DR REGINALD LIEW, senior consultant cardiologist at The Harley Street Heart and Vascular Centre, tells us why apparently healthy individuals, including athletes, aren’t exempt from heart diseases like cardiac arrhythmia or an enlarged heart. Plus, how tests like ECG (or electrocardiogram) can help.
Maintaining a good exercise routine has plenty of health benefits, but there’s a paradox. Excessive stress on the heart, especially if you have an underlying heart condition, can increase the risk of a cardiac event.
Thanks to smartwatches and wearable devices, more people are now detecting abnormalities that serve as early warning signs. Media attention on athletes like Christian Eriksen’s collapse at Euro 2020 and Sergio Aguero’s early retirement due to cardiac arrhythmia also further raised awareness of this issue.
The link between fit individuals and heart conditions like cardiac arrhythmia
Common heart conditions like heart attack, heart failure and stroke are often linked to poor lifestyle factors such as smoking, obesity and a poor diet. However, there are other heart conditions that may not be related to these factors. Instead, they may result from genetic disorders, heart muscle disorders, heart rhythm disorders and inflammation. Athletes and apparently fit people can have these heart conditions that may present themselves for the first time when exercising.
Cardiac arrhythmia – a type of heart disorder that cause the heart to beat abnormally fast, slow or in an erratic way – is common among those with underlying heart conditions but can also present in healthy individuals. Prolonged stress on the heart, like endurance training and long-distance cycling, is believed to contribute to excessive heart strain and an enlarged heart, raising the risk of cardiac arrhythmia.
Symptoms of heart disease
- Erratic heartbeats or excessively fast heart rates, which may persist even during recovery
- Dizziness, lightheadedness or collapse
- Chest pain during exertion
- Excessive breathlessness during exercise
Athletes often know their bodies well and should be attuned to sudden performance drops or changes in their smartwatch parameters. Classic heart disease symptoms like heavy breathing or chest tightness when walking briskly may not apply to athletes, who may experience subtler changes.
Spotting a serious cardiac problem
Watch out for the above symptoms, stop exercising if you encounter any of them, and seek medical help! I also recommend seeing a doctor if you have any cardiac risk factors or notice an abnormal heart rhythm or skipped beats. You should have a medical check-up (that includes examination and ECG tests) prior to participating in heavy exercise, especially if you haven’t trained in a long time.
Too much exercise?
Excessive exercise may cause the blood pressure and heart rate to go up too quickly if the person has underlying coronary artery disease, heart muscle disorder or a history of hypertension. In those who exercise regularly, prolonged intense aerobic activity can raise the risk of cardiac problems. These include atrial fibrillation and an enlarged heart. Lifelong endurance athletes may develop more heart scar tissue and stiffer heart muscle and blood vessels. These can increase their chances of heart diseases later in life.
The relationship between exercise amount and cardiac problems appears to follow a U- or J-shaped curve. People who don’t exercise have a higher risk, moderate exercisers have low risk, and those who exercise all the time may have a slightly higher risk.
ECG tests and heart screenings for cardiac arrhythmia
I recommend athletes get a baseline medical check-up and ECG test. Depending on initial results, the doctor may recommend an echocardiogram and exercise treadmill test. In some cases, a CT scan of the heart may be useful to look for blockages or unusual anatomy of the coronary arteries. Those above the age of 50 with cardiac risk factors should certainly have an annual check-up.
Those who are into endurance sports would benefit from a cardiopulmonary exercise test (CPET). It assesses cardiovascular and respiratory responses to exercise and helps to determine fitness levels and anaerobic threshold. Over time and with training, this number can improve.
The Harley Street Heart and Vascular Centre (Gleneagles Hospital)
#02-38/41 Annexe Block, 6A Napier Road
6472 3703 | harleystreet.sg
This article first appeared in the June 2024 edition of Expat Living. You can purchase the latest issue or subscribe so you never miss a copy!
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