Sports and Heart Disease

Sports activity is recommended by the medical community because it improves fitness and reduces cardiovascular morbidity and mortality. However, physical exercise may precipitate acute fatalities in both adults and young competitive athletes with concealed heart diseases. The risk:benefit ratio of physical exercise differs among these two age groups. In adults, physical activity can be regarded as a ‘two-edged sword’: vigorous exertion increases the incidence of acute coronary events in individuals who did not exercise regularly, whereas habitual physical activity reduces the overall risk of myocardial infarction and sudden coronary death by preventing development and progression of coronary atherosclerotic lesions. In adolescents and young adults, competitive sport is associated with a significant increase of the risk of sudden death. Sports is not the ‘per se’ cause of the enhanced mortality in this age group; rather, it acts as a trigger of cardiac arrest in those athletes who are affected by silent cardiovascular conditions, mostly cardiomyopathy, premature coronary artery disease, and congenital coronary anomalies, which predispose to life-threatening ventricular arrhythmias during effort. This points to the need for a preparticipation screening aimed at early identification and disqualification of those subjects affected by at-risk cardiovascular diseases.

This chapter will focus on the physiologic adaptive changes of the cardiovascular system to sustained physical exercise (‘athlete’s heart’); the causes and mechanisms of the increased cardiovascular risk during sports activity; the prevention of sudden death by preparticipation screening; and the management strategies, including eligibility to competitive sports activity, of athletes diagnosed with a potentially lethal cardiovascular disease.