Why athletes young and old are not immune from heart issues

David Isbell, MD

Cardiology

When athletes experience a cardiac event, it can come as a shock. Doctors often recommend regular exercise as a building block to good heart health, so how can athletes, who exercise strenuously or sometimes professionally, suffer from such serious heart-related health issues?

David Isbell, MD, cardiologist with Prisma Health, answered a few of the most common questions about athletes and heart disease to give you a better idea of how to stay active while remaining heart healthy.

If you exercise regularly or if you are an athlete, are you safe from developing heart disease?

While regular exercise or athletic skills can help to protect you from heart disease, it’s not a surefire preventive.

Some heart conditions may be inherited, and some can exist undetected for years or even decades. Environment, diet, genetics and other risk factors may make you more likely to experience heart disease or problems with your heart regardless of your activity level.

Anyone with a strong family history of cardiovascular disease, or who has multiple risk factors for it, may benefit from regular heart exams to be sure it’s in optimal condition, especially as they age.

Are there changes athletes should make as they age to maintain heart health?

“The most important thing for an older athlete to remember is that they are not immune to developing heart disease,” Dr. Isbell said. “Exercise and physical fitness have been shown to reduce cardiovascular incidents across age groups, but concerns can still arise.”

Older athletes should get routine medical check-ups and be monitored by a physician for the development of issues like high blood pressure or elevated cholesterol, which tend to increase with age.

Even if an older athlete is asymptomatic (meaning they’ve never shown any signs or symptoms of heart disease), they may benefit from a baseline EKG and maximal exercise stress test just to be sure. This is doubly important if the athlete has a family history of cardiovascular disease.

Any aging athlete who suddenly experiences chest pain, shortness of breath or decreased exercise tolerance should see a specialist as soon as possible.

What are the most common heart issues among athletes?

For those over the age of 35, the most common cardiac conditions are about the same as those of the general population:

• Heart attacks caused by atherosclerosis (the thickening or hardening of arteries)
• Atrial fibrillation (an irregular heart rhythm)
• Congestive heart failure

For younger athletes, heart disease is seen less often but is still a possible concern. It may be genetic or become acquired over time.

“One of the most common genetic conditions in younger athletes is hypertrophic cardiomyopathy,” Dr. Isbell said. “It’s an inherited condition that affects about 1 in every 500 individuals, and the resulting irregular heart rhythm may result in sudden death.”

Other conditions like coronary artery anomalies (a defect you’re born with), arrhythmogenic right cardiomyopathy (a disease of the heart muscle) and electrical channel abnormalities (causing an irregular heartbeat) are far rarer but are sometimes encountered.

Environmental toxins and autoimmune diseases can also cause serious heart health concerns in otherwise healthy athletes.

Does COVID-19 infection affect heart health in athletes?

Infection with COVID-19 can affect the heart in a variety of ways, but the most serious complication is viral myocarditis.

“Myocarditis is characterized by inflammation of the heart muscle,” Dr. Isbell said. “It’s most frequently caused by a viral infection, like influenza, adenovirus (the common cold), and recently we’ve seen it occurring after COVID-19 infections.”

Among those who were hospitalized, cardiac injury has been shown in up to 20% of cases, and it seems to correspond with how severe the overall course of the illness was. For athletes, around 2–3% who were infected with COVID-19 have experienced myocarditis as a result of the virus.

Many athletic programs have developed specific diagnostic exams to help pinpoint which athletes who have contracted COVID-19 have developed cardiac injury. Fortunately, for the vast majority who are diagnosed, cases are mild and resolve without treatment. Adverse events are extremely rare.

Does a heart murmur in an athlete signal a more serious problem?

“Most heart murmurs discovered in athletes are considered benign, or ‘innocent’,” Dr. Isbell said. “Most benign murmurs have certain key differences from more serious ones – changes in timing, pitch, location or other characteristics.”

Intense physical training can lead the heart to ‘adapt’ itself to allow for increased blood flow. When the volume of blood goes up as the heart contracts, it can make the sound of the heart seem louder or more prominent during examination.

If an athlete is experiencing the symptoms of a heart murmur, it’s important to sit down with a specialist to discuss your concerns. They can often discover quickly whether the heart murmur is benign. An echocardiogram, a simple and noninvasive test, may be performed to exclude more serious conditions and help make sure the heart is performing normally.

Will a regular sports physical catch any possible issues? What should athletes do to make sure they are heart healthy?

Regular, routine sports physicals are an important tool to help identify athletes at risk. Generally, this physical involves putting together a detailed personal and family history as well as performing a physical exam.

If the athlete has certain risk factors (like sudden, premature cardiac death in a close relative or prior cardiovascular symptoms), further diagnostic testing may be required.

“Even with the most advanced testing, not all athletes at risk can be identified,” Dr. Isbell said. “It’s essential that athletic training facilities and venues have automated external defibrillators (or AEDs) and staff trained in life support and how to use these devices on site.”

Serious heart conditions are rare in athletes. About 10–12 million people in the United States are considered athletes, and only around .3% of them will be affected. Many of those who struggle with heart disease don’t have a family history or any warning signs.

To stay heart healthy, athletes should maintain regular routine sports physicals and be sure to share with their doctor any new or concerning issues, even if they seem small or explained by something else.