Athletic Heart Syndrome

1. Physiology
   1. Normal reversible adaptations of heart to Exercise
2. Signs
   1. Increased Left Ventricular wall thickness by 15-20%
   2. Increased Left Ventricular End Diastolic Volume by 10%
   3. Resting Heart Rate: 40-60 bpm
   4. Irregular pulse
   5. Increased Pulse Pressure
   6. S3 Gallup at Apex (S4 Gallup should raise red flag)
   7. Physiologic split S2
3. Radiology
   1. Chest XRay
      1. May show globular cardiomegaly
      2. Increased pulmonary vasculature
   2. Echocardiogram: Left Ventricular Dilatation (dynamic)
      1. Left Ventricular wall thickening (static)
      2. Normal Systolic and Diastolic function
4. Diagnostics: Electrocardiogram
   1. Electrocardiogram changes resolve when exercising
   2. Sinus Bradycardia with or without arrhythmia
   3. Atrioventricular conduction delays
      1. First degree block
         1. Athletes: 10-33% Incidence
         2. General population: 0.65% Incidence
      2. Mobitz I
         1. Athletes: 10% Incidence
         2. General population: 0.003% Incidence
      3. Mobitz II
         1. Athletes: 8% Incidence
   4. Increased QRS Complex height
      1. Left Ventricular Hypertrophy criteria
      2. Right Ventricular Hypertrophy criteria
   5. Wide QRS Complex (incomplete Right Bundle Branch Block)
      1. Athletes: 14% Incidence
      2. General athletes: 10% Incidence
   6. Repolarization changes
      1. ST segment elevation
      2. Flipped T Waves
   7. Increased false positive stress tests