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February is American Heart Month, designed to raise awareness of heart disease, understand risk factors that increase the likelihood of heart disease, and promote lifestyle habits that promote a healthy heart (1, 2).
As an athlete your heart is your powerhouse. Most athletes intentionally live a healthy lifestyle to support their sport and therefore have reduced cardiac risk factors. However, most sudden cardiac death in athletes – an estimated 1 in 100k-300k athletes under 35 and 1 in 15k joggers or 1 in 50k marathoners over 35 (3) – are due to an underlying congenital heart condition or pre-existing heart disease. With detection of these conditions, lives can be saved.
“Just because you run 40 - 50 miles per week doesn’t mean you can’t have a potential cardiac concern”
– Dr. Jonathan Kim, MD, Sports Cardiologist on The More Than Miles Podcast, Episode 4
Red Flag Symptoms
The following are some Red Flags - signs of something more serious going on - that athletes and runners should be aware of, especially when they occur during any part of exercise (4,5):
Chest tightness, pain, or pressure (some describe as the feeling of something sitting on your chest)
Excessive, new onset shortness of breath
Feeling more winded than usual at a given activity level (not just on one day, but repetitively feeling more exhausted than usual at an effort that normally wouldn’t cause this)
Heart racing or fluttering in your chest
Lightheadedness or fainting
Runners are notorious for pushing through pain and often injuries. But if you experience any of the above symptoms, it’s important to not push through them and hope they go away in the next mile or two like you might with, say, ankle pain (which I also advise against, but that’s another blog post). The presence of any of these symptoms, especially when experienced during exertion, warrant a visit to a cardiologist to further explore.
Family History
In addition to any physical symptoms, a family cardiac history can provide important insight to identify if an athlete is at risk of a cardiac condition. Heart conditions that are genetic are the primary cause of sudden cardiac death among athletes under the age of 35, so knowledge of congenital conditions in the family is especially important for younger athletes.
It is important to know if you have any blood relatives (especially if they are your parent or sibling) who have had any of the following (4,5):
Been told that they have a heart condition or arrhythmia (i.e. hypertrophic cardiomyopathy, Wolf Parkinson White, Long QT syndrome, and others)
Sudden or unexplained death, especially before age 50, or an event requiring resuscitation (CPR)
Placement of a defibrillator or pacemaker before age 50
If any of these are part of your family history, start by talking with your primary care physician to determine the next steps.
What is Sports Cardiology? (6)
Sports Cardiology is a new niche in the field of cardiology. A sports cardiologist recognizes that athletes have unique needs and demands on the heart with their sport. A sports cardiologist assesses your heart through the lens of an athlete and can perform tests for the heart that regular work ups may not catch due to athletes’ high cardiovascular fitness baseline. They can provide consultations prior to participation in sport or progression into longer endurance events like marathons or ultramarathons. You can read more about when to seek a sports cardiologist here.
Thanks for reading - I hope that you learned something today about heart health and can share this information with a friend or family member. Remember, you can’t beat a healthy heart!
Dr. Elizabeth Karr PT, DPT
References:
1. Live to the beat. Live to the Beat | Million Hearts. https://www.livetothebeat.org/. Accessed February 6, 2023.
2. What is heart-healthy living? National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health/heart-healthy-living. Published March 24, 2022. Accessed February 6, 2023.
3. Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular preparticipation screening of competitive athletes. Circulation. 1996;94(4):850-856. doi:10.1161/01.cir.94.4.850.
4. Edwards KM, Seynders K, Kim J. More Than Miles Episode 04: Dr. Jonathan Kim: Sports Cardiology & Return to Endurance Exercise Post COVID-19. https://open.spotify.com/episode/2MPrsu6QylWuicO4iG5qul?si=rsInCo95Rk6tX5MxI38cyg.
5. Wilens T. MGH Cardiovascular Screen.
6. Sports Cardiology Program at Emory Healthcare. www.emoryhealthcare.org. https://www.emoryhealthcare.org/centers-programs/sports-cardiology/index.html. Accessed February 6, 2023.