II. Physiology
- Regular intensive Exercise results in normal reversible heart adaptations with cardiac remodeling
III. Signs
- Increased Left Ventricular wall thickness by 15-20%
- Increased Left Ventricular End Diastolic Volume by 10%
- Resting Heart Rate: 40-60 bpm
- Irregular pulse
- Increased Pulse Pressure
- S3 Gallup at Apex (S4 Gallup should raise red flag)
- Physiologic split S2
IV. Imaging
-
Chest XRay
- May show globular cardiomegaly
- Increased pulmonary vasculature
-
Echocardiogram: Left Ventricular Dilatation (dynamic)
- Left Ventricular wall thickening (static)
- Normal Systolic and Diastolic function
V. Diagnostics: Electrocardiogram
- Electrocardiogram changes resolve when exercising
- Sinus Bradycardia with or without Arrhythmia
- Increased False Positive stress tests
- Atrioventricular conduction delays
- Increased QRS Complex height
- Left Ventricular Hypertrophy criteria
- Right Ventricular Hypertrophy criteria
- Wide QRS Complex (incomplete Right Bundle Branch Block)
- Repolarization changes
- ST Segment Elevation
- Flipped T Waves