (cold remedies, decongestants, “diet pills”), ergogenic aids (caffeine, Sudafed, cocaine, human growth hormone (HGH), anabolic steroids), various prescription medications (particularly non-steroidal anti-inflammatory drugs such as Motrin and oral contraceptives), and various dietary supplements.

Treatment of Hypertension in the Athlete

The first approach to treatment will involve “non-pharmacologic” therapy–treatment WITHOUT medications. Since we know the list of “bad” behaviors (noted above), our first efforts should be to eliminate these. We should also note that regular physical activity is helpful in this regard….but if you’re reading here, you’re probably already an athlete. Other useful measures include: ensuring adequate potassium intake (particularly for endurance athletes) and a variety of relaxation techniques (meditation, yoga, Tai Chi, etc.).

If medications are needed to control an athlete’s hypertension, several broad categories of medications are available. Each category has its own benefits and drawbacks. Anything I say here is a simplification, and there is an art and science to the selection of blood pressure medications for a patient. You will need to work carefully with your physician to choose an approach that WORKS FOR YOU.

1. ACE (angiotensin converting enzyme) inhibitors. Examples include: Altace, Zestril, lisinopril, enalapril. May be the drug of choice for athletes. There are few side effects if they are used in individuals who do not have kidney disease. Athletes taking ACE inhibitors may experience a sudden decrease in the BP just after a workout (potentially leading to blackout or syncope), so they should be aware of this possibility and have a cool-down period at the end of each workout.

2. Calcium channel blockers. Examples include: Norvasc, Calan, Isoptin, Cardizem. These medications are also useful in the athlete. They do not lead to a decrease in exercise capacity. They can lead to a decrease in the heart rate and contractility (strength) of the left ventricle (heart’s main pumping chamber), but this is compensated for by an increase in the stroke volume (the amount of blood the heart ejects with each heartbeat).

3. ARB’s (antiotensin receptor blockers). Examples include: Avapro, Atacand, Cozaar. These medications are similar to the ACE inhibitors. Again, they have a favorable side effect profile.

4. Central alpha-agonists. Examples include: Catapres, Tenex. These medications are not generally useful for the athlete. Side effects include: fatigue, orthostatic hypotension (decrease in the BP related to body position), and fluid and electrolyte imbalances.

5. Diuretics. Examples include: hydrochlorothiazide (HCTZ), Lasix. These should generally be avoided in the athlete. There is an increased risk of heat-related illness, impaired exercise capacity, cramps, and even arrhythmias. In hot weather, these medications may lead to unacceptably high losses of magnesium and potassium.

6. Beta-blockers. Examples include: Inderal, Lopressor, Toprol, Labetalol, Coreg. This is another category of drugs that should generally be avoided in the athlete. They lead to a significant reduction in maximum exercise capacity along with decreased cardiac output and VO2 max. They are also associated with increased perception of exertion and impaired temperature regulation.

Participation Recommendations for Athletes with Hypertension

Prudent recommendations for athletes with hypertension are summarized nicely in a report from the 36th Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities. For athletes with high normal blood pressure or mild hypertension, there should be no restrictions to exercise or sports participation. The blood pressure should be checked every 2-4 months. For athletes with moderate or severe hypertension, activities should be restricted until the blood pressure is controlled.

Banned Substances

The World Anti-Doping Agency (WADA) publishes a listing of medications or other substances that are banned for use by athletes during competition. Athletes should be aware of the ramifications (for their particular sport and circumstance) if they choose, along with their physician, to use medications which are included on the banned list.

Filed Under: Heart problems Tagged With: blood pressure, hypertension, medication

In the News: Link Between Peripheral Artery Disease (PAD) and Coronary Artery Disease

January 8, 2010 By Larry Creswell, MD Leave a Comment

We’ve talked previously here at the blog about coronary artery disease (CAD), and we’ve talked about several important risk factors.

Earlier this week in Science Daily, there was an article entitled “Severe Asymptomatic Heart Disease May Accompany Narrowing in Leg Arteries.” The article reports on a recent study from the Netherlands which points out the important association between peripheral artery disease (PAD)–blockages in the arteries of the legs, that can produce pain or discomfort while exercising–and CAD.

Individuals who are found to have PAD should be checked carefully for co-existing CAD.

Filed Under: Heart problems

Do You Have "Athlete’s Heart"?

December 6, 2009 By Larry Creswell, MD 298 Comments

 

Do you have “athlete’s heart”?

If you’re a well-trained endurance athlete, you probably do. And don’t even know it. But that’s okay, because “athlete’s heart” is generally a good thing. Here’s why….

We’ve known for more than a century that there are a variety of cardiac changes that are associated with exercise. As long ago as 1899, S. E. Henshen at the University of Uppsala Sweden published a report entitled, “A Study in Sports Medicine; Skiing and Competitive Skiing,” recognizing that skiers developed enlarged hearts that were a response to exercise. And we’ve learned a lot more during the past 100 years about the heart’s adaptation to exercise.

Today, we use the terms, “athlete’s heart” or “athlete’s heart syndrome” to refer to the entire collection of the heart’s physiological adaptations to exercise. Those adaptations come in 2 main forms: structural changes and electrical changes.

Structural changes

Over time, the well-trained athlete’s heart adapts in order to provide a high cardiac output (volume of blood pumped per unit of time) in the most efficient manner. Because of mechanical advantage (after all, the heart is only a pump), the heart adapts by increasing the volume of its chambers, decreasing its heart rate, and increasing the thickness of the heart’s muscular walls–particularly the ventricles (the pumping chambers).

Changes in the structure of the heart will not be the same for every athlete. These changes will be most pronounced for athletes who engage in the aerobic sports (running, swimming, cycling, rowing, etc.).

The thickness of the left ventricular wall is usually less than 1.3 cm in thickness, with many individuals having a thickness of 1.0 cm or so. Well-trained athletes may have a left ventricular wall thickness of up to 1.5 cm, again an adaptation that helps with the generation of additional cardiac output during exercise.

Electrical changes

Athletes can have a variety of electrical changes that show up on an ECG. The most common finding is a slow heart rate (that we call “bradycardia” when the heart rate is less than 60 beats per minute). You’ll know that you and your athletic friends may have a resting heart rate that is much less than even 60 beats per minute. Yet the medical profession arbitrarily calls 60 to 100 beats per minute “normal”….for most individuals. For the well-trained athlete, though, a heart rate less than 60 beats per minute is typical and simply reflects the efficiency that the heart has developed over time due to exercise.

There are many other findings that can be present on the athlete’s ECG, including sinus arrhythmia, wandering atrial pacemaker, first- and second-degree heart block, junctional rhythm, and various types of repolarization abnormalities. These terms will only be meaningful to a medical professional, but suffice it to say that, when we add up the frequencies of all of these findings, an athlete’s ECG is very often “abnormal.”

Physical examination

In addition to the structural and electrical changes, there can be changes in the physical examination, as well. Athletes are more likely than non-athletes to have murmurs or other heart sounds (heard by stethoscope) that are simply a manifestation of the structural and electrical changes mentioned above.

Why is this important?

I’ve said that all of these changes, or adpations, are a good thing. And they are! But here’s the problem….

Imagine this scenario. And it’s pretty typical. A 42-year-old man, an avid triathlete, crashes while cycling, fractures his clavicle, and requires operation for repair of the clavicle fracture. He gets an ECG before the operation to screen for any unrecognized heart problems….and behold, he has an abnormal ECG. His physicians overlook the fact that the “abnormal” ECG may be very “normal” for an endurance athlete….and they order a variety of (possibly unneeded) additional heart tests to look for any specific heart disease. And, in the end, they don’t find anything wrong.

It’s important for you and your physicians to remember that you’re an athlete and that you may have features of the “athlete’s heart syndrome.” The next time you’re at the doctor’s office and he or she is listening to your heart with a stethoscope, you might ask the doctor if there was a murmur. Mention that you’ve learned something about athlete’s heart syndrome and ask if any murmur might be due to that. You’ll impress your doctor….and you’ll be helping your doctor remember that athlete’s are special.

This another area where you can be as knowledgable (or perhaps more knowledgable) than your doctor. Take charge.

Filed Under: Exercise & the heart, Heart problems Tagged With: athlete's heart

  • « Previous Page
  • 1
  • …
  • 4
  • 5
  • 6
  • 7
  • 8
  • Next Page »