Athlete's heart

Overview
Athlete's heart is a term that refers to concentric and symmetric hypertrophy of the left ventricle that occurs in some athletes. It is important to distinguish Athlete's heart, which is not a true cardiomyopathy from hypertrophic obstructive cardiomyopathy (HOCM), which is a true cardiomyopathy and places the athlete at risk of sudden death.

Traditional Criteria for Distinguishing Athlete's Heart from HOCM
Several criteria can be used to distinguish these two entities:

The degree of left ventricular wall thickness

 * In athlete's heart the LVH is symmetric and less than or = to 12 mm
 * Rarely the LV thickness can be 14-16 mm and this makes it difficult to distinguish from HOCM. Athletes who engage in strength training may develop this pattern, ahtletes who engage in endurance training do not.
 * If the degree of thickening is out of proportion to the type and intensity of exercise, this suggests HOCM

The pattern of left ventricular wall thickness

 * Athleste's heart is symmetric
 * HOCM is more often asymmetric, but may in some cases be symmetric

The left ventricular cavity size

 * HOCM has smaller LV cavitary dimensions in general

Sophisticated Criteria and Testing to Distinguish Athlete's Heart from HOCM

 * Doppler mitral valve inflow patterns are diagnostic of HOCM 9prolonged isovolumic relaxation time, reduced peak E velocity, prolonged deceleration time, increased peak A velocity, and decreased E/A ratio as compared to normal controls or athletes)
 * Tissue doppler echocardiography
 * Electrocardiogram: HOCM is favored if there are prominent q waves, large increases in voltages, and deep T wave inversions
 * The presence of an LV outflow tract gradient favors the diagnosis of HOCM
 * A speckled pattern on MRI favors the diagnosis of HOCM