Exercise-Induced Cardiovascular Adaptations and Approach to Exercise and Cardiovascular Disease

Highlights

• Athletes may develop physiological adaptations found on ECG and imaging that may overlap with pathological conditions.

• ECG and imaging findings must be integrated with both the clinical history and other diagnostic testing to determine expected adaptions vs pathological abnormality.

• For athletes found to have asymptomatic and symptomatic cardiovascular disease, risk stratification must be considered before return to competitive sports participation.

• In contemporary clinical practice, a patient-centered SDM approach has become the accepted paradigm of treatment option discussions with patients.

Abstract

The role of the sports cardiologist has evolved into an essential component of the medical care of athletes. In addition to the improvement in health outcomes caused by reductions in cardiovascular risk, exercise results in adaptations in cardiovascular structure and function, termed exercise-induced cardiac remodeling. As diagnostic modalities have evolved over the last century, we have learned much about the healthy athletic adaptation that occurs with exercise. Sports cardiologists care for those with known or previously unknown cardiovascular conditions, distinguish findings on testing as physiological adaptation or pathological changes, and provide evidence-based and “best judgment” assessment of the risks of sports participation. We review the effects of exercise on the heart, the approach to common clinical scenarios in sports cardiology, and the importance of a patient/athlete-centered, shared decision-making approach in the care provided to athletes.