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Physiologic and pathophysiologic changes in the right heart in highly trained athletes

Physiologische und pathophysiologische Auswirkungen auf das rechte Herz bei Leistungssportlern

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Abstract

Exercise causes changes in the heart in response to the hemodynamic demands of increased systemic and pulmonary requirements during exercise. Understanding these adaptations is of great importance, since they may overlap with those caused by pathological conditions. Initial descriptions of athlete’s heart focused mainly on chronic adaptation of the left heart to training. In recent years, the substantial structural and functional adaptations of the right heart have been documented, highlighting the complex interplay with left heart. Moreover, there is evolving evidence of acute and chronic cardiac damage, mainly involving the right heart, which may predispose subjects to atrial and ventricular arrhythmias, configuring an exercise-induced cardiomyopathy. The aim of this article is to review the current knowledge on the physiologic and pathophysiologic changes in the right heart in highly trained athletes.

Zusammenfassung

Unter sportlicher Hochleistung werden Kreislauf und Lunge besonders beansprucht. Die damit einhergehenden physiologischen Vorgänge können Überschneidungen zu pathologischen Veränderungen unter Krankheitsbedingungen aufweisen. Beim Sportherz wurde das Augenmerk bislang auf akute und chronische Veränderungen des systemischen Kreislaufs und des linken Herzens gerichtet. Erst in den letzten Jahren wurden Veränderungen des rechten Herzens und die Interaktion mit dem linken Herzen näher untersucht. So kommt es unter pathophysiologischen Bedingungen zu rechtskardialen Veränderungen, die zu atrialen und ventrikulären Arrhythmien prädisponieren, welche das Bild einer durch Leistungssport hervorgerufenen Kardiomyopathie prägen können. Dieser Beitrag fasst die bisher bekannten physiologischen und pathophysiologischen Vorgänge am rechten Herzen und im kleinen Kreislauf bei Leistungssportlern zusammen.

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Compliance with ethical guidelines

Conflict of interest. A. D’Andrea, A. La Gerche, E. Golia, R. Padalino, R. Calabrò, M.G. Russo, and E. Bossone state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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  1. Second University of Naples, Monaldi Hospital, Via M. Schipa 44, 80122, Naples, Italy

    A. D’Andrea MD

  2. Baker IDI Heart and Diabetes Institute, Melbourne, Australia

    A. La Gerche

  3. Heart Department, Cava de’ Tirreni and Amalfi Coast Hospital, University of Salerno, Salerno, Italy

    E. Golia, R. Padalino, R. Calabrò, M.G. Russo & E. Bossone

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  1. A. D’Andrea MD
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  2. A. La Gerche
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Correspondence to A. D’Andrea MD.

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A. D’Andrea and A. La Gerche contributed equally to this work.

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D’Andrea, A., La Gerche, A., Golia, E. et al. Physiologic and pathophysiologic changes in the right heart in highly trained athletes. Herz 40, 369–378 (2015). https://doi.org/10.1007/s00059-015-4220-8

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