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Fizička kultura
2018, vol. 72, iss. 2, pp. 139-147
article language: Serbian, English
document type: Review Paper

Creative Commons License 4.0
Athlete's heart
aUniversity of Belgrade, Faculty of Pharmacy
bUniversity of Belgrade, Faculty of Sports and Physical Education
cUniversity of Belgrade, Faculty of Medicine
dUniverzitet u Ilinoisu, Koledž primenjenih zdravstvenih nauka, Odeljenje za fizikalnu terapiju, Čikago, SAD
eUniverzitet u Beogradu, Farmaceutski fakultet + Klinički centar Srbije, Klinika za kardiologiju



The athlete's heart is a set of morphological and functional characteristics that develop over time due to sports training. These adaptive changes result in increase in cardiac work efficiency and economy. They are manidested as cardiac muscle hypertrophy and dilation, with accompanying angiogenesis and slower heart rate, that are influenced by variable regulatory systems and genetic predisposition. The problem of sudden cardiac death in athletes, which persists despite numerous activities aimed at prevention, creates the need for a better definition of the athlete's heart, especially in terms of its differentiation from certain pathological conditions. This is of particular importance in the context of cardiac electrical activity. Right heart adaptations, hormonal regulatory mechanisms and the effects of nonphysiological adaptations during training, that may lead to pathologic alterations direction, are all relevant in the investigation of adverse cardiac events in athletes. In order to prevent sudden cardiac death in athletes, it is necessary to examine competitive athletes as well as apparently health individuals who recreationally exercise at a high volume. There are guidelines for mass screening and individual examinations, for all age groups and both genders, as well as for public service staff who require intense physical activity during their occupation. Both American and European recommendations require a detailed anamnesis and physical examination, whereas European, apart from that, require initial electrocardiography. The implementation of additional tests is necessary if the existence of any underlying pathophysiologic process is suspected. Checks should be performed before engaging in sports activities, as well as during training and competition periods.


morpho-functional changes; sudden cardiac death; prevention; recommendations


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Beaudry, R., Haykowsky, M.J., Baggish, A. & La Gerche, A. (2016). A Modern Definition of the Athlete’s Heart-for Research and the Clinic. Cardiology Clinics, 34(4), 507 - 14.
D’Andrea, A., Riegler, L., Golia, E., Cocchia, R., Scarafile, R., Salerno, G., et al. (2013). Range of right heart measurements in top-level athletes: The training impact. International Journal of Cardiology, 164(1), 48 - 57.
Dickhuth, H.H., Röcker, K., Mayer, F., König, D. & Korsten-Reck, U. (2004). Endurance training and cardiac adaptation (athlete’s heart). Herz, 29(4), 373 - 80.
Dong, J.G. (2016). The role of heart rate variability in sports physiology. Experimental and Therapeutic Medicine, 11(5), 1531 - 6.
Douglas, P.S., O'Toole, M.L., Katz, S.E., Ginsburg, G.S., Hiller, W.D. & Laird, R.H. (1997). Left ventricular hypertrophy in athletes. American Journal of Cardiology, 80(10), 1384 - 8.
Kaşıkcıoğlu E. (2011). The incognita of the known: the athlete’s heart syndrome. The Anatolian Journal of Cardiology, 11(4), 351 - 9.
Lee, P.T., Dweck, M.R., Prasher, S., Shah, A., Humphries, S.E., Pennell, D.J., et al. (2013). Left ventricular wall thickness and the presence of asymmetric hypertrophy in healthy young army recruits: data from the LARGE heart study. Circulation: Cardiovascular Imaging, 6(2), 262 - 7.
Levine, B.D. (2001). Exercise Physiology for The Clinician. U P.D. Thompson (ur.) Exercise &Sports Cardiology (str. 3-30). Singapore: Mc-Graw-Hill.
Major, Z., Csajági, E., Kneffel, Z., Kováts, T., Szauder, I., Sidó, Z. & Pavlik, G. (2015). Comparison of left and right ventricular adaptation in endurance-trained male athletes. Acta Physiologica Hungarica, 102(1), 23 - 33.
Maron, B.J. (2015). Historical Perspectives on Sudden Deaths in Young Athletes with Evolution over 35 Years. American Journal of Cardiology, 116(9), 1461 - 8.
Maron, B.J., Levine, B.D., Washington, R.L., Baggish, A.L., Kovacs, R.J. & Maron, M.S. (2015). Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 2: Preparticipation Screening for Cardiovascular Disease in Competitive Athletes: A Scientific Statement From the American Heart Association and American College of Cardiology. Journal of the American College of Cardiology 66(21), 2356 - 61.
Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D., et all (2007). Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation, 115(12), 1643 - 455.
Mitchell, J.H., Haskell, W., Snell, P. & Van Camp, S.P. (2005). Task Force 8: Classification of sports. Journal of the American College of Cardiology, 45(8), 1364 - 7.
Nakamura, F.Y., Soares-Caldeira, L.F., Laursen, P.B., Polito, M.D., Leme, L.C. & Buchheit, M. (2009). Cardiac autonomic responses to repeated shuttle sprints. International Journal of Sports Medicine, 30(11), 808 - 13.
Naylor, L.H., George, K., O’Driscoll, G. & Green, D.J. The athlete’s heart: a contemporary appraisal of the ‘Morganroth hypothesis’. (2008). Sports Medicine, 38(1), 69 - 90.
Oliva, A., Grassi, V.M., Campuzano, O., Brion, M., Arena, V., Partemi, S., et al. (2017). Medico-legal perspectives on sudden cardiac death in young athletes. International Journal of Legal Medicine, 131(2), 393 - 409.
Oxborough, D., Heemels, A., Somauroo, J., Mc-Clean, G., Mistry, P., Lord, R., et al. (2016). Left and right ventricular longitudinal strain-volume/ area relationships in elite athletes. The International Journal of Cardiovascular Imaging, 32(8), 1199 - 211.
Oxborough, D., Sharma, S., Shave, R., Whyte, G., Birch, K., Artis, N., et al. (2012). The right ventricle of the endurance athlete: the relationship between morphology and deformation. Journal of the American Society of Echocardiography, 25(3), 263 - 71.
Pelliccia, A., Culasso, F., Di Paolo, F.M. & Maron, B.J. (1999). Physiologic left ventricular cavity dilatation in elite athletes. Annals of Internal Medicine, 130(1), 23 - 31.
Pelliccia, A., Maron, B.J., Spataro, A., Proschan, M.A. & Spirito, P. (1991). The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. The New England Journal of Medicine, 324(5), 295 - 301.
Pelliccia, A., Adami, P.E. (2017). The Female Side of the Heart: Sex Differences in Athlete’s Heart. JACC: Cardiovascular Imaging, 10(9), 973 - 5.
Pelliccia, A., Maron, B.J., Culasso, F., Spataro, A. & Caselli, G. (1996). Athlete’s heart in women. Echocardiographic characterization of highly trained elite female athletes. JAMA, 276(3), 211 - 5.
Perseghin, G., De Cobelli, F., Esposito, A., Lattuada, G., Terruzzi, I., La Torre, A., et al. (2007). Effect of the sporting discipline on the right and left ventricular morphology and function of elite male track runners: A magnetic resonance imaging and phosphorus 31 spectroscopy study. American Heart Journal, 154(5), 937 - 42.
Pluim, B.M., Zwinderman, A.H., Laarse, A., et al. (1999). The Athlete's Heart. A Meta - Analysis of Cardiac Structure and Function. Circulation, 100, 336 - 44.
Popovic, D., Mazic, S., Nešić, D., Velkovski, S., Stojiljković, S., Mijić, N., et al. (2007). Sindrom sportskog srca. Srpski arhiv za celokupno lekarstvo, 135(3-4), 222 - 9.
Popovic, D., Mazic, S., Djordjevic - Dikic, A., et al. (2004). Echocardiographic cardiac measurements in male elite basketball players of national level. Flemish Journal of Sports Medicine and Sports Science, 98, 17 - 22.
Popovic, D., Damjanovic, S., Markovic, V., Vujisic-Tesic, B., Petrovic, M., Nedeljkovic, I., et al. (2011). Systolic right ventricular adaptive changes in athletes as predictors of the maximal functional capacity: a pulsed tissue Doppler study. The Journal of Sports Medicine and Physical Fitness, 51(3), 452 - 61.
Popovic, D., Ostojic, M.C., Popovic, B., Petrovic, M., Vujisic-Tesic, B., Kocijancic, A., et al.. (2013). Brain natriuretic peptide predicts forced vital capacity of the lungs, oxygen pulse and peak oxygen consumption in physiological condition. Peptides, 43, 32 - 9.
Popovic, D., Plecas-Solarovic, B., Pesic, V., Petrovic, M., Vujisic-Tesic, B., Popovic, B., et al. (2014). How does stress possibly affect cardiac remodeling? Peptides, 57, 20 - 30.
Prakken, N.H., Velthuis, B.K., Bosker, A.C., Mosterd, A., Teske, A.J., Mali, W.P. & Cramer, M.J. (2011). Relationship of ventricular and atrial dilatation to valvular function in endurance athletes. British Journal of Sports Medicine, 45(3), 178 - 84.
Priori, S.G., Blomström-Lundqvist, C., Mazzanti, A., Blom, N., Borggrefe, M., Camm, J., et al., ESC Scientific Document Group. (2015). 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). European Heart Journal, 36(41), 2793 - 867.
Puffer, J.C. (2001). Overview of the athletic heart syndrome. U P.D. Thompson (ur.), Exercise & Sports Cardiology. (str. 30-42). Singapore: Mc-Graw-Hill.
Neri Serneri, G.G., Boddi, M., Modesti, P.A., Cecioni, I., Coppo, M., Padeletti, L., et al. (2001). Increased Cardiac Sympathetic Activity and Insulin - Like Growth Factor - I Formation Are Associated with Physiological Hypertrophy in Athletes. Circulation Research, 89(11), 977 - 82.
Sharma, S., Drezner, J.A., Baggish, A., Papadakis, M., Wilson, M.G., Prutkin, J.M. et al. (2017). International Recommendations for Electrocardiographic Interpretation in Athletes. Journal of the American College of Cardiology, 69(8), 1057 - 75.
Sharma, S., Merghani, A. & Mont, L. (2015). Exercise and the heart: the good, the bad, and the ugly. European Heart Journal, 36(23), 1445 - 53.
Silva, J.A.Jr., Santana, E.T., Manchini, M.T., Antônio, E.L., Bocalini, D.S., Krieger, J.E., et al. (2014). Exercise training can prevent cardiac hypertrophy induced by sympathetic hyperactivity with modulation of kallikrein-kinin pathway and angiogenesis. PLoS One, 9(3), e91017.
Sanchis, L., Sanz-de La Garza, M., Bijnens, B., Giraldeau, G., Grazioli, G., Marin, J., et al. (2017). Gender influence on the adaptation of atrial performance to training. European Journal of Sport Science, 17(6), 720 - 6.
Teske, A.J., Prakken, N.H., De Boeck, B.W.L., Velthuis, B.K., Doevendans, P.A. & Cramer, M.J.M. (2009). Effect of long term and intensive endurance training in athletes on the age-related decline in left and right ventricular diastolic function as assessed by Doppler echocardiography. American Journal of Cardiology, 104(8), 1145 - 51.
The International Olympic Committee (IOC) Consensus Statement on Periodic Health Evaluation of Elite Athletes: March 2009 (2009). Jurnal of athletic training, 44(5), 538-557.
Thomas, L.R. & Douglas, P.S. (2001). Echocardiographic findings in athletes. U P.D. Thompson (ur.), Exercise & Sports Cardiology. (str. 43-70). Singapore: McGraw-Hill.
Toufan, M., Kazemi, B., Akbarzadeh, F., Ataei, A. & Khalili, M. (2012). Assessment of electrocardiography, echocardiography, and heart rate variability in dynamic and static type athletes. International Journal of General Medicine, 5, 655 - 60.
Fagard, R.H. (1992). Impact of different sports and training on cardiac structure and function. Cardiology Clinics, 10, 241 - 56.
Hainline, B., Drezner, J.A., Baggish, A., Harmon, K.G., Emery, M.S., Myerburg, R.J., et al. (2016). Interassociation consensus statement on cardiovascular care of college student-athletes. Journal of the American College of Cardiology, 51(4), 344 - 57.
Calore, C., Zorzi, A., Sheikh, N., Nese, A., Facci, M., Malhotra, A., et al. (2015). Electrocardiographic anterior T-wave inversion in athletes of different ethnicities: differential diagnosis between athlete’s heart and cardiomyopathy. European Heart Journal, 37(32), 2515 - 27.
Corrado, D., Pelliccia, A., Heidbuchel, H., Sharma, S., Link, M., Basso, C., et al. (2010). Recommendations for interpretation of 12-lead electrocardiogram in the athletes. European Heart Journal, 31(2), 243 - 59.