title: The hearts of competitive athletes: an up-to-date overview of exercise-induced cardiac adaptations.
abstract: Intense and regular physical exercise is responsible for various cardiac changes (electrical, structural and functional) that represent physiological adaptation to exercise training. This remodeling, commonly referred to as 'athlete's heart', can overlap with several pathological entities, in which sudden cardiac death may be the first clinical presentation. Although pre-competitive screening can identify athletes with life-threatening cardiovascular abnormalities, there are no widely used standardized pre-participation programs and those currently implemented are controversial. Data from personal and family history, features of physical examination and changes in the 12-lead electrocardiogram can raise the suspicion of cardiac disease and lead to early detection of entities such as hypertrophic cardiomyopathy. However, interpreting the electrocardiogram is often challenging, because some changes are considered physiological in athletes. Thus, clinical decision-making in such cases can prove difficult: missing a condition associated with an increased risk of life-threatening events, or conversely, mislabeling an athlete with a disease that leads to unnecessary disqualification, are both situations to avoid. This paper provides an up-to-date review of the physiological cardiac effects of exercise training and highlights key points that should be taken into consideration in the assessment of young competitive athletes.
authors.affiliation: Hospital das Forças Armadas, Lisboa, Portugal; Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal. Electronic address: heldores@hotmail.com.
authors.forename: Hélder
authors.initials: H
authors.lastname: Dores
authors.affiliation: Centro de Medicina Desportiva de Lisboa, Lisboa, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Freitas
authors.affiliation: Department of Cardiovascular Sciences - St. George's University of London, London, United Kingdom.
authors.forename: Aneil
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
authors.affiliation: Department of Cardiovascular Sciences - St. George's University of London, London, United Kingdom.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000222:Adaptation, Physiological; D056352:Athletes; D015444:Exercise; D006321:Heart / Q000502:physiology*; D006801:Humans
keywords: Adaptação fisiológica; Athlete's heart; Coração de atleta; Morte súbita; Physiological adaptation; Rastreio; Screening; Sudden cardiac death