Athlete’s heart symptoms

Heart symptoms: when do you need to worry?

An athlete’s heart is often under heavy stress, and it is important to take good care of its health. Suspected heart symptoms are a typical reason to visit the doctor or an emergency unit. The situation is often challenging to the doctor because similar symptoms can be caused by many other conditions, not just heart diseases. Many kinds of examinations are often needed before the diagnosis is certain.

The most typical symptoms of a heart condition include chest pain, arrhythmia, disturbance in consciousness and reduced performance. It is particularly important for an athlete to identify a symptom indicating a heart condition in order to have the issue examined in good time.

Chest pain

All people have chest pain at some point in their lives, and it is usually caused by a harmless complication. However, not all of the pain felt in and around the heart is cardiac in nature. Generally, chest pain is caused by something in the musculoskeletal system. The reason may be muscle pain caused by, for example, overexertion or injury. The pain can spread through the neural system: an issue in the intervertebral foramen of the cervical spine can be felt on the chest. An issue in the upper back or the neck-shoulder area may occur as chest pain.

The most likely cause of the pain can be deduced from the nature of the symptoms. If the pain worsens when you make certain movements, the issue is likely to be in the musculoskeletal system. If the pain worsens in a front-leaning or lying position or after eating, the issue may be related to the oesophagus.

The probability of a coronary artery disease grows with age. Chest pain in a twenty-something athlete is very rarely caused by coronary artery disease, but for a fifty-year-old this is obviously possible. Symptoms of the coronary artery disease usually worsen during exertion and are alleviated after a few minutes’ rest. The pain often spreads across the body, while pain in the musculoskeletal system is generally local. Coronary artery disease often causes constrictive pain or a feeling of weight on the chest. The probability of coronary artery disease increases if you have any risk factors associated with it, such as high blood pressure or extensive family history.

Myocarditis is often related to a febrile respiratory infection. The infection is often in the pericardium and cardiac muscle. A classical symptom is sharp chest pain that worsens during inhalation and when changing position. According to studies, this is not nearly always the case; the pain can be constrictive, for example. An athlete should promptly seek treatment if they start feeling chest pain in connection with a respiratory infection, particularly if a feeling of arrhythmia is involved.

An athlete should consider seeking treatment if they have chest pain that occurred quickly, gets worse through exertion or is related to a respiratory infection. A cardiologist’s assessment is often needed unless the cause is obvious after an interview with a doctor, a clinical examination and laboratory tests, or if there is a reason to suspect a heart condition.

Shortness of breath (dyspnoea)

Shortness of breath during exertion is normal. Many diseases manifest themselves as abnormal shortness of breath. Asthma is probably the most common cause for shortness of breath that limits an athlete’s capacity. Cardiomyopathy, coronary artery disease and valve disorder may manifest themselves as exertion-related shortness of breath.

Usually, cardiomyopathy is suspected when the attending physician diagnoses anomalies in the ECG. Some cardiomyopathy conditions are hereditary, which is why it is important for the athlete to provide information on any heart diseases of close relatives during health examinations. If cardiomyopathy occurs in close relatives, an ultrasound examination is in order. Coronary artery disease can manifest itself as shortness of breath, occurring when a certain strain level is reached and receding quickly in rest. A stress test may be needed to analyse the situation. A valve disorder usually causes heart murmur, and a cardiologist can easily confirm the diagnosis with an ultrasound examination.

If shortness of breath occurred quickly or gets gradually worse, further examinations are required. A cardiological assessment is needed if the cause cannot be determined with laboratory tests, MRI images or functional capacity tests of the lungs or if the attending doctor suspects a heart disease.

Arrhythmias

Everybody has cardiac arrhythmias. In long-term ECG monitoring (Holter examination), adults typically experience a few dozen atrial and ventricular extrasystoles within 24 hours. The number grows as they age. Most arrhythmias are harmless but they can cause irritating symptoms.

It is usually not possible to treat an athlete’s arrhythmia with medicine because the commonly used beta blocker medication slows down the patient’s heart rate and reduces their performance capacity. In the best case, arrhythmia can be cured by invasive treatment, or catheter ablation. The most important thing for an athlete is to find out whether the arrhythmia is harmless or potentially harmful.

Arrhythmia may not necessarily involve any symptoms. Most people describe the symptoms caused by extrasystoles as a kind of jumps in the chest or a similar feeling of irregular pulse. Another common symptom of arrhythmia is the feeling of palpitation. Palpitation induced by arrhythmia generally starts very suddenly and often ends suddenly, too. Gaps in heartbeats or an abnormally slow rhythm may cause sudden dizziness or a feeling of your eyes blackening. The patient may also lose consciousness.

Extrasystoles are usually harmless but numerous ventricular extrasystoles are a reason to attend further cardiological examinations. Numerous atrial extrasystoles expose the patient to atrial fibrillation. An athlete should attend a heart ultrasound examination in case they are diagnosed with atrial fibrillation or atrial flutter.

Family background is examined when analysing arrhythmia. There may be hereditary heart conditions, such as the long QT syndrome which may predispose the patient to sudden death. This is why they may not be allowed to do competitive sports. ECG is an important examination, but it rarely provides hints at the nature of the disorder if the monitoring occurs during the phase with no symptoms. However, a normal ECG may reveal an extra electrical pathway between atria and ventricles. Long-term ECG monitoring is often needed to clarify the situation. In recent years, many alternatives for a regular Holter examination have entered the market, and mobile solutions are available as well. They are more helpful in diagnosing more rarely occurring arrhythmias.

If an athlete has a feeling of arrhythmia, this generally requires further examinations. There are exceptions such as the rarely occurring feeling of a jump in the chest or a similar symptom indicating a moderate case of premature heartbeats. A cardiologist is often needed to help analyse arrhythmia. Symptoms of concern include arrhythmias that started quickly, occur frequently, worsen through exertion or are associated with a respiratory infection. This also applies to disturbances in consciousness, including the feeling of blackening in the eyes, occurring as a new symptom. However, one exception to this is the feeling of dizziness or weakness when standing up quickly; it is usually caused by decreasing blood pressure (orthostatic symptom), which is a benign occurrence.

Reduced performance

Many kinds of problems occur when an athlete’s performance capacity decreases. At first, the trainer, sports physician and other experts usually work together to address the issue. However, one should keep in mind the possibility of a heart disease if no other obvious reason can be determined. Many heart issues can lead to reduced performance. These include conditions such as certain types of arrhythmia, coronary arterial disease, valvular diseases and cardiomyopathy. Diagnosis of an abnormal ECG or heart murmur increases the probability of a heart defect. Quickly reduced performance capacity after a respiratory infection may indicate myocarditis.

Cardiologist services

A heart disease may involve various symptoms. Many other diseases can cause similar symptoms, which makes diagnosing the disease more difficult. Simple anaemia caused by iron deficiency may be the reason for a reduced performance capacity and shortness of breath associated with exertion.

If heart symptoms are suspected, it is worthwhile carrying out basic examinations at first, including

• an interview conducted by a doctor (nature of symptoms, in which time period did they manifest themselves, etc.)
• listening to the heart and lungs (asthma wheeze, heart murmur) and
• laboratory tests (including ECG).

Depending on the situation, an MRI image of the lungs and heart and functional tests of the lungs are taken as well.

A cardiologist’s assessment is often needed, particularly in case of diagnostic problems. An athlete should seek a cardiologist’s help on relatively light grounds.

Text: Kjell Nikus, Professor of Cardiology, Doctor of Medicine, Specialist in internal medicine and cardiology, Heart Hospital