Athlete’s heart
1. Which of the following ECG findings is most characteristic of Athlete’s Heart?
✅ Explanation: Sinus bradycardia is a hallmark finding in well-trained athletes due to increased vagal tone. It is considered a physiological adaptation.
2. Which echocardiographic feature best differentiates Athlete’s Heart from hypertrophic cardiomyopathy (HCM)?
✅ Explanation: Athlete’s heart typically shows increased LV cavity size, while HCM presents with smaller LV cavity and abnormal diastolic filling.
3. Which hormone plays a major role in cardiac remodeling seen in Athlete’s Heart?
✅ Explanation: IGF-1 mediates physiological hypertrophy through the PI3K-Akt pathway, promoting adaptive cardiac remodeling in athletes.
4. In Athlete’s Heart, what happens to the resting stroke volume?
✅ Explanation: Resting stroke volume increases due to enhanced cardiac compliance and chamber dilation, contributing to lower resting heart rate.
5. Which of the following is TRUE about left ventricular (LV) mass in Athlete’s Heart?
✅ Explanation: Physiological adaptation includes proportional LV mass increase with training intensity and athlete body size.
6. What structural cardiac adaptation is most typical in endurance athletes?
✅ Explanation: Endurance training leads to eccentric hypertrophy due to increased volume load, resulting in chamber dilation and mild wall thickening.
7. Which of the following is LEAST likely in an athlete with physiological cardiac adaptation?
✅ Explanation: A reduced ejection fraction <45% is not typical in athlete’s heart and suggests pathology. Physiological adaptations maintain or slightly increase EF.
8. What is the significance of early repolarization pattern on ECG in athletes?
✅ Explanation: Early repolarization with J-point elevation is common and benign in athletes, often reflecting increased vagal tone.
9. Which imaging modality is most useful to distinguish athlete’s heart from HCM?
✅ Explanation: Cardiac MRI provides detailed structural assessment and tissue characterization, helping differentiate physiological from pathological hypertrophy.
10. Athlete’s heart is more likely to regress with:
✅ Explanation: Athlete’s heart regresses with detraining or deconditioning, confirming its reversible and physiological nature.
11. What is the expected pattern of left atrial size in athlete’s heart?
✅ Explanation: Athlete’s heart may include mild to moderate LA enlargement due to increased preload, but function remains preserved.
12. The typical heart rate variability in athletes is:
✅ Explanation: Trained athletes often have increased heart rate variability due to autonomic balance favoring parasympathetic tone.
13. Which demographic is more likely to develop marked athletic cardiac remodeling?
✅ Explanation: Male endurance athletes have the highest degree of physiological remodeling due to training intensity and hormonal factors.
14. Which change is seen in the right ventricle of endurance athletes?
✅ Explanation: The right ventricle may show mild dilatation with preserved function, part of the balanced physiological adaptation in athletes.
15. What is a red flag for pathological hypertrophy rather than athlete’s heart?
✅ Explanation: Asymmetrical septal hypertrophy is characteristic of HCM and not seen in physiological athletic adaptations.
16. Which ECG change would raise suspicion of underlying pathology in an athlete?
✅ Explanation: T-wave inversion in lateral leads may indicate cardiomyopathy or other pathology, not typical for benign athletic adaptations.
17. What physiological effect allows trained athletes to have lower resting HR?
✅ Explanation: Resting bradycardia in athletes results from increased parasympathetic (vagal) activity and high stroke volume.
18. VO2 max is typically:
✅ Explanation: VO2 max increases with aerobic training due to improvements in cardiac output, capillary density, and mitochondrial efficiency.
19. Athlete’s heart most commonly affects which chambers?
✅ Explanation: Cardiac remodeling in athlete’s heart often affects all four chambers, especially in endurance sports.
20. After how many weeks of detraining can athlete’s heart begin to regress?
✅ Explanation: Reversal of cardiac adaptations can begin as early as 4–6 weeks of detraining, confirming its physiological nature.
21. In athlete’s heart, which echocardiographic feature is most commonly observed?
A. Increased left ventricular cavity size
B. Decreased ejection fraction
C. Right ventricular hypokinesia
D. Thickened mitral valve leaflets
22. Which of the following is typically absent in athlete’s heart but present in pathological hypertrophy?
A. Diastolic dysfunction
B. Mild LV wall thickening
C. Resting bradycardia
D. Increased stroke volume
23. A key differentiating test between athlete’s heart and cardiomyopathy is:
A. Deconditioning with repeat imaging
B. Chest X-ray
C. Serum troponin level
D. 24-hour urine protein
24. Athlete’s heart typically shows which pattern on ECG?
A. Sinus bradycardia and voltage criteria for LVH
B. Prolonged QT interval
C. Frequent ventricular ectopy
D. Delta wave
25. Which of the following supports a diagnosis of athlete’s heart over hypertrophic cardiomyopathy?
A. Symmetric wall thickening with normal diastolic function
B. Family history of sudden cardiac death
C. Asymmetric septal hypertrophy
D. Presence of late gadolinium enhancement on MRI
20-Point Summary Table: Athlete’s Heart
| 🔢 No. | 📘 Topic | Athlete’s heart🧠 Key Point |
|---|---|---|
| 1️⃣ | Definition | Athlete’s heart is a benign, adaptive increase in cardiac size and function due to long-term endurance or strength training. |
| 2️⃣ | Cause | Physiological remodeling from regular intensive aerobic or anaerobic exercise. |
| 3️⃣ | Types of Training | Endurance (e.g., running) → volume overload; Strength (e.g., weightlifting) → pressure overload. |
| 4️⃣ | LV Cavity | Dilated in endurance athletes; concentric hypertrophy in strength athletes. |
| 5️⃣ | LV Wall Thickness | Mildly increased, but usually ≤13 mm. |
| 6️⃣ | RV Changes | Right ventricular enlargement may occur, often proportional to LV changes. |
| 7️⃣ | Resting Heart Rate | Often bradycardia (<60 bpm) due to high vagal tone. |
| 8️⃣ | ECG Findings | Sinus bradycardia, 1st-degree AV block, early repolarization, voltage criteria for LVH. |
| 9️⃣ | VO₂ Max | Increased significantly due to better cardiac output and peripheral efficiency. |
| 🔟 | Stroke Volume | Increased both at rest and during exercise. |
| 1️⃣1️⃣ | Diastolic Function | Normal or enhanced; helps differentiate from pathological hypertrophy. |
| 1️⃣2️⃣ | LA Enlargement | Mild left atrial enlargement may be seen due to increased preload. |
| 1️⃣3️⃣ | Ejection Fraction (EF) | Normal or mildly reduced at rest, but increases with exercise. |
| 1️⃣4️⃣ | NT-proBNP/Troponin | May be mildly elevated post-exercise but returns to normal—distinguishes from pathology. |
| 1️⃣5️⃣ | Reversibility | Changes regress within 3–6 months of detraining. |
| 1️⃣6️⃣ | Differentiation from HCM | No family history, symmetric hypertrophy, normal diastolic function, regression with detraining. |
| 1️⃣7️⃣ | Symptoms | Usually asymptomatic; no exertional syncope, angina, or breathlessness. |
| 1️⃣8️⃣ | Echocardiography Role | Key tool to differentiate from cardiomyopathy—assesses wall thickness, cavity size, function. |
| 1️⃣9️⃣ | MRI Findings | Normal tissue characteristics, no fibrosis or LGE (Late Gadolinium Enhancement). |
| 2️⃣0️⃣ | Prognosis | Excellent; associated with reduced cardiovascular risk and improved longevity. |
Athlete’s Heart vs Hypertrophic Cardiomyopathy (HCM) — Comparison Table
| 🔢 No. | 🔍 Feature | 🏃♂️ Athlete’s Heart | ❌ Hypertrophic Cardiomyopathy (HCM) |
|---|---|---|---|
| 1️⃣ | Etiology | Physiological adaptation to training | Genetic disorder (AD; MYH7, MYBPC3 mutations) |
| 2️⃣ | LV Wall Thickness | Mild increase (usually ≤13 mm) | Often >15 mm (especially septal) |
| 3️⃣ | Pattern of Hypertrophy | Symmetrical | Asymmetrical (septal > posterior wall) |
| 4️⃣ | LV Cavity Size | Normal or increased | Normal or decreased |
| 5️⃣ | Diastolic Function | Normal or enhanced | Often impaired |
| 6️⃣ | Systolic Function | Normal EF, ↑ during exercise | Normal or hyperdynamic EF, ↓ with obstruction |
| 7️⃣ | Regression with Detraining | Yes (within months) | No regression |
| 8️⃣ | ECG Findings | Bradycardia, voltage criteria for LVH, early repolarization | LVH, T-wave inversion, Q waves, arrhythmias |
| 9️⃣ | Family History | Negative | Positive in ~60% |
| 🔟 | Symptoms | Asymptomatic | May have syncope, angina, palpitations, dyspnea |
| 1️⃣1️⃣ | Risk of Sudden Cardiac Death (SCD) | Very low | High, especially in young athletes |
| 1️⃣2️⃣ | Fibrosis on Cardiac MRI | Absent | Often present (Late Gadolinium Enhancement) |
| 1️⃣3️⃣ | NT-proBNP / Troponin Levels | Mild transient rise post-exercise | May be persistently elevated |
| 1️⃣4️⃣ | LA Size | Mildly enlarged | Often enlarged |
| 1️⃣5️⃣ | LVOT Obstruction | Absent | May be present (dynamic) |
| 1️⃣6️⃣ | Response to Exercise | Normal or supernormal | Limited by obstruction or arrhythmia |
| 1️⃣7️⃣ | Genetic Testing | Not indicated | Useful for diagnosis and family screening |
| 1️⃣8️⃣ | Tissue Doppler Imaging | Normal E’ velocity | ↓ E’ velocity (diastolic dysfunction) |
| 1️⃣9️⃣ | Management | Reassurance, monitor if unclear | Lifestyle restriction, beta-blockers, ICD if needed |
| 2️⃣0️⃣ | Prognosis | Excellent, improves fitness and longevity | Risk of SCD; lifelong monitoring needed |
Image Question-56
What is the name of the wave marked by arrow? [A] L wave[B] M wave[C] R wave[D] Y wave L-wave in Transmitral flow Doppler waves is a marker of [A] Advanced diastolic dysfunction[B] Advanced systolic dysfunction[C] Improved diastolic dysfunction
