Signs and treatment of athlete's heart syndrome. Athletic Heart: What is Athletic Heart Syndrome? What does a sports heart mean?

It's no secret that an athlete's heart is different from the heart of an ordinary person. Instead of 50-70 ml per contraction, it “pumps” up to 200 ml, and instead of pumping out about 5 liters per minute (normal for ordinary people in a calm state), the sports “pump” is capable of pumping up to 40 liters per minute (at a heart rate of 190-200) .

Who can know the athletic heart as well as one who specializes in this organ? Smolensky A.V., Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Natural Sciences, Director of the Research Institute of Sports Medicine of the Russian State University of Physical Culture.

If these numbers don't give you a clear idea of ​​what the athletic heart can do, try imagining four buckets that need to be emptied or refilled in just one minute! Estimate how long this will take if you use a regular water tap. Are you impressed now?

Adaptation is the main sports word.

As you know, the task of any training is to initiate adaptations in the body. The heart, like everything else, adapts to heavy loads. These adaptations can be of a different nature, but most often they are associated with hypertrophy (increase in size) of the left ventricle. Many people know about two types of hypertrophy, which for simplicity are called L-hypertrophy (increase in internal volume) and D-hypertrophy (increase in wall thickness). In fact, there are three possible types of changes in the heart associated with heavy loads: concentric hypertrophy, eccentric hypertrophy and concentric remodeling (see figure and table).

Each of these types of changes corresponds to its own set of signs that distinguish the changed heart from the organ of an ordinary healthy person (not an athlete). The first two types of changes, so to speak, are normal, but the third type is bad.

However, characterizing different types of changes in this way, it should be noted that any left ventricular hypertrophy of LVH is considered by modern medicine as an independent risk factor for the occurrence of pathologies that can manifest with age. Therefore, it is often said that once a person has formed a sports heart, he should continue playing sports in at least some form throughout his life. As long as normal athletic form is maintained, the likelihood of problems occurring is low (on the contrary, an athletic person is healthier). However, with the transition to a sedentary lifestyle, the likelihood of problems increases, the most common of which is hypertension. And over the years it can give rise to a whole cluster of secondary diseases.

Why do athletes die?

Trying to justify that professional sport is harmful to health, examples of deaths among active athletes are often cited as evidence, without specifying their causes. It turns out that since a person played sports, that means he died from it.

Meanwhile there are statistics that objectively indicate the causes of deaths in sports. So in the diagram we see, that the main cause of such deaths is a disease that has genetic causes: hypertrophic cardiomyopathy (abbreviated as HCM). It accounts for 36% of all known deaths in sports. This is one of the few diseases for which exercise is strictly contraindicated. To reliably detect HCM, it is necessary to take a sample of heart tissue for analysis. However, there are a number of signs revealed by simultaneous analysis of ECG and EchoCG, which make it possible to make a preliminary diagnosis and prescribe an unpleasant control procedure to confirm it. The prevalence of HCM in the population is approximately two cases per 1000 people. This means that every five hundredth person cannot seriously engage in sports, only physical education.

Another 17% of total sports deaths are caused by coronary artery abnormalities. It is also a hereditary disease, which is widespread, for example, in certain regions of Italy. This is very rare in Russia.

If you look further through this list, you will notice that most deaths are associated with one or another hereditary disease, and only a small number of them are associated with sports activities, and even then, first of all, not with heavy loads, but with various ways to increase performance. Translated from neat medical to colloquial: “There is no need to dope or manipulate blood”.

Separately, it is worth mentioning the mortality rate of children and adolescents during sports. The largest number of such deaths are associated (again) NOT with high load, but with thoracic concussion. It is a shake of the heart or a blow to the chest that is the most common cause child mortality in sports. This is the risk of any increased activity in which the described traumatic effects can be obtained: falling, colliding with obstacles, and so on.

Insufficient recovery and overtraining.

Let's continue talking about the heart. Insufficient recovery of athletes during the training process very often leads to overtraining. There are more than enough signs by which this condition can be identified - any doctor working with athletes will accurately determine them. And qualified athletes themselves know about existing control methods.

Overtraining causes disruption of long-term adaptations (for which the athlete trains). In the most severe cases, this further leads to neuroendocrine disorders and nervous overstrain, then to disturbances in organ function and primary stress damage to the myocardium. In a word, this is no joke!

The most common causes of overtraining are:
- weekly increase in loads by more than 10%,
- increasing the duration of the period of intense exercise to 3 weeks or more,
- inclusion of more than one type of intensive developmental work in one training session,
- insufficient recovery between developmental training sessions,
- early specialization in children's sports.

Primary signs of self-control: sleep and appetite disturbances, increased resting pulse, apathy, changes in normal blood pressure, decreased libido. Methods of medical control - based on blood tests with assessment of hormone levels.

Monitoring the condition of the heart.

Under particularly heavy loads typical of professional sports, almost all high-level athletes have certain changes in the myocardium. These changes can be both physiological (a normal result of adaptation) and pathological (diseases, including hereditary ones). It is worth recalling where we started: left ventricular hypertrophy is considered by modern medicine as an independent risk factor. However, this hypertrophy, as we remember, can be different: most often it is normal, but sometimes it is “bad”.

Taking into account such risks, it should be considered extremely important to periodically monitor the condition of the heart, and if there is the slightest suspicion of any serious abnormalities, conduct a more detailed examination. This is especially important after suffering from “flu-like” illnesses (after which the likelihood of heart complications is very high) or when an unreasonable arrhythmia is detected. Both smell like myocarditis (inflammation of the myocardium).

Athletes diagnosed with myocarditis should be suspended from training for up to six months, no matter how terrible a sentence this may seem. The conclusion that training can be continued is made only on the basis of a comprehensive examination of the heart, which will show that no clinically significant abnormalities have been detected.

Sport for life.

Heart changes associated with professional sports, in some cases (especially in strength sports) lead to the fact that by middle age or older age (after the end of a sports career) people face the problem of high blood pressure. Quite often in such cases, one of the effective ways to combat the disease is to return to sports, but in a gentle manner. Therefore, many strength athletes (where these problems are most acute) continue to go to the gym at 50 and 60 years old. Of course, without the kind of stress that they allowed themselves during their professional sports activities.

The information below is primarily for specialists, however, do not forget that “Saving drowning people...” often becomes a problem for these same “... drowning people,” so it is useful to at least have this information just in case. So, signs of a normal athletic heart...

But, for comparison, signs of “bad” changes that can occur in athletes...

Source of information: www.1-fit.ru (2014).

It is indicated that the athlete should be removed from training until the ECG is completely normalized. Sanitation of foci of chronic infection is necessary.

When treating dystrophic changes, it is necessary to take into account their genesis.

In case of excessive exposure to catecholamines on the myocardium, the use of beta-blockers is recommended, and in case of insufficient catecholamine exposure, levodopa (a precursor of catecholamines).

The use of drugs that improve myocardial metabolism is also indicated: Rhythmocor, Cardioton, ATP-LONG, ATP-forte, Potassium orotate, Folic acid, Calcium pangamate, anabolic steroids, Cocarboxylase, multivitamins, pyridoxal phosphate, vitamin B12, Riboxin, carnitine preparations.

Preventive pharmacotherapy of the early stages of chronic physical overstrain of the heart involves the use of drugs that, in their action, can be regarded as activating the synthesis of nucleic acids and proteins, normalizing electrolyte balance, and having an adrenolytic effect. However, their purpose should be differentiated depending on the presence of the predominant factor - dilatation and/or hypertrophy, since this involves influencing the main pathogenetic mechanism of manifestations of the “sports” heart - systolic and/or diastolic function of the myocardium.

In the case of predominance of myocardial hypertrophy, assessed by the mass of the left ventricular myocardium and the myocardial mass index, over dilatation, the use of metabolic drugs that enhance plastic processes in the myocardium should be limited, since at the stage of a pathological “athletic” heart the development of hypertrophy may increase. In this case, drugs with an energizing effect are indicated that enhance the formation of ATP and creatine phosphate, which are necessary to enhance both systole and diastole. For this purpose, preparations of adenosine triphosphoric acid and its coordination compounds that provide a more stable effect are recommended - ATP-LONG, ATP-forte, Egon. The mechanism of action of these drugs is based on the effect on the purinergic receptors of the heart, which leads to the limitation of calcium “overload” of myocytes, vasodilation of the coronary arteries, reduction of afterload and economization of cardiac activity. In addition, coordination complexes are less susceptible to deamination by adenosine deaminase, which provides a prolonged effect, in contrast to adenosine triphosphoric acid. Metabolic products ATP-LONG and ATP-forte are capable of activating intracellular de novo ATP synthesis through the stage of formation of purine bases.

The action of creatine phosphate (Neoton) is based on the suppression of 5-nucleotidase activity, which leads to a decrease in the breakdown of ATP in cells, especially in red blood cells. Creatine phosphate preparations, through de novo synthesis, increase the pool of intracellular creatine phosphate, helping to enhance myocardial contractile activity. More attractive from this point of view are chelated compounds of creatine phosphate with magnesium ions (Reaton), which ensures higher effectiveness of the drug, since in the form of a chelate complex it is less susceptible to destruction and can be used in the form of tablets containing 0.5 g of the active substance. Reaton is the first tableted chelate complex of creatine phosphate.

To enhance energy processes in the myocardium, the use of lipoic acid is indicated, which takes part in the synthesis of acetyl-coenzyme A, which reduces the amount of lactate produced and increases the formation of pyruvic acid, which is an active energy substrate. An increase in energy production and a decrease in the accumulation of lactate in myocardiocytes is inherent in cocarboxylate and especially in its chelate form with magnesium ions - Alactone. The drugs affect the alternative pathway for energy production in myocytes, activating the transketolase reaction of the pentose phosphate shunt for glucose oxidation.

Another drug that directly affects the reactions of the pentose phosphate shunt is Rhythmocor. Rhythmocor contains gluconic acid in the form of magnesium and potassium salts. The bioavailability of the drug is about 95%, which avoids the side effects of magnesium on the gastrointestinal tract, since the absorption of other magnesium drugs from the gastrointestinal tract does not exceed 40%. Gluconic acid stimulates the pentose phosphate pathway of glucose oxidation in the myocardium, increasing energy production in the myocardium and skeletal muscles and helps reduce the severity of clinical and ECG manifestations of the “athletic” heart syndrome, and also significantly improves physical performance. Rhythmocor also has an antiarrhythmic effect, which allows us to consider it as a means of pathogenetic therapy for mitral valve prolapse.

It should be noted that magnesium in the form of a salt of gluconic acid is found in the preparation Cardioton, which also contains folic acid and hawthorn extract (vitexin glycoside). The latter has moderate cardiotonic activity, which differs in its mechanism of action from cardiac glycosides, which makes it possible to use Cardioton for mitral valve prolapse, including with a “sports” heart. Vitexin, which is included in cardioton, realizes its effect through strengthening the adaptive Frank-Starling mechanism, and not through an increase in calcium ions in myocardiocytes, which distinguishes it favorably from cardiac glycosides, which are contraindicated in the case of diastolic dysfunction in a “sports” heart.

To enhance energy processes, the use of L-carnitine preparations is indicated. By improving the utilization of fatty acids, carnitine reduces energy deficiency by stimulating the formation of ATP in mitochondria. In addition, carnitine preparations can increase the ejection fraction without affecting the development of myocardial hypertrophy. Carnitine can also reduce acidosis.

In case of a “sports” heart, the prescription of drugs containing respiratory enzymes - cytochrome C (Cytomac) and Coenzyme Q10 Compositum is also justified. The drugs improve tissue respiration by influencing electron transport in the mitochondrial respiratory chain and enhance oxidative phosphorylation.

In case of severe hypertrophy and development of systolic dysfunction of the myocardium and concomitant cardiac arrhythmias, as well as in persons with sympathicotonia, the administration of beta-blockers is indicated. Their use is contraindicated in case of bradycardia (heart rate less than 55 beats/min); if necessary, dose selection should be titrated and take into account the fact that beta-blockers are included in the list of drugs prohibited by WADA.

In case of a dilated form of an “athletic” heart, in addition to energy-acting drugs, the prescription of drugs that affect the plastic metabolism of the myocardium may be justified.

It is generally accepted to prescribe Methyluracil in combination with folic acid and vitamin B12. Another regimen includes Potassium orotate, cocarboxylase and vitamin B15. If there is a heart rhythm disorder, Rhythmocor or Panangin is added to the above-described regimens. It is also possible to prescribe anabolic steroids. By enhancing protein biosynthesis, they are able to increase the mass of the myocardium, normalizing the ratio of the mass of the ventricular myocardium to the size of the cavities. The drugs have different androgenic-anabolic indexes, which should be taken into account when using them. The drugs are contraindicated in adolescence. It should be remembered that anabolic steroids are classified as doping drugs, so their prescription must be strictly justified and only for therapeutic purposes!

To prevent chronic overexertion syndrome in athletes, the use of various multivitamin regimens is also proposed (Seifulla, 1999). There are also known attempts to develop methods for the prevention of chronic overexertion syndrome in young athletes using adaptogens of plant origin (Polysol-2, Antihypoxin), methods of physical rehabilitation, as well as the use of antioxidants (Ascorbic acid, Tocopherol acetate, Methionine) (Polyakov, 1994; Azizov, 1997; Aidaeva, 1998).

The effectiveness of therapy with magnesium preparations has been shown for manifestations of disadaptation to physical activity, while the use of Magnesium orotate helps to increase physical performance in athletes (Dzhalalov, 2000; Bogoslav, 2001).

Preparations containing magnesium (Magne-forte, Ritmokor, Magne-B6, Magnerot) are most justified in the presence of tonogenic dilatation. Natural antagonists of calcium ions, they help reduce the “calcium” overload of myocytes, thereby improving the diastolic function (relaxation) of the myocardium, which leads to activation of the Frank-Starling mechanism and increased contractile function. In case of severe diastolic dysfunction, it is possible to use dihydropyridine calcium channel blockers (Amlodipine, Lacidipine). However, their pronounced hemodynamic (BP-lowering) effect should be taken into account. Therefore, it is better to give preference to magnesium-containing drugs. In addition, some drugs have a pronounced antiarrhythmic effect (Ritmokor, Magnerot), which allows their administration to prevent cardiac arrhythmias. These drugs do not affect the heart rate, so they can be prescribed for bradycardia.

With tonogenic dilatation, it is possible to use drugs that inhibit the carnitine-dependent mechanism of fatty acid oxidation - Trimetazidine, Ranolazine. However, their use should be of a course nature. It should be remembered that with the hypertrophic form of the “athletic” heart, their use is inappropriate.

In recent years, the homeopathic method has been increasingly used to prevent and eliminate the consequences of the negative effects of intense sports on the body. This method has no scientific basis. Homeopathic remedies have been shown to be completely ineffective in clinical trials. And the people who use them, as a rule, are victims of charlatans.

It should be noted that cardiac pathology can also appear in teenage athletes. Young athletes with a pathological “sports” heart should be under constant supervision of a cardio-rheumatologist.

In addition, Quercetin, Lipin, Glycine, Tanakan, etc. are used.

The correct training regimen is of great importance in preventing the development of pathological “sports” heart.

The scientific substantiation of sports training regimes in childhood, adolescence and youth is important (Khrushchev, 1991).

This also applies to the physical health program. The threshold value of exercise intensity that provides a minimal health effect is considered to be work at the level of 50% of VO2max or 65% of the maximum age-related heart rate (corresponds to a heart rate of about 120 beats/min for beginners and 130 beats/min for trained runners). Training at a heart rate below these values ​​is ineffective for developing endurance, since the stroke volume of blood in this case does not reach its maximum value and the heart does not fully use its reserve capabilities.

Metabolic drugs in pediatric practice (S.S. Kazak, 2006)

Consequently, the range of safe loads that have a training effect in health-improving physical education, depending on age and level of preparedness, can range from 120 to 150 beats/min. Training with a higher heart rate in recreational running cannot be considered advisable, since it has a clear sports focus. This is confirmed by the recommendations of the American Institute of Sports Medicine (AISM).

When choosing training loads for young athletes, the characteristics of their hemodynamics should be taken into account. So, according to I.T. Korneeva et al. (2003), at rest in young athletes with a normokinetic type of blood circulation, the chronoinotropic mechanism is practically not involved in ensuring cardiac output, and athletes with this type of blood circulation should be considered as insufficiently adapted to perform endurance work. For young athletes with a hyperkinetic type of blood circulation, volumetric, low-intensity loads should be recommended, and for young athletes with a normokinetic type of blood circulation, an increase in the volume of loads in a gentle increasing mode.

The problem of the physiological and pathological “sports” heart remains relevant and in modern conditions is caused by increasing physical and psycho-emotional stress in sports, intense struggle during competitions, and a high level of sports achievements. A properly developed training process under medical supervision with adequate pharmacological support makes it possible to prevent the development of a pathological “sports” heart and maintain the health of athletes.

Why does an athletic heart develop?

To answer this question, you need to understand the basics of heartbeat. According to the Frank-Starling law, the more a muscle fiber is stretched, the more forcefully it will contract in response. In humans, during physical activity, the cardiovascular system is activated and also increases. This is necessary so that as much blood as possible flows through the lungs, and a larger volume of oxygen-enriched blood reaches the skeletal muscles, which carry out the load. In its turn, the more blood volume flows through the chambers of the heart, the more the myocardial fibers stretch, and, accordingly, the more force they contract. With constant training, thickening of the muscle fibers gradually develops., which is compensatory, adaptive in nature, because the greater the need of skeletal muscles for oxygen, the more blood should be enriched with oxygen in the lungs. Within a few months from the start of regular training, the athlete develops slight, uniform myocardial hypertrophy. As you train, the heart adapts more and more to physical activity and becomes more trained, which ensures the full functioning of the skeletal muscles.

At this time, the usual performance indicators of the heart chambers also change, which can be measured and assessed using and. They increase (the amount of blood flowing through the heart per minute and per heart beat) - more than 5 liters per minute and more than 70 ml per beat, respectively. At the same time, due to adaptive mechanisms in the cardiac muscle, the frequency of electrical impulses through the myocardium decreases, which is manifested by a decrease in heart rate per minute (about 50 beats per minute, compared to 70-80 beats per minute in an untrained person). A decrease in heart rate () under conditions of systematic exercise has a very beneficial effect on the heart muscle itself, because with a rapid heartbeat (which is typical for an ordinary person with a pulse of 100-120 per minute after exercise), there is an increased need for oxygen for the heart muscle.

Compensatory hypertrophy itself is of enormous importance for performing professional sports, because providing skeletal muscles with oxygen during speed or power loads is the most important factor in the adaptation of the athlete’s body. That is, in essence, compensatory hypertrophy is a favorable condition relative to the entire organism, however, with the further development of hypertrophy, when the heart enlarges two or more times (compared to a normal heart), cardiac diseases may appear. So, in particular, with a hypertrophied heart, problems of a secondary nature, etc., often arise.

In the course of studies that are constantly carried out to assess the physical condition of athletes, it has been revealed and proven that upon cessation of training, a gradual weakening of compensatory mechanisms in the cardiac muscle is possible with the heart returning to normal, normal sizes. Generally minor myocardial hypertrophy does not pose any threat to life or health if the size of the heart does not exceed permissible limits. As soon as an athlete’s examination reveals criteria that significantly exceed the indicators of physiological hypertrophy, and complications arise, he should engage in professional sports.

What sports develop the “athlete’s heart”?

In order for the specified adaptive mechanisms to form in the heart muscle, a person must engage in certain sports for a long time and professionally, with regular training. Typically, an athletic heart is formed when engaging in high-speed sports that require great endurance. These types of sports include long-distance running, skiing, triathlon, and cycling.

In more powerful sports (weightlifting, wrestling, boxing, group games, etc.), hypertrophy develops rarely, in isolated cases, and then, as a rule, when the athlete is predisposed to cardiac pathology.

Is it possible to develop a sports heart through physical education?

When engaging in physical activity as usual (exercise, jogging, Nordic walking, swimming), hypertrophy does not develop, but adaptation mechanisms in the heart are still formed. Thus, in individuals who regularly and for a long time engage in physical exercise, the heart rate also decreases and the minute volume of blood increases, but a clearly defined thickening of muscle fibers does not occur. In order for the “athlete’s heart” to be formed, long-term daily training that develops endurance is necessary, lasting at least 3-4 hours of intensive training per day.

“Athlete's heart” – a disease or a norm?

For a long time after the start of training, the athlete feels satisfactory. His tolerance to physical activity increases, and he tolerates even intense training quite well, without tachycardia and without shortness of breath. This is precisely due to the fitness of the heart muscle, which, due to hypertrophy, is capable of better satisfying the body’s needs during exercise.

However, as hypertrophy increases, especially if the intensity of training increases, the athlete may develop certain clinical manifestations. Thus, when the size of the heart increases two or more times compared to the norm, an athlete may experience the so-called athlete's heart syndrome, which is manifested by shortness of breath, a feeling of irregular heartbeat, a feeling of heartbeats against the anterior chest, and dizziness. Sometimes fainting may occur. As hypertrophy increases, various heart rhythm disturbances are possible (,), which can lead to loss of consciousness. IN Due to the fact that it has become larger, and the growth of the coronary arteries (these are the arteries that supply oxygen to the heart muscle itself) does not occur, the heart itself begins to suffer from a lack of oxygen. Developing. With a very high load that is unusual for the athlete, it may occur.

Typically, such serious health problems develop if the athlete has already identified changes in the cardiovascular system, and he continues to train as before.

Diagnostic criteria

In order to identify a mature athlete's heart, each athlete must undergo annual (echocardioscopy, echo-CS). This technique allows you to reliably assess the volume of the heart, the size of the atria and ventricles, as well as the thickness of the myocardial walls. If these indicators are much higher than normal, the sports doctor should decide whether to stop or reduce the intensity of training. In addition, a simple test can help in assessing the fitness of the heart muscle (based on calculating heart rate after exercise).

athlete's heart on echocardiography (ultrasound)

In addition to Echo-CS, all athletes are required to undergo an ECG once every six months. On the ECG, you can see indirect signs of left ventricular hypertrophy (deviation of the electrical axis of the heart (EOS) to the left, disturbances in repolarization processes, sometimes along all walls of the left ventricle, as well as conduction disturbances in the atrioventricular node and/or the His bundle system).

signs of left ventricular hypertrophy on the ECG

Should an athlete's heart be treated?

As mentioned above, myocardial hypertrophy during professional sports can be leveled out independently after the cessation of intense training. Of course, no athlete can imagine his future life without playing sports, but with the development of severe myocardial hypertrophy, intense endurance training is strictly contraindicated. However, light physical exercise is quite acceptable if there are no obvious contraindications (hypertension, previous heart attacks and strokes, hemodynamically significant heart rhythm disturbances).

Myocardial hypertrophy without these diseases does not require drug treatment, but in the latter case, regular monitoring by a doctor with medications taken on an ongoing basis is required.

Sports heart in childhood

A child involved in professional sports has some characteristics and differences from an adult. This is due to a discrepancy in the growth of internal organs (including the heart) compared to the musculoskeletal system, as well as a hormonal “explosion” in adolescents (especially girls). After just 2-3 months of daily strength and speed training, the child experiences adaptive changes in the cardiovascular and respiratory systems. In other words, the rudiments of myocardial hypertrophy begin to form already at this time.

Before sending a child to big sports, parents should carefully take care of a full medical examination. Regarding the cardiovascular system, it is necessary to conduct an ECG, ultrasound of the heart, etc. Those children who have begun to engage in professional sports should conduct the same studies annually and visit a cardiologist.

Children who do not experience any clinical manifestations during or after exercise (loss of consciousness, darkness before the eyes, stupor, sensations of interruptions in the heart, pain in the chest) can continue playing sports. Otherwise, intense training is contraindicated.

Video: about athlete's heart syndrome

Video: about the causes of death of athletes

Video: about cardiac hypertrophy and its consequences