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The Cardiologist as Part of the Athlete Medical Team

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Textbook of Sports and Exercise Cardiology

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Abstract

Cardiologists are often called upon to interpret cardiac testing in athletes, evaluate symptomatic athletes, or to prescribe safe exercise in those athletes with known cardiac disease. This requires the ability to interact successfully with the athlete medical team, work efficiently and effectively, and understand that because of athletic adaptations and the cardiovascular demands of sports, the athlete is a unique cardiac patient. Thus, working with athletes requires a distinct set of Sports Cardiology core competencies, which have been defined recently by both the European Society of Cardiology (ESC) and the American College of Cardiology (ACC). While these competencies broadly define the knowledge base required to practice Sports Cardiology, in practice the cardiologist is often asked to work with a specific athlete population. In these instances, a five step approach is recommended: (1) Understand the specific sport and how it is governed; (2) Define the cardiovascular demands of that sport; (3) Consider the internal and external sports environment; (4) Identify the normal range of cardiovascular adaptations for the sport; (5) Estimate the cardiovascular risk of that particular sport.

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Author information

Authors and Affiliations

  1. Sports Cardiology Consultants LLC, Chicago, IL, USA

    Christine E. Lawless

Authors
  1. Christine E. Lawless
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Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    The discipline of Sports Cardiology has been driven by:

    1. (a)

      ECG screening in Italy

    2. (b)

      Beliefs in health benefits of exercise

    3. (c)

      Observation that exercise triggers sudden cardiac death

    4. (d)

      Studies documenting cardiac enlargement in athletes

    5. (e)

      All of the above

  2. 2.

    If the cardiologist is asked to interpret ECGs and echocardiograms in basketball athletes:

    1. (a)

      Tests can be interpreted according to normal ranges in non-athletic populations

    2. (b)

      Tests are best interpreted according to published norms in basketball athletes

    3. (c)

      Should use the “International Recommendations for Electrocardiographic Interpretation in Athletes”

    4. (d)

      b and c are acceptable

    5. (e)

      None of the above

  3. 3.

    Core competencies for a Sports Cardiologist include:

    1. (a)

      Exercise physiology and adaptation

    2. (b)

      Cardiac evaluation

    3. (c)

      Substance abuse and doping

    4. (d)

      Sports eligibility in individuals with cardiac disease

    5. (e)

      All of the above

1.2 Answers

  1. 1.

    The correct answer is “e”, as all of these observations and practices have contributed to the development of Sports Cardiology. The ancient Greek physician Herodicus promoted the health benefits of exercise to his patients. In fact, he recommended that his patients walk regularly from Athens to Megara, a distance of a little more than 20 miles. As mentor for Hippocrates, Herodicus passed these beliefs on to his famous student. Contemporary epidemiology has been able to demonstrate that the ancient Greeks were correct, and that regular exercise does, indeed, confer lower mortality and improved outcomes. The first episode of exercise related sudden cardiac death occurred in 490 BC, with sudden collapse of Athenian courier Pheidippides. But the abrupt unexpected death of young athletes continues to fascinate modern clinicians, prompting the creation and development of the Italian ECG based screening program. This practice has now “gone global”, causing cardiologists who interpret cardiac testing in athletes to differentiate the nuances between athletic adaptation and early disease. As echocardiography and advanced imaging have allowed more precise imaging of the heart, the normal limits of athletic adaptation have been defined.

  2. 2.

    The correct answers are “b and c”. An athlete’s ECG cannot be interpreted as one would interpret an ECG in a non-athletic individual, as the athletic adaptations may result in a high incidence of false positives. One might use the “International Recommendations for Electrocardiographic Interpretation in Athletes” as a reference to interpret an athlete ECG; but the clinician is advised to dig deep into the published literature for normative data in a specific athletic population. In the case of the basketball athlete, excellent published references are available.

  3. 3.

    The correct answer is “e”, all of the above, as a sports cardiologist is required to have knowledge of all of these areas. See the ESC paper, and the ACC paper for details.

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Lawless, C.E. (2020). The Cardiologist as Part of the Athlete Medical Team. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_2

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