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Athletic Heart Syndrome


Athletic heart syndrome is the adaptation of an athlete's heart in response the physiologic stresses of strenuous physical training. It can be difficult to distinguish a significant medical condition from an athletic heart.


The heart adapts to physical demands by enlarging, especially the left ventricle. Enlargement increases the cardiac output, the amount of blood pumped with each beat of the heart. The exact type of adaptation depends on the nature of the physical demand. There are two types of demand, static and dynamic. Static demand involves smaller groups of muscles under extreme resistance for brief period. An example is weight lifting. Dynamic training involves larger groups of muscles at lower resistance for extended periods of time. Examples are aerobic training and tennis. Cardiac enlargement is associated with dynamic training. The heart's response to static training is hypertrophy, thickening of the muscle walls of the heart. As the wall of the heart adapts, there are changes in the electrical conducting system of the heart. Because of the larger volume of blood being pumped with each heart beat, the heart rate when at rest decreases below the normal level for nonathletes.

Sudden unexpected death (SUD) is the death of an athlete, usually during or shortly after physical activity. Often, there is no warning that the person will experience SUD, although in some cases, warning signs appear which cause the person to seek medical advice. Importantly, cases of death occurring during physical activity are not caused by athletic heart syndrome, but by undiagnosed heart disorders.

Causes and symptoms

Athletic heart syndrome is the consequence of a normal adaptation by the heart to increased physical activity. The changes in the electrical conduction system of the heart may be pronounced and diagnostic, but should not cause problems. In the case of SUD, other heart problems are involved. In 85-97% of the cases of SUD, an underlying structural defect of the heart has been noted.


The changes in the heart beat caused by the electrical conduction system of the heart are detectable on an electrocardiogram. Many of the changes seen in athletic heart syndrome mimic those of various heart diseases. Careful examination must be made to distinguish heart disease from athletic heart syndrome.


The yearly rate for occurrence of SUD in people less than 35 years of age is less than 7 incidents per 100,000. Of all SUD cases, only about 8% are exercise related. On a national basis, this means that each year approximately 25 athletes experience SUD. In persons over age 35, the incidence of SUD is approximately 55 in 100,000, with only 3% of the cases occurring during exercise.



Alexander, R. W., R. C. Schlant, and V. Fuster, editors. The Heart. 9th ed. New York: McGraw-Hill, 1998.

Athletic Heart Syndrome

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