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Cardiovascular Adaptations in Triathlon

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Triathlon Medicine

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Abstract

Regular physical activity has a positive impact on general health and well-being. The volume and the intensity of training undertaken by competitive athletes, particularly those engaging in endurance sports, including the triathlon, is between 10- to 20-fold higher than the current recommendations for the general population. Such athletes develop a constellation structural and functional adaptations within the heart (“athlete’s heart”) that permit the generation of a large and sustained increase in cardiac output for prolonged periods and also impact on the surface 12-lead ECG.

Sinus bradycardia, first-degree atrioventricular (AV) block, voltage criteria for ventricular hypertrophy and incomplete right bundle branch block are common electrical manifestations in endurance athletes. Up to 50% of endurance athletes have a ventricular cavity dimensions that exceed the upper limit of normal, and a proportion of large males may reveal a left ventricular end diastolic diameter >60 mm. Occasionally structural adaptations may overlap with those observed in individuals with cardiomyopathy.

Sudden death is a very rare event in triathlons but usually affects males and most commonly occurs in the swim section. Deaths may be due to an inherited or genetic cardiac abnormality in young (<35-year-old) athletes and atherosclerotic coronary artery disease in older athletes.

The impact of life-long participation in endurance exercise on an otherwise normal heart is unclear, but there is emerging evidence that male endurance athletes who have been competing for several years have a higher prevalence of atrial fibrillation. A small proportion of studies have also shown a higher prevalence of myocardial scar.

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Author information

Authors and Affiliations

  1. Cardiology Clinical and Academic Group, St. George’s, University of London, London, UK

    Sanjay Sharma

  2. Emergency Medicine, University of Costa Rica, San José, Costa Rica

    Maximiliano Moreira Accame

Authors
  1. Sanjay Sharma
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  2. Maximiliano Moreira Accame
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Corresponding author

Correspondence to Sanjay Sharma .

Editor information

Editors and Affiliations

  1. International Triathlon Union ITU, Medical Committee Maison du Sport International, Lausanne, Switzerland

    Sergio Migliorini

Appendix: The ITU PPE

Appendix: The ITU PPE

1.1 ITU Medical Documents

1.1.1 Pre-competition Health Screening

The ITU Medical Committee strongly recommends a periodic health evaluation (PHE) for all the triathletes, performed by a sports physician, starting with a Pre Participation Examination (PPE) prior to engaging in competitive sport. (ITU Competition Rule 2.4 Health)

More than 90% of sudden death in competitive athletes are related to pre-existing cardiovascular problems (SCD). The SCD of an athlete on the field remains the most devastating medical event in sports.

The purpose of this screening is to identify, as accurately as possible, athletes at risk in order to advise them accordingly. According to the European Society of Cardiology (ESC), epidemiology studies on population of thousands of competitive athletes showed a decrease of up to 89% in SCDs with a PPE including a 12-lead rest ECG.

The screening takes place in three steps:

  1. 1.

    Answer the Medical Questionnaire: this questionnaire is strictly confidential and must be given to the responsible team doctor before the medical examination.

  2. 2.

    Physical Examination: by the doctor following the IOC recommendations published in the “Lausanne Recommendations” about the Sudden Cardiovascular Death in Sport Consensus.

    1. (a)

      Cardiac auscultation:

      • Rate/rhythm

      • Murmur: systolic/diastolic

      • Systolic click

    2. (b)

      Blood pressure

    3. (c)

      Radial and femoral pulses

    4. (d)

      Marfan stigmata

  3. 3.

    A 12-lead rest electrocardiogram (ECG). Doctor to look for anomalies in rhythm, conduction or repolarisation.

Select cases with a positive personal history, family history of potentially inherited cardiac disease or positive physical or ECG result will require further evaluation by an age-appropriate cardiac specialist.

All athletes competing in the ITU competitions in junior, U 23 and elite categories must have completed a pre-competition health screening which includes a questionnaire, a physical examination and an ECG following the IOC’s recommended procedure.

Thereafter, all athletes junior, U 23 and elite, competing in the ITU competitions, must complete the medical questionnaire and undergo a medical examination each year and, in addition, must undergo a resting ECG every 2 years.

It is the responsibility of the National Federations to ensure that these Pre-Competition Health Screening procedures have been performed and the NFs are required to confirm to ITU with the PPE Certification that all entered athletes have completed the screening.

For all other triathletes age-group, this screening is strongly recommended .

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Sharma, S., Accame, M.M. (2020). Cardiovascular Adaptations in Triathlon. In: Migliorini, S. (eds) Triathlon Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-22357-1_11

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