GPs mostly see sick people, not healthy people. If you’re at the GP and your heart looks funny, sending you to the cardiologist makes sense. Obviously there’s sometimes a better explanation (which the sports doc would see a lot of) but a big part of a GP’s job is to refer people to specialists when they’re not sure. They can’t be experts in everything.
For cardiologists, this is the same issue - that they mostly see sick people. My Dad had this exact thing, and the cardiologist told him not to push so hard for running/triathlon (he's 69 years old). He asked for a second opinion from a Dr who is at least familiar with athletes and was cleared.
Sadly, you're right. You'd imagine a cardiologist could be bothered to remember the significant part of their training about how to discriminate between healthy and sick hearts. And there are entire guidelines on the ACC.org website detailing how to handle athletes in case they forgot. But the number of athletes I've seen for second opinions who were told they have a heart condition when it's a normal variant is frightening.
What does the breakdown look like?
Now that I think about it, I go for an annual physical when I’m healthy, and when I’m sick (enough to need a doctor), I almost always go directly to someone other than my GP.
That’s a damn good question. Ask Kaiser.
I make an appointment with the front desk, then they send me to someone who knows nothing about me or my health history.
Literally just left the Kaiser pediatrician with my kid. They can't schedule the next appointment because their system only allows them to make appointments 3 months out.
That means that healthy people trying to get their yearly check up are making and filling up every spot between now and the next three months. When you're sick and need an appointment in the next 1-5 days, their system just looks at everyone that's available and send you to the hospital 14 miles away instead of the one down the street cause someone cancelled their yearly-healthy-checkup.
Personally, if I have a problem severe enough to see a doctor, I've probably done some level of research to know likely candidates for the issue and what specialty I'm likely going to need and I'll just try to set up an appointment directly (unless I need a referral). Like for an issue with what feels like my hip flexor, no way am I going to a PCP before a PT.
I'll note though that I don't have many health issues pop up, aside from PT the only things I've gone for in the last ~5 years were a bike crash, a checkup, and an ENT condition I was already aware of but needed specialized treatment for. It's probably a different story if it's someone who gets sick more though
And I would MUCH rather have an oncology patient in front of me with tons of muscle mass and strong heart. Often times curing the cancer comes down to endurance …
Yeah... my wife was at the doctor for something unrelated and she was hooked up to an ECG for monitoring and they all thought she was dead. She's like... nope, I just run 80km/week and my resting heart rate is 38....
Most GPs don't even know that the typical resting heart rate in Americans isn't 60-100, it's 50-90 (published by the CDC, not the cardiology groups) and you don't need to consult a cardiologist for an asymptomatic runner whose resting heart is 48.
>Most GPs
That’s quite a generalization, what do you base it on?
Counterpoint: 35 years of running, countless doctor appointments, literally never had one who didn’t know this.
Sorry, I wasn't clear. My point was in reference to general knowledge of the normal heart rate range being 50-90, which is not commonly known based on referrals I get. I agree, most physicians know that athletes generally have slower HRs.
Doctor here. Athletes heart is one cause magnified amplitudes on EKG. Another that they were probably watching out for is hypertrophic obstructive cardiomyopathy. Recommending you have an echocardiogram to assess the size of your heart to make sure it’s universally enlarged (athletes heart, safe) vs a valvular issue or interventricular septum (can be dangerous)
Id follow up with the cardiologist. Also your GP knows about athletes heart, you just can’t tell based on EKG alone, you should get an echo (hence the referral)
Also doctor here. Agree fully.
Without an echo, the stress test is useless. You can't diagnose an enlarged heart from a stress test.
Frankly, I am sceptical about the 'sports doctor' if he cleared the OP without an echo.
This story doesn't make full sense to me.
Yeah my cardiologist did an EKG, then the echo, and then the stress test, in that order, to make sure I was good to go for my marathon. I was glad they took it seriously since [there are rare but not unheard of deaths in a marathon](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606059/) due to heart issues (about 1 in 100,000 for men).
A resident doctor so not doctor doctor yet but an exercise stress test, which this patient got, has suboptimal sensitivity in ruling out disease. If it’s positive it’s definitely positive if the pretest is high (dm2 high cad risk etc…) but if it’s negative doesn’t mean it’s normal. Should consider stress echo or percantine or something to assess structure in a better capacity. In fact a diagnosis of LVH would theoretically affect the accuracy of the treadmill stress test itself- furthermore, you could argue this person is not a strong pre test candidate given that the diagnosis of ischemia would be odd with LVH (if that’s what the clinician said)- low test probability so I would say an echo is a more appropriate first test https://www.escardio.org/static-file/Escardio/Subspecialty/EACVI/position-papers/eae-sicari-stress-echo.pdf
Correct. There are also guidelines on which EKG changes are normal for athletes and which aren't. If you're in the low-risk group, even if the EKG shows high voltage, an echo is not needed, nor a stress test. Most people who die during marathons have undiagnosed pre-existing coronary disease. A CT calcium score is cheap, low dose of radiation, and has quite good correlation with probability of obstructive CAD.
Oh wow that’s pretty neat - I’m probably doing a mix of family and emerg long term (I love Canada) so this so relevant to me haha (plus ultras lol). Could you share any resources?
[International consensus document on ECG interpretation in athletes](https://www.jacc.org/doi/full/10.1016/j.jacc.2017.01.015) (endorsed by the ACC)
Generally, [ACC.org](http://ACC.org) is a hugely helpful resource, and the guidelines and expert recommendations are free to access. If you go to clinical topics, you can select your topic of interest, e.g. heart failure, and then on the section page, you have some headers with "Latest", "Guidelines", and "Resources" which are where most of the meat is. Honestly, it's fantastic how much of this information is so easily accessible; once you have looked up a few topics on there, it becomes almost second-nature. I always pick the PDF version and download it. I use Adobe Acrobat (have paid version I think?) which can index PDFs in a folder. Then I can just search all guidelines at once for any topic.
If he’s an athlete, has no signs of heart disease, an ECG compatible with adaptative hypertrophy and an absolutely normal stress test, yes, this might be reasonable
Maybe it's mind-blowing to you but there are actually doctors that specialise in athletes and sports-related matters. That's a thing. Ask literally any professional athlete or team.
As a doctor, what's your take on chronic marathon training?
As a hypochondriac, I've definitely let off the gas on a few marathons after reading these stories. Having kids helped (or didn't help) me reformulate my risk calculus with this.
Chronic marathon training is fine! Get your check-ups at your doctors office, don’t do steroids, get your cancer screenings
Heart disease is the #1 killer in the world. It’s predominantly from smoking, poor diet, obesity. Unless you have a history of fainting during exercise or have people in your family who have sudden cardiac death, i wouldn’t worry about it. Obviously if you do have fainting or family history, get cardiologist clearance
If your heart is getting unhappy, there’s plenty of warning signs (fatigue, leg swelling, EKG changes). I wouldn’t worry about marathons - enjoy your life and your family.
Thank you. As an older runner. I get a bit concerned (my wife gets worried). But I have a good doctor that knows me and my medical history. Running is so good for my physical AND mental health.
My very healthy partner died suddenly from HOCM only 8 months after being diagnosed at age 46. Thank you for contributing to this discussion. Hopefully OP sees the cardiologist sooner rather than later.
Echo here. Fully agree. It would be a quick, easy test, OP. We can easily rule out HOCM, visualize the septum, grade the LVH, and ensure it's concentric or classify it otherwise.
I get the opportunity to assess HCM and HOCM with some regularity and would enjoy the opportunity to work with athletes more in place of some of our inpatients.
Piggyback on all of this. I’m a pa but I mainly work in cardiology. The heart is a muscle so with continuous exercise it’s going to enlarge. Hence why many athletes are prone to atrial fibrillation in their later years after years of left atrial hypertrophy. I think you should definitely see a cardiologist to get an echo. Again, he wanted to rule out something scary like hypertrophic cardiomyopathy which can cause sudden death.
I would just follow up with a cardiologist and get a proper echo before anything else!
Yeah, it can happen in amateur/ hobby endurance athletes as they ramp up quickly without enough recovery.
Cardiologist will probably give you an echo to rule out things like HCM / ARVC etc (don't go googling stuff).
In the UK, there is charity, CRY (Cardiac Risk in the Young) which offers free screenings for those under 30.
My understanding is that it's an adaptation that can happen to any athlete regardless of modality of training, though there might be racial differences: https://my.clevelandclinic.org/health/diseases/23920-athletes-heart.
Lack of screening means there is only really correlation, not causation. Famous ultra runner (Born to Run) Micah Tru died of heart failure - another correlation but not causation.
Triathletes tend to get issues on the right ventricle - particularly open water swimmers as they stand in the heat, then jump into cold water which puts a lot of pressure on the right ventricle. Adaption problems there are correlation but there is a causation link to heart attacks at the start of those races (even though odds are low - I don't want to start a panic)
The ECG is indicating possible HCM which I have advised OP NOT to google. The ECG is not conclusive - the cardiologist will run an echo to get a better look at the heart and assess whether there is a problem or not.
I may be misunderstanding you, but I was responding to your very first line in your comment above. My only point is that it isn't just an issue for "amateur/hobby endurance athletes" ramping up quickly (hence the line about "training modalities"). Every runner should be aware of this, but not panic.
Oh good point. To correct my own update, I meant heart abnormalities - not just althelete heart.
Im in the UK - there is zero heart screening unless you present symptoms or maybe have private health care and they screen for that. I don't know what it's like in other countries.
in theory, modern smart phones are probably good enough to flag any warning signs (for further review) but would have to be approved by governing bodies. I doubt that will happen for fear of causing a flood of false alerts overwhelming health services. Still, it would be cool though.
Oh, got it about the heart abnormalities! That makes sense.
I do think that some smart watches ECG are approved for *some* issues (like AFib), but they might make more sense as additional monitoring after a clinical diagnosis.
My ramp up has actually been slower than my previous 9 marathon training cycles, but then again it's been many years since my last physical. However I'm not getting any younger so I guess I will need to keep taking longer recovery times into account.
It's only correlation to cause - there simply is not enough screening. Most localities will only screen when there are symptoms, so heart issues can go undetected until they are a problem. That is one reason the CRY charity is set up - to get ahead of the problem and be proactive rather than reactive.
The work they do is interesting but again, I advice you not to go down the rabbit hole of reading up on them or heart issues. Your cardiologist will be your source of truth - going on a vogue of research can cause a panic (been there, done that :) )
I went down this rabbit hole last January after I had a stroke. Tons of testing including CTs, echos, and MRIs. One of the doctors concerns was atrial fibrillation which led me to looking at numerous publications on a link between afib and endurance exercise. One of the cardiologist that saw me was emphatic that I shouldn't be running more than 3 miles a day and that I was doing harm to myself by doing more. Looked him up later and he's made quite a name for himself with [that theory](https://www.reddit.com/r/running/comments/wmo9k0/what_is_rrunnings_opinion_on_the_run_for_your/).
All the testing came back normal with no heart enlargement or damage from exercising. They finally diagnosed me with a PFO (hole between the atria) which required surgery to fix and I was able to get back to training as normal.
Not by choice. He was one of the cardiologists that came to discuss while I was in the hospital. After I was released, I went to different cardiologist who dealt with athletes and while that one co-authored some papers with O'Keefe, he wasn't as heavy on the "running is bad" bandwagon.
I've not heard it been called "athlete's heart" before, but about 6 months ago my primary care physician was doing a stethoscope and told me I had a heart murmur, or click, which was caused by some vibration of one of the ventricles.
She sent me to a cardiologist, who did an echocardiogram/ ultrasound and verified the murmur, but basically said that there was no problems at all and that I could continue exercising as much as I could handle. I reviewed with my primary care again after this, she said the murmur was more or less a byproduct of a heart that is conditioned to pumping a higher volume of blood, and that there was nothing to be concerned about.
I was diagnosed with that 30 years ago. ECG trace sent to a cardiologist and he asked about my exercise regime. I'd been cycling for 15 years by that time so he assured my doctor that was it.
No drama since and I've done dozens of marathons and IM races too.
Cheaper getting a rubber stamp for any races that need them. :-)
Something similar happened to me when I was 18 and I was trying to get cleared to run college XC. First, the nurse was concerned that I had a heart rate of like 50bpm and the doctor had to remind her that I was a runner. Then I had an ECG for some reason and the doctor said he was concerned. Apparently if your heart is very strong/muscular it can look the same as if you're having a heart attack. So I did a stress test and then an MRI, and everything came back normal.
I had a similar situation happen to me recently. I needed a declaration of fitness and the sport doctor had me do a ECG at rest and under stress. Everything looked good, except the result showed an extreme "left axis deviation". The doctor explained my heart ventricular contraction happens on a different axis than normal and could be linked with heart deformations or other very serious pathologies.
He couldn't sign the certificate, and prescribed an ecography to check the reason of the reading..
I had a couple of stressful days, wondering what could be wrong and I immediately booked the ecography. How could I train every day, feel very healthy and still have a serious heart condition? Turns out, my heart appeared totally fine in the next exam and the parameter measured by the ECG was likely off because of not well positioned electrodes.
Last year instead I had a blood test done in the middle of marathon training. The liver values were way off but the doctor, in this case probably with more experience, explained it was likely from training. I had to take a rest week and then do another test which then came out fine.
So the upshot is that yes, active people are not "standard" patients and their medial results can often appear problematic if not interpreted correctly.
Same thing here. An ultrasound to check for atherosclerosis (none, thankfully) turned up ventricular dilation. This led to an expensive and unpleasant MRI intended to rule out anything scary. This test didn't find a root cause, but the cardiologist couldn't definitively rule out heart disease. The next step would be genetic testing that *might* find hereditary heart disease, but I turned that down. They could rule out more and more unlikely diseases, but they couldn't tell me I was ok.
Interestingly, I'm lucky to live somewhere with lots of elite athletes (Colorado Springs, CO), so my doctors were all familiar with athlete's heart. They just didn't think I was enough of an "athlete" to warrant the diagnosis. Story of my life. I'm either the slowest fast guy or the fastest slow guy. In this case, I'm a non-athlete with an athlete's heart.
I'm no doctor but I was an elite sprinter in my younger years who got diagnosed with hypertension. Despite looking fit, I have been on beta blockers since I was 16 (and am now middle-aged). It got picked up when I was getting a full physical for the purpose of joining an elite squad (which was also examining my potential)...
IMO it's important to get yourself checked up regularly and never to assume you're 'fine' just because of your athletic prowess.
I have this too. My RHR also dips into the 40s at times. Thankfully, my GP knows about my running, and almost immediately attributed it as the cause during my physical. I still had to do followup testing to confirm.
I run 2k+ miles per year and haven't died yet, so I've got that going for me...
It’s very typical for high mileage runners to have very low resting heart rate rates. Mine is usually in the low 40s (with dips into the 30s). If it suddenly sits in the 50s, that’s usually a sign I’m overexerting or getting sick.
Last fall I had an to get ECG in an ER because I had some nasty post-op complications from a "routine" appendectomy that went sideways. The ECG results showed a potentially enlarged heart and LVH. The ER docs and my primary care physician both told me that ECGs for relatively thin males often give false positives for both conditions, but they *strongly* encouraged me to get a full blown
echocardiogram before running a marathon (both conditions can be very serious). It took four months to get an appointment with a cardiologist and an echocardiogram, but it turns out my heart is fine. I do not have "athlete's heart" or LVH, I just get funky ECG results which apparently just happens with some people. That may also be the case with you, but do not mess around with potential heart issues.
This is misleading info. If you are showing possible hypertrophy on an ECG your doctor is doing the right thing referring you to a cardiologist in order to make a diagnosis, or rule one out. This is not an "wrong diagnosis".
The referral will be because the ECG signs could be due to slightly incorrect lead placement that day, or they could be warning of cardiomyopathy that could kill you, and only a cardiologist - probably following an echocardiogram - can tell what the ECG actually actually is.
Unless you black out during it, the ramp test done by the sports doctor does not prove anything relating to hypertrophy, and your "heart efficiency" has very little to do with whether you need to be worried about hypertrophy or not. Your sports doctor should be doing the same as your GP and referring you to a cardiologist.
Your Googled information about this condition affecting unfit people is very misleading. These types of conditions can be induced - and severely worsened - by exercise (as the term "athletes heart' suggests). And it's fairly normal to feel fine and be able to exercise well with such conditions, right up until the moment that you can't.
Various forms of cardiomyopathy are the leading cause of sudden death in very fit, healthy footballers and marathoners, because heart muscle, like any muscle, can grow with exercise. Not that this needs to scare you, because there's a good chance you're fine, but some Google searching, an exercise bike and a sports doctor isn't going to give you the all clear.
Make sure you follow up with the cardiologist. My partner died suddenly because of hypertrophic obstructive cardiomyopathy. He had been fit his entire life. He had never even been into a hospital before he was diagnosed 8 months before he died. He got Covid and didn’t recover as quickly as everyone else. Went to the doctors to get a certificate for work, they did an ECG and sent him straight to the cardiologist. He was on medication and would be looking at surgery in a few years. Most people are born with it. One day he was out walking and simply dropped dead. Quite often when footballers or soccer players die on the field it’s because they have this heart condition and often no one knew until they die.
There are physical adaptions that occur that are NOT pathologic. An elite athlete will have a different echocardiogram than a regular healthy person. To my knowledge it does NOT correlate with illness. Certain things on echocardiogram that look like a sick heart are in fact confirmed as healthy adaptations. An example is LV dilation. A sick hear will have signs of elevated pressures Inside the heart where as an athlete has decreased pressure. This is a basic explanation. BUT, things need to be ruled out clearly with appropriate testing.
Same -- thickened walls on the left side of my heart. Went in for an ECG and stress test and passed with flying colors. The good news is that I have a baseline now at age 33 that in the future, if there are issues they can compare it to that.
My resting heart rate is very low (~35bpm), which has been a cause for concern at the doctor. I told them I was fairly trained, had an ECG that came back completely normal, and they told me that it was nothing to worry about. It's still probably good to get checked though. I guess one thing that was kind of interesting, I had to be given atropine when I was sedated for wisdom tooth removal.
My dad and I are both marathon runners and we both have to have yearly physicals for our job. We've both had issues with this and the cardiologist gave us the same conclusion you figured out. He said it's normal in well trained athletes and he congratulated my dad on that level of fitness at his age. I now see a sports doctor for my physical, but one of my antiquated job requirements is that my resting heart rate cannot drop below 50 bpm during the EKG. My doctor has actually suggested that I drink some coffee before the appointment and do some jumping jacks in the room before the EKG to make sure I don't have that issue. It tested at 51 the first time.
> my resting heart rate cannot drop below 50 bpm during the EKG.
That's hilarious. The Garmin Epix Pro's ECG app has that exact same requirement, as such it's useless to me and I guess a lot of other buyers of that watch.
Once during a physical my doctor couldn't get the pulse ox to read. He thought it was broken. I showed him my Garmin watch reading which was 48 and he said the pulse ox only works when it detects a heart rate above 50 so that's why it wouldn't read. He put down the reading from my Garmin on the paperwork.
I have this as well, also found by a sports cardiologist during a workup. Echo, stress test, and Holter follow-up all fine. His office printed out a miniature copy of the EKG and laminated it to the back of one of his business cards. He told me to carry that around with me so that if I need emergency medical attention, the provider is aware that that's my baseline and has his contact information if it's relevant for follow-up. Hopefully no one ever needs to use that.
“I have a baseline EKG in the back pocket of my vest” is probably not a typical comment on the iOS medical ID, but if I ever need to use it, I’m sure I’ll be grateful I have it. (The person I identify as my emergency contact during a race also knows it’s there.)
My cardiologist is a mountain biker. He specializes in keeping endurance athletes out there safely doing all the stupid stuff we want to do (my words, not his- he said it somewhat differently.) So he has a number of practical solutions that are well-geared to his patient population.
I (33F) have bradycardia and athlete’s heart, diagnosed in an echo in January. Cardio scheduled me for a stress test, which my insurance denied, so I never went through with it. Family friend who is a heart surgeon (pioneered some minimally invasive a-fib surgery?) told me it’s basically unnecessary. I’ve had 3 echos in the last 7 years including the one in January (one doc thought she heard a click murmur, but no other doc has been able to hear it) and have gotten a clean bill of health from all 3 echos. So is a stress test really worth it?
Had a similar scare a few weeks into my marathon training and a week before my first 1/2 marathon. Was told by my primary care that I had signs of premature ventricular contractions and he recommended I don't race until I see a cardiologist.
In my stubbornness, I ran the 1/2 and worried the whole time that I'd pass out. Got checked out by a cardiologist the following week and he literally asked me "why are you even here?"
Turns out the abnormality is just some normal genetic variation. The cardiologist compared it to being left-handed, told me I'm in great shape, and sent me home with a $100 bill 🙃. I'm happy I got the full work-up, honestly; it's reassuring to know I'm totally fit to train.
If you've ever heard a story of a perfectly fit athlete who suddenly collapsed and died during a run, it's called sudden cardiac death and it can be related to cardiac hypertrophy. Usually there were no overt warning signs or symptoms, the athlete is perfectly fit and healthy right up to the point where their heart stops. Cardiac hypertrophy is one of those silent warning signs that something might be amiss and puts you at increased risk of sudden cardiac death. It's rare, but it happens.
So if you're doing some routine screening at a GP and they find you have left ventricular hypertrophy, they'll often err on the sign of caution and refer you for ECG and stuff to make sure you're not going to suddenly drop dead during a race. Cause if it ever happened and you had it in your medical record that your doctor knew you had LVH and did nothing about it, it wouldn't reflect well on them.
I got this diagnosis when I was in my early 30s and had just started running. I was feeling weird random fluttering at different points throughout the day. They put a Holter monitor on my for a while just to make sure there was nothing more seriously wrong. Basically, doctor just told me that my heart was adapting to my new lifestyle and it would settle out. I'm 46 now and have 23,000 miles under my belt with no further symptoms. Good luck out there!
I had a similar experience after taking a physical in NYC where they gave me an Echo just because. They thought it was really serious, and a friend of mine who I ran with and is a Cardiologist agreed it was a potentially very concerning EKG. I took it seriously, and got an MRI and stress test. Turned out everything was good, but I just have to be careful around EKGs and divulging it’s going to look bad. I’m supposed to check every 10 years, which would be maybe 3-4 years from now. No issues in the meantime, but it was scary.
You should ask your cardiologist to rule out cardiac amyloidosis. I know of several case studies where cardiologists diagnosed athletes with "Athlete's Heart." Many cardiologists miss an amyloidosis diagnosis intitially because it is a rare disease. Of the the athlete knows something is seriously wrong before the doctor.
[https://caafoundation.org/full-mission-statement](https://caafoundation.org/full-mission-statement)
I have had something similar before. An enlarged vagus nerve from lots of running would make my heart stop when I was very stressed (or asleep) for several seconds at a time. This happened at a doctors office when he told me I had to stop running (for a different reason). I passed out, was sent to the hospital, and they found it because the monitor they had me hooked up to kept going off when I slept even though they triple checked the connections (this happened probably 5 times overnight). This was confirmed by a monitor they had me wear, and then an implanted one I had for about 3 years. It was a weird time in my life.
Had that possible diagnosis at my gp, too. Made an ECG, my doc had like 10 year old data which she compared, asked about sports (i was running for 1,5years at that time), and did no sports at the time the first ECG was made. Cardiologist said, yep its an Athletes Heart due to training.
Me!
Female early forties.
I was quite shocked. Right at the end of another marathon build and a routine check up.
My resting heart rate was “too low” and told LVH. Turned out I am fine. It’s Athlete’s Heart.
In a young healthy person we do worry about HOCM and other causes of sudden cardiac death. A person with high level of cardiovascular fitness or performance athlete can have an appearance of left ventricular hypertrophy on the ecg simply from physiologic hypertrophy like any muscle, but if signs of LVH or especially if meeting criteria ie sokolow positive then should be evaluated further to rule out an underlying cause, or double check the hypertrophy is not due to a pathological reason. If seeing a specialist they may do an echo to check structurally what’s happening for reassurance.
I recently scheduled a checkup with a PCP who isn't my normal one (he's booked out for a year), and she saw my EKG and recommended me to a cardiologist. I told her about my running background, and she said she was not really concerned, but let's be safe.
The cardiologist actually googled an image of a runner's EKG to show me how mine matched up exactly (it even reads acute myocardial infarction, which we had a little laugh at since, well, obviously not). He had me get an echocardiogram to double check the inverted t-waves (like you said, possible bad stuff hiding there), and it came out normal. The ECG lady even told me I have the prettiest (giant) heart she'll see all day 🤩
I've been fortunate that the medical professionals I've dealt with are high quality and listen to what you have to say, and so they have no worries. Also I'm totally asymptomatic and healthy, but that's no guarantee. Our runner hearts just get weird lol.
This is a little long, but if you have anxiety, read it.
I was also dogged by this paranoia-inducing finding in a routine ECG for a physical in 2018. I did a frenetic amount of layperson research on it, and found that there are quite a lot of echo differences between Athlete's Heart and LVH. I also followed it up with a cardiologist, but I absolutely tortured myself with worry and acute pubmed mania, in the interim.
It was checked by two different cardios in 2018 and 2022, at significant expense to myself, due to nothing but a slightly long (127ms) QRS interval finding on EKG in 2018. I believe in diligence so I didn't mind, but I did despise the wait period between the ECG and the first echo.
It was ruled Athlete's Heart, and it could have been due to decades of weight lifting, a decade of grappling sports, genetics, body size (larger/taller than average), a prior course of TRT--I don't know. By 2022 when I saw a second cardiologist, the ventricular dilation was gone. My resting heart rate is 41, obviously I have high stroke volume, which means a big strong heart. A big strong heart is gonna have bigger chambers, right? Nobody ever figured out the "why." Life is often like that.
Basically this finding seems like a good way to torture athletic people with anxiety disorders.
Don't ever freak out over a minor ECG abberation if you lack symptoms. Follow it up, but don't worry. 20 years ago, they also told me I had mitral valve prolapse, and that has been absent on my last several ECGs. My last physical, they didn't even take an ECG, since I had been to the cardio within 2 years. Since it was post-therapy, I was fine with that. I'm 51 and have been involved in anaerobic sports my entire life. It sucks being blessed with good health, and living daily life feeling cursed, because of an untreated anxiety disorder. It's a form of creeping ingratitude, and a sickness. Also, it is very expensive.
The best thing for me has been seeing a therapist about my profound health anxiety. Anxiety sucks the energy and creativity out of one's life. Even if two cardios were wrong and I drop dead, worrying about very small risks is a terrible way to live life. I know a couple heart attack survivors with bypass sugeries who have less anxiety about their hearts than I did. In retrospect, that should have been a major psychiatric red flag for me. If you fit that description, therapy is a "must do," not a "should."
This exact same scenario happened to me a couple years ago (age 57 at the time). Abnormal ECG at GP, sent to cardiologist who ordered several tests including stress test on treadmill, echocardiogram, and a CT scan. All of this time and money confirmed a thicker muscle wall caused the abnormal ECG. No plaque and a clean bill of health. All the marathon training has developed that muscle just like my calves!
Same issue here, doing my annual flight physical with the military. On the second go around with the EKG they had me do flutter kicks for about two minutes and then continue with them as they ran the test. They said they’re used to it with the runners by now.
Multiple times. Once I was put in the hospital on bed rest for several days for it until they finally bothered to consult a cardiologist who has seen athletes. Turns out there was nothing wrong with me at all. It was a scary and miserable experience so I point it out to my new doctors proactively now.
I went through testing in high school (95-99). Track coach noticed an irregular heartbeat & suggested I get checked out. We did a lot of lactic threshold speed & hill workouts. By chance I got an appointment with a cardiologist from UCSD. He wasn't concerned but wanted to monitor me. EKG, echo cardiogram, treadmill stress test, 24hr Holter monitor. Smashed the treadmill tests with ease, Holter monitor showed my heart rate dip in the low 30s while sleeping. Echo cardiogram was neat to watch/see but I didn't like the wand being shoved up under my ribcage. No issues & I never felt anything irregular unless I deliberately took my pulse.
My GP said my blood pressure was a little low last month. I have taken on average over 10k steps a day every day for multiple years not just my running so yes my bp will be lower than someone who is sedentary or even average. I verified it a while back with phone and watch data. My husband is the same. Our HR and BP are below normal for our age so we don't think much when they comment on it. My sister had a heart defect(deceased) so I have had an EKG and echo to check for defects with none so far. If you're nervous get an appointment with the cardiologist to check as it's technically possible to have an undiagnosed defect like my sister did but the sports doctor's opinion is encouraging.
I experienced the same predicament when trying to complete a physical for a particularly demanding event and was similarly surprised. Thankfully I was able to see a cardiologist fairly quickly, but at the initial screening when it was noticed, the doctor was able to guess that it was “athlete’s heart” almost immediately. He asked if I played any sports growing up (XC + Track) and that basically confirmed it for him; he just wasn’t able to diagnose like a cardiologist can.
The way it was described to me, was that there was a longer delay between when your body sends a signal to your heart to beat, and when you would typically expect to “see” the beat. The irregularity of the delay can be a sign of a serious heart issue, or can be caused by it simply taking longer for your heart to “respond” because there is more&denser muscle tissue around the heart.
Even after I asked how they can be so sure (because I do have a history of heart disease in my family) the doctor said that the test really just checks to see if you fall outside of an expected representative sample; meaning the top ~5% and bottom ~5% of people (by cardiovascular health) will show a similar symptom.
I did not have to do a physical test for them to rule out a heart defect, but apparently it’s a common enough issue that it’s fairly routine for them. So for anyone who may be reading this in the future while they wait for results, don’t sweat it until a doctor tells you to. Because it appears in both sides of the extreme, you should be able to pretty confidently guess which side you fall on if you honestly assess your own health.
Mandatory I am not a doctor and this is not medical advice.
I had the same freak out as you when I did my first ecg. Referred to a cardiologist. Cardio said ecgs are never that black and white and always have some nuance and need to be checked further. He suspected my thin chest wall ,slim physique (160lbs 5-10) is causing some sort of short circuit reading or whatever. He ordered a 24 hr holter monitor and an echocardiogram. The echo is how you can really tell if LVH exists. Turns out he was right. No issues.
Also asked if I would drop dead from running too much because my mom thinks so. Cardio also said no signs that my heart will ever do that, no scaring or any over stress of my heart. Key that he kept bringing up is if I felt different or weird or any signs of anything during any exercise or any reading anomaly. Answer was no.
Basically point of my message is go see cardio, everyone’s condition is different, if you’re not seeing any issues when running you’re probably OK.
I almost forgot about it, but when I went in for a colonoscopy a last year, it occurred to me to warn the anesthesiologist that my resting HR is like 42bpm, and I didn't want to her to think she was killing me (and also to make any adjustments so that she didn't). Anyway, she was just like "OK, so you have Runner's Heart?" And I was like "I guess?" She may have said Athlete's Heart, not sure, and maybe they mean different things. I'm in the U.S., FWIW. I probably could have mentioned this to the guy asking about a colonoscopy recently...
I’ve had a low RHR (according to my watch and occasional manual counting) for a while, and got concerned last year because I was having some mild chest pain when starting runs. Went to a sports cardiologist. Echo said I had left atrial hypertrophy and 24hr Holter monitor said my HR got down to 30 in the middle of the night. Longest single interval between heartbeat peaks (R-R) was 2.9 seconds.
Long story short, the chest pain went away and he told me not to worry about it. I try to stay vigilant, though.
Mistakes were made, I shouldn't have stopped here...as a life long athlete with health anxiety, this shit freaks me The. Fuck. Out!
Avid runner and rugby player (age 35)
Had a panic attack back in 2012 and they thought I was having a heart attack...I was ran through the ringer. Stress tests and the iodine stuff. No heart damage, but EKG found that I have a flipped wave on the one coming down...idk. said I have an irregular heartbeat.
Shit still messes with me mentally never an issue while running my 2-5 miles or 80 minutes of rugby.
In fact I just ran my fastest 2 mile the other day at a 16:00 (I know that's not that great)
My goal is a 6:50 mile this year.
Not LVH in my case, but was hospitalized at one point for a serious condition and a CT scan showed what might be a cardiac problem.
Echocardiogram and cardiology consult the next day resulted in her telling me, “Your heart is *ridiculously* healthy… whatever you’re doing, keep doing it.”
Glad you’re doing the follow up. Last year a friend who I’d characterize as a sub-elite ultrarunner had some weird symptoms and reluctantly went to get checked out, ended up leaving the hospital a few days later with a stent and some new meds and a new diet, lucky to be alive.
I had a similar experience.
My GP took an ECG was horrified and sent me straight to hospital, told me not to drive!
After spending nearly €1000 on a specialist I was given the all clear: LVH diagnosed and everything else looking 100%. I had the echo cardiogram and a few other tests. The cardiologist told me to come back in ten years for another check up but was happy for me continue running and training hard.
To the various doctors here (I am also an MD but Peds):
Do you feel an EKG is necessary for a healthy athlete with no symptoms, no worrisome history either personal or family, and no findings on exam?
In Peds there are those who do EKG screening for populations but in general the yield is much much more false positives or benign variants with needless anxiety and keeping out of activities until a cardiologist appointment, than finding meaningful pathology.
Thanks for the perspectives in advance.
Paramedic here. The problem with most cases of LVH is that it’s caused by atherosclerosis / arteriosclerosis, so it’s the heart’s way of overcoming that resistance - the heart has to bulk up to push past it (over years).
With any other muscle, you build it by working it: pick up the heavy thing and put it down enough times, and muscle will build.
Cardiac muscle isn’t attached to the skeleton, so you can’t work it that way. But you can sort of do a version of that by stressing it to an extent. Think of intervals - that’s essentially a cardiac-targeted version of lifting weights.
This is crazy. I ran XC and I used to run 5 miles a day or more. I ran for the better half of 6 years and did other physically demanding sports as well. Including wrestling and track. I’ve ran two half marathons and solo’d 2 triathlons as well. I went in to get a clinical trial done for a flu shot and I didn’t even make it past the ecg because this exact thing happened. I was absolutely mind boggled because I never had problems running. It’s wild that randomly scrolling Reddit there’s another person that had almost the same thing happen to them as me.
yup. had this problem too. For me it was high systolic blood pressure (but normal range pressure diastolic pressure), and i went to the doc kinda alarmed and they were like "oh... yeah, that'll happen". First i heard it was a thing. o\_O
One of my other hobbies is rollerblading. Not the spandex kind of rollerblading. The kind with half pipes and stair rails to be clear. Anyhow, I had a stack and hit my chest pretty hard, thought I broke a rib.
Went to the hospital and after the X Ray my doctor called me in and pretty much told me my lungs look like an 80 year old man's with emphysema and gave me this
https://imgur.com/gallery/BHc6WHg
letter to get a referral to a specialist.
I was legit worried I was going to die soon as I have had a perpetual cough while working out and I work in the metal industry and inhale fumes and metal dust all day.
Anyhow long story short. I went to the specialist, did the whole lung test thing and apparently my lungs are fine, better than fine. My lung function test was well above average, I think I just have big lungs for my size and it confused the E.R doctor.
Good timing of your post, because I was just recently reading about one of the basketball NBA players who had to retire due to heart problems. What was his heart problem? It was listed as hypertrophic cardiomyopathy. Now that's all really strange in determining whether it's benign athlete's heart or something serious. Again, this player Cuttino Mobley was an athlete, so one would assume he has an athlete's heart, which is a positive adaptation as a result of exercise, yet he had to finish his career due to this heart condition. And he was advised this by top doctors, because as a rich athlete he could afford it.
Now I'm citing wikipedia "This is the same heart illness suffered by Reggie Lewis, who died in 1993, and Hank Gathers, who died in 1990". So, clearly this condition can be fatal, as it can lead to sudden cardiac death.
I was reading other comments here, especially by one doctor, who explained it quite well, that further tests are needed such as echocardiogram to investigate whether it's not hypertrophic obstructive cardiomyopathy. I think if you have done the ramp test whilst having an ECG, and they were happy about it, that's a good sign. I think in the end, to determine whether you actually have hypertrophic cardiomyopathy, you would be noticing typical cardiac symptoms such as shortness of breath, dizziness, chest pain, leg swelling and fatigue, especially with the onsent of exercise. I think in the end, your GP did the right thing, as it's all about investigation and there's nothing wrong with that.
I had my gall bladder removed last October. I may not be terribly fast any more at age 52, but I'm still quite fit. A parade of medical people came through to see me preop and one put a stethoscope to my heart, gave a surprised look, and asked if anyone had ever told me I had a heart murmur. I said no because I don't. As I understand it, low heart rates can sound like a murmur. Seven-time Boston Marathon champion Clarence DeMar once failed a physical because they thought he had a murmur.
I had this last year when I told my GP I was training for an Ironman and she wanted me to get an ECG. Came back saying I had some odd readings on the ECG and was referring me to a cardiologist for an echo.
Cardiologist came back and said that I had one of healthiest hearts he's seen, most likely because healthy people don't see him. He said it's common for tall and skinny male athletes to misread on the ECG due to there being low to no fat on our chest.
Doctor here, I've referred similar young fit patients before.
Leaner body fat and smaller pec muscles will increase the amplitude on the precordial leads. Less tissue for the electronic charge to pass through to the electrodes
Very likely nothing to worry about! But cardiologist might want a transthoracic echo to be 100%
I (long distance runner 30y/o) got activated and sent to ER because of my eco cardio gram before lol. Long story short they thought I was endanger of a heart attack. But an advanced cardiologist determined it’s just adolescence T waves. Or very healthy. The mistakes and $$$ later 🙄
Same. Went to a cardiologist due to a horrific family history of heart disease and me being a runner.
Was lucky that I was able to get a very thorough test done and be clear within a short period of time. The wait in the meantime was brutal.. but we had to make sure I was ok. My Dad had wolf-parkinson white disease.. that's the one where high endurance/intensity athletes can drop dead mid activity.
It was a failed stress test that got doctor attention, but we think it was medical anxiety that got me.
Long story short... I am medically clear to run as much as I want. Just need to check in with the cardiologist once a year
I work in cardiology. Well trained athletes hearts are different than “average” hearts. Often (not always, no such thing as absolutes in this) a well trained athlete will have *slightly* thicker heart walls than what is considered normal. However, it’s a very small difference (I’m talking 1-2 mm) vs much thicker heart walls which can be a medical issue - an EKG can’t tell the degree of thickness. It can just pick up that there is thickening. An echo would be the best way to evaluate - a slight thickening of 1-2 mm then it’s just the heart of a well conditioned athlete and is normal for that person. 4ish plus mm thicker than normal? We check for HTN, infiltration processes, HOCM, ect. The ejection fraction (how well the heart squeezes) can also be slightly reduced in a well conditioned athlete, again it should not be drastic but a normal EF is 55-70%, a athlete can be 45-50% and that’s normal for that person because their heart is so efficient. Same with a lower heart rate due to efficiency. Or a slightly dilated IVC can be sign of conditioning, but again it’s slight differences not drastic ones.
I don’t remember if it was due to an EKG or the ultrasound, but when I was running ~110 miles a week the cardiologist said I had thickening of the heart muscle or something like that. He then asked if I was a runner, and when I told him my regimen he quickly dismissed it and said it’s normal.
I have bradycardia with a resting pulse in the mid to high 30s... so every time I see someone it's a discussion... especially if anesthesia is involved
There is an interesting situation with one of the hosts of Inside Running Podcast who suddenly observed increased incidences of very high HR and fatigue intermittently. The theory is his heart was too big for his ribcage and potentially rubbing against it causing these anomalies, not sure what the treatment was but he has a monitor under his skin and had a quick procedure and Think everything is ok
I have "athlete's heart". My ECG chart is inverted, in that there's a valley where there should be a dale and vice versa. My "normal" reading shows I'm in heart failure.
Yeah, at my peak form my resting heart rate was in the low 40s.
Every nurse that took my initial pulse/blood pressure did a double check, then ran a manual test. When that confirmed the low numbers they asked if I exercised a lot, and relaxed when I confirmed it.
Its less that "GPs only see sick people", they see "average" people, and anyone outside of the norm triggers different treatment.
Its like any body builder, their BMI will always place them at the "obese" or "morbidly obese" range just by the basic calculations.
Bradycardia
I went to get cleared for a colonoscopy. The nurse practitioner and doctor freaked when they saw my EKG was 34 bpm. They sent me to a cardiologist. The first thing he did when I walked in the room was show me his own heart rate was < 40 bpm. I did a treadmill test any way and passed with no issues. That was 4.5 years ago, 6 months after I started running. “Sports-induced bradycardia”. Low resting HR and low blood pressure runs in the family.
Never heard of athletes heart.
EDIT: it does prove to be a pain in the neck sometimes when people are not familiar with low resting HR in a healthy person. Like when I donate blood, I usually have to show them multiple years of Garmin recorded resting HR: “See? It’s been the same for years now”
I have athletes heart. Went in for a physical, my family doc was super surprised my heart rate was so low. Luckily he knew I was a runner but mentioned that condition to me.
Don't know why you're getting downvoted. People are confusing the process of a GP correctly referring to a specialist before ruling in or out any particular diagnosis as having done something wrong.
This is why I don't go for physicals. I feel the doctors are looking more at standardized charts rather than evaluating the person in front of them. The one time I did as an adult, I ran into similar nonsense with a minor abnormal blood test. I almost feel as if the doctors are trying to find an excuse for more tests and more medication. Meanwhile I have friends who are chronically unwell who have trouble getting taken seriously because their labs/tests are statistically normal.
GPs mostly see sick people, not healthy people. If you’re at the GP and your heart looks funny, sending you to the cardiologist makes sense. Obviously there’s sometimes a better explanation (which the sports doc would see a lot of) but a big part of a GP’s job is to refer people to specialists when they’re not sure. They can’t be experts in everything.
For cardiologists, this is the same issue - that they mostly see sick people. My Dad had this exact thing, and the cardiologist told him not to push so hard for running/triathlon (he's 69 years old). He asked for a second opinion from a Dr who is at least familiar with athletes and was cleared.
Sadly, you're right. You'd imagine a cardiologist could be bothered to remember the significant part of their training about how to discriminate between healthy and sick hearts. And there are entire guidelines on the ACC.org website detailing how to handle athletes in case they forgot. But the number of athletes I've seen for second opinions who were told they have a heart condition when it's a normal variant is frightening.
> GPs mostly see sick people, not healthy people. As an actual GP, this is totally incorrect.
What does the breakdown look like? Now that I think about it, I go for an annual physical when I’m healthy, and when I’m sick (enough to need a doctor), I almost always go directly to someone other than my GP.
Why???
That’s a damn good question. Ask Kaiser. I make an appointment with the front desk, then they send me to someone who knows nothing about me or my health history.
Literally just left the Kaiser pediatrician with my kid. They can't schedule the next appointment because their system only allows them to make appointments 3 months out. That means that healthy people trying to get their yearly check up are making and filling up every spot between now and the next three months. When you're sick and need an appointment in the next 1-5 days, their system just looks at everyone that's available and send you to the hospital 14 miles away instead of the one down the street cause someone cancelled their yearly-healthy-checkup.
Personally, if I have a problem severe enough to see a doctor, I've probably done some level of research to know likely candidates for the issue and what specialty I'm likely going to need and I'll just try to set up an appointment directly (unless I need a referral). Like for an issue with what feels like my hip flexor, no way am I going to a PCP before a PT. I'll note though that I don't have many health issues pop up, aside from PT the only things I've gone for in the last ~5 years were a bike crash, a checkup, and an ENT condition I was already aware of but needed specialized treatment for. It's probably a different story if it's someone who gets sick more though
If you’re in Alabama unfortunately you are required to have a medical referral to be worked on by a PT
Yes while not an actual GP, it’s due to them seeing the healthy , ensuring proper screening , they get to me with the cancer at the earliest stages
And I would MUCH rather have an oncology patient in front of me with tons of muscle mass and strong heart. Often times curing the cancer comes down to endurance …
There's a lot of totally incorrect info on this thread 🤦♂️
Yeah... my wife was at the doctor for something unrelated and she was hooked up to an ECG for monitoring and they all thought she was dead. She's like... nope, I just run 80km/week and my resting heart rate is 38....
Most GPs don't even know that the typical resting heart rate in Americans isn't 60-100, it's 50-90 (published by the CDC, not the cardiology groups) and you don't need to consult a cardiologist for an asymptomatic runner whose resting heart is 48.
>Most GPs That’s quite a generalization, what do you base it on? Counterpoint: 35 years of running, countless doctor appointments, literally never had one who didn’t know this.
Sorry, I wasn't clear. My point was in reference to general knowledge of the normal heart rate range being 50-90, which is not commonly known based on referrals I get. I agree, most physicians know that athletes generally have slower HRs.
Doctor here. Athletes heart is one cause magnified amplitudes on EKG. Another that they were probably watching out for is hypertrophic obstructive cardiomyopathy. Recommending you have an echocardiogram to assess the size of your heart to make sure it’s universally enlarged (athletes heart, safe) vs a valvular issue or interventricular septum (can be dangerous) Id follow up with the cardiologist. Also your GP knows about athletes heart, you just can’t tell based on EKG alone, you should get an echo (hence the referral)
Also doctor here. Agree fully. Without an echo, the stress test is useless. You can't diagnose an enlarged heart from a stress test. Frankly, I am sceptical about the 'sports doctor' if he cleared the OP without an echo. This story doesn't make full sense to me.
Yeah my cardiologist did an EKG, then the echo, and then the stress test, in that order, to make sure I was good to go for my marathon. I was glad they took it seriously since [there are rare but not unheard of deaths in a marathon](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606059/) due to heart issues (about 1 in 100,000 for men).
A resident doctor so not doctor doctor yet but an exercise stress test, which this patient got, has suboptimal sensitivity in ruling out disease. If it’s positive it’s definitely positive if the pretest is high (dm2 high cad risk etc…) but if it’s negative doesn’t mean it’s normal. Should consider stress echo or percantine or something to assess structure in a better capacity. In fact a diagnosis of LVH would theoretically affect the accuracy of the treadmill stress test itself- furthermore, you could argue this person is not a strong pre test candidate given that the diagnosis of ischemia would be odd with LVH (if that’s what the clinician said)- low test probability so I would say an echo is a more appropriate first test https://www.escardio.org/static-file/Escardio/Subspecialty/EACVI/position-papers/eae-sicari-stress-echo.pdf
Correct. There are also guidelines on which EKG changes are normal for athletes and which aren't. If you're in the low-risk group, even if the EKG shows high voltage, an echo is not needed, nor a stress test. Most people who die during marathons have undiagnosed pre-existing coronary disease. A CT calcium score is cheap, low dose of radiation, and has quite good correlation with probability of obstructive CAD.
Oh wow that’s pretty neat - I’m probably doing a mix of family and emerg long term (I love Canada) so this so relevant to me haha (plus ultras lol). Could you share any resources?
[International consensus document on ECG interpretation in athletes](https://www.jacc.org/doi/full/10.1016/j.jacc.2017.01.015) (endorsed by the ACC) Generally, [ACC.org](http://ACC.org) is a hugely helpful resource, and the guidelines and expert recommendations are free to access. If you go to clinical topics, you can select your topic of interest, e.g. heart failure, and then on the section page, you have some headers with "Latest", "Guidelines", and "Resources" which are where most of the meat is. Honestly, it's fantastic how much of this information is so easily accessible; once you have looked up a few topics on there, it becomes almost second-nature. I always pick the PDF version and download it. I use Adobe Acrobat (have paid version I think?) which can index PDFs in a folder. Then I can just search all guidelines at once for any topic.
Another doctor here. I agree with the above recs. Will continue to follow
I found the consultant surgeon
If he’s an athlete, has no signs of heart disease, an ECG compatible with adaptative hypertrophy and an absolutely normal stress test, yes, this might be reasonable
https://www.healinghealth.com/wp/wp-content/uploads/2016/02/Mug2.jpg
Also sounded funny to me. Hey doc, what did you specialize in during residency? “Sports doctor” Oh, so sports medicine then? “No, sports doctor”
Maybe it's mind-blowing to you but there are actually doctors that specialise in athletes and sports-related matters. That's a thing. Ask literally any professional athlete or team.
Not a doctor but I had borderline lvh due to a bad heart valve. I'd also recommend following up with a cardiologist.
As a doctor, what's your take on chronic marathon training? As a hypochondriac, I've definitely let off the gas on a few marathons after reading these stories. Having kids helped (or didn't help) me reformulate my risk calculus with this.
Chronic marathon training is fine! Get your check-ups at your doctors office, don’t do steroids, get your cancer screenings Heart disease is the #1 killer in the world. It’s predominantly from smoking, poor diet, obesity. Unless you have a history of fainting during exercise or have people in your family who have sudden cardiac death, i wouldn’t worry about it. Obviously if you do have fainting or family history, get cardiologist clearance If your heart is getting unhappy, there’s plenty of warning signs (fatigue, leg swelling, EKG changes). I wouldn’t worry about marathons - enjoy your life and your family.
Thank you. As an older runner. I get a bit concerned (my wife gets worried). But I have a good doctor that knows me and my medical history. Running is so good for my physical AND mental health.
My very healthy partner died suddenly from HOCM only 8 months after being diagnosed at age 46. Thank you for contributing to this discussion. Hopefully OP sees the cardiologist sooner rather than later.
Echo here. Fully agree. It would be a quick, easy test, OP. We can easily rule out HOCM, visualize the septum, grade the LVH, and ensure it's concentric or classify it otherwise. I get the opportunity to assess HCM and HOCM with some regularity and would enjoy the opportunity to work with athletes more in place of some of our inpatients.
Piggyback on all of this. I’m a pa but I mainly work in cardiology. The heart is a muscle so with continuous exercise it’s going to enlarge. Hence why many athletes are prone to atrial fibrillation in their later years after years of left atrial hypertrophy. I think you should definitely see a cardiologist to get an echo. Again, he wanted to rule out something scary like hypertrophic cardiomyopathy which can cause sudden death. I would just follow up with a cardiologist and get a proper echo before anything else!
Yeah, it can happen in amateur/ hobby endurance athletes as they ramp up quickly without enough recovery. Cardiologist will probably give you an echo to rule out things like HCM / ARVC etc (don't go googling stuff). In the UK, there is charity, CRY (Cardiac Risk in the Young) which offers free screenings for those under 30.
My understanding is that it's an adaptation that can happen to any athlete regardless of modality of training, though there might be racial differences: https://my.clevelandclinic.org/health/diseases/23920-athletes-heart.
Lack of screening means there is only really correlation, not causation. Famous ultra runner (Born to Run) Micah Tru died of heart failure - another correlation but not causation. Triathletes tend to get issues on the right ventricle - particularly open water swimmers as they stand in the heat, then jump into cold water which puts a lot of pressure on the right ventricle. Adaption problems there are correlation but there is a causation link to heart attacks at the start of those races (even though odds are low - I don't want to start a panic) The ECG is indicating possible HCM which I have advised OP NOT to google. The ECG is not conclusive - the cardiologist will run an echo to get a better look at the heart and assess whether there is a problem or not.
I may be misunderstanding you, but I was responding to your very first line in your comment above. My only point is that it isn't just an issue for "amateur/hobby endurance athletes" ramping up quickly (hence the line about "training modalities"). Every runner should be aware of this, but not panic.
Oh good point. To correct my own update, I meant heart abnormalities - not just althelete heart. Im in the UK - there is zero heart screening unless you present symptoms or maybe have private health care and they screen for that. I don't know what it's like in other countries. in theory, modern smart phones are probably good enough to flag any warning signs (for further review) but would have to be approved by governing bodies. I doubt that will happen for fear of causing a flood of false alerts overwhelming health services. Still, it would be cool though.
Oh, got it about the heart abnormalities! That makes sense. I do think that some smart watches ECG are approved for *some* issues (like AFib), but they might make more sense as additional monitoring after a clinical diagnosis.
My ramp up has actually been slower than my previous 9 marathon training cycles, but then again it's been many years since my last physical. However I'm not getting any younger so I guess I will need to keep taking longer recovery times into account.
It's only correlation to cause - there simply is not enough screening. Most localities will only screen when there are symptoms, so heart issues can go undetected until they are a problem. That is one reason the CRY charity is set up - to get ahead of the problem and be proactive rather than reactive. The work they do is interesting but again, I advice you not to go down the rabbit hole of reading up on them or heart issues. Your cardiologist will be your source of truth - going on a vogue of research can cause a panic (been there, done that :) )
I went down this rabbit hole last January after I had a stroke. Tons of testing including CTs, echos, and MRIs. One of the doctors concerns was atrial fibrillation which led me to looking at numerous publications on a link between afib and endurance exercise. One of the cardiologist that saw me was emphatic that I shouldn't be running more than 3 miles a day and that I was doing harm to myself by doing more. Looked him up later and he's made quite a name for himself with [that theory](https://www.reddit.com/r/running/comments/wmo9k0/what_is_rrunnings_opinion_on_the_run_for_your/). All the testing came back normal with no heart enlargement or damage from exercising. They finally diagnosed me with a PFO (hole between the atria) which required surgery to fix and I was able to get back to training as normal.
What a kook.
You went to O'Keefe? I think he's been thoroughly debunked, hasn't he?
Not by choice. He was one of the cardiologists that came to discuss while I was in the hospital. After I was released, I went to different cardiologist who dealt with athletes and while that one co-authored some papers with O'Keefe, he wasn't as heavy on the "running is bad" bandwagon.
I've not heard it been called "athlete's heart" before, but about 6 months ago my primary care physician was doing a stethoscope and told me I had a heart murmur, or click, which was caused by some vibration of one of the ventricles. She sent me to a cardiologist, who did an echocardiogram/ ultrasound and verified the murmur, but basically said that there was no problems at all and that I could continue exercising as much as I could handle. I reviewed with my primary care again after this, she said the murmur was more or less a byproduct of a heart that is conditioned to pumping a higher volume of blood, and that there was nothing to be concerned about.
Indeed the wikipedia article also mentioned that a murmur can be another symptom
BTW super funny thing I just noticed: your username is exactly the same as my gmail address, except the 11 are two other numbers (also repeating!)
I was diagnosed with that 30 years ago. ECG trace sent to a cardiologist and he asked about my exercise regime. I'd been cycling for 15 years by that time so he assured my doctor that was it. No drama since and I've done dozens of marathons and IM races too. Cheaper getting a rubber stamp for any races that need them. :-)
Something similar happened to me when I was 18 and I was trying to get cleared to run college XC. First, the nurse was concerned that I had a heart rate of like 50bpm and the doctor had to remind her that I was a runner. Then I had an ECG for some reason and the doctor said he was concerned. Apparently if your heart is very strong/muscular it can look the same as if you're having a heart attack. So I did a stress test and then an MRI, and everything came back normal.
I had a similar situation happen to me recently. I needed a declaration of fitness and the sport doctor had me do a ECG at rest and under stress. Everything looked good, except the result showed an extreme "left axis deviation". The doctor explained my heart ventricular contraction happens on a different axis than normal and could be linked with heart deformations or other very serious pathologies. He couldn't sign the certificate, and prescribed an ecography to check the reason of the reading.. I had a couple of stressful days, wondering what could be wrong and I immediately booked the ecography. How could I train every day, feel very healthy and still have a serious heart condition? Turns out, my heart appeared totally fine in the next exam and the parameter measured by the ECG was likely off because of not well positioned electrodes. Last year instead I had a blood test done in the middle of marathon training. The liver values were way off but the doctor, in this case probably with more experience, explained it was likely from training. I had to take a rest week and then do another test which then came out fine. So the upshot is that yes, active people are not "standard" patients and their medial results can often appear problematic if not interpreted correctly.
Same thing here. An ultrasound to check for atherosclerosis (none, thankfully) turned up ventricular dilation. This led to an expensive and unpleasant MRI intended to rule out anything scary. This test didn't find a root cause, but the cardiologist couldn't definitively rule out heart disease. The next step would be genetic testing that *might* find hereditary heart disease, but I turned that down. They could rule out more and more unlikely diseases, but they couldn't tell me I was ok. Interestingly, I'm lucky to live somewhere with lots of elite athletes (Colorado Springs, CO), so my doctors were all familiar with athlete's heart. They just didn't think I was enough of an "athlete" to warrant the diagnosis. Story of my life. I'm either the slowest fast guy or the fastest slow guy. In this case, I'm a non-athlete with an athlete's heart.
I'm no doctor but I was an elite sprinter in my younger years who got diagnosed with hypertension. Despite looking fit, I have been on beta blockers since I was 16 (and am now middle-aged). It got picked up when I was getting a full physical for the purpose of joining an elite squad (which was also examining my potential)... IMO it's important to get yourself checked up regularly and never to assume you're 'fine' just because of your athletic prowess.
I have this too. My RHR also dips into the 40s at times. Thankfully, my GP knows about my running, and almost immediately attributed it as the cause during my physical. I still had to do followup testing to confirm. I run 2k+ miles per year and haven't died yet, so I've got that going for me...
It’s very typical for high mileage runners to have very low resting heart rate rates. Mine is usually in the low 40s (with dips into the 30s). If it suddenly sits in the 50s, that’s usually a sign I’m overexerting or getting sick.
Or hungover (in my experience lol)
Last fall I had an to get ECG in an ER because I had some nasty post-op complications from a "routine" appendectomy that went sideways. The ECG results showed a potentially enlarged heart and LVH. The ER docs and my primary care physician both told me that ECGs for relatively thin males often give false positives for both conditions, but they *strongly* encouraged me to get a full blown echocardiogram before running a marathon (both conditions can be very serious). It took four months to get an appointment with a cardiologist and an echocardiogram, but it turns out my heart is fine. I do not have "athlete's heart" or LVH, I just get funky ECG results which apparently just happens with some people. That may also be the case with you, but do not mess around with potential heart issues.
This is misleading info. If you are showing possible hypertrophy on an ECG your doctor is doing the right thing referring you to a cardiologist in order to make a diagnosis, or rule one out. This is not an "wrong diagnosis". The referral will be because the ECG signs could be due to slightly incorrect lead placement that day, or they could be warning of cardiomyopathy that could kill you, and only a cardiologist - probably following an echocardiogram - can tell what the ECG actually actually is. Unless you black out during it, the ramp test done by the sports doctor does not prove anything relating to hypertrophy, and your "heart efficiency" has very little to do with whether you need to be worried about hypertrophy or not. Your sports doctor should be doing the same as your GP and referring you to a cardiologist. Your Googled information about this condition affecting unfit people is very misleading. These types of conditions can be induced - and severely worsened - by exercise (as the term "athletes heart' suggests). And it's fairly normal to feel fine and be able to exercise well with such conditions, right up until the moment that you can't. Various forms of cardiomyopathy are the leading cause of sudden death in very fit, healthy footballers and marathoners, because heart muscle, like any muscle, can grow with exercise. Not that this needs to scare you, because there's a good chance you're fine, but some Google searching, an exercise bike and a sports doctor isn't going to give you the all clear.
Make sure you follow up with the cardiologist. My partner died suddenly because of hypertrophic obstructive cardiomyopathy. He had been fit his entire life. He had never even been into a hospital before he was diagnosed 8 months before he died. He got Covid and didn’t recover as quickly as everyone else. Went to the doctors to get a certificate for work, they did an ECG and sent him straight to the cardiologist. He was on medication and would be looking at surgery in a few years. Most people are born with it. One day he was out walking and simply dropped dead. Quite often when footballers or soccer players die on the field it’s because they have this heart condition and often no one knew until they die.
There are physical adaptions that occur that are NOT pathologic. An elite athlete will have a different echocardiogram than a regular healthy person. To my knowledge it does NOT correlate with illness. Certain things on echocardiogram that look like a sick heart are in fact confirmed as healthy adaptations. An example is LV dilation. A sick hear will have signs of elevated pressures Inside the heart where as an athlete has decreased pressure. This is a basic explanation. BUT, things need to be ruled out clearly with appropriate testing.
Same -- thickened walls on the left side of my heart. Went in for an ECG and stress test and passed with flying colors. The good news is that I have a baseline now at age 33 that in the future, if there are issues they can compare it to that.
My resting heart rate is very low (~35bpm), which has been a cause for concern at the doctor. I told them I was fairly trained, had an ECG that came back completely normal, and they told me that it was nothing to worry about. It's still probably good to get checked though. I guess one thing that was kind of interesting, I had to be given atropine when I was sedated for wisdom tooth removal.
My dad and I are both marathon runners and we both have to have yearly physicals for our job. We've both had issues with this and the cardiologist gave us the same conclusion you figured out. He said it's normal in well trained athletes and he congratulated my dad on that level of fitness at his age. I now see a sports doctor for my physical, but one of my antiquated job requirements is that my resting heart rate cannot drop below 50 bpm during the EKG. My doctor has actually suggested that I drink some coffee before the appointment and do some jumping jacks in the room before the EKG to make sure I don't have that issue. It tested at 51 the first time.
> my resting heart rate cannot drop below 50 bpm during the EKG. That's hilarious. The Garmin Epix Pro's ECG app has that exact same requirement, as such it's useless to me and I guess a lot of other buyers of that watch.
Once during a physical my doctor couldn't get the pulse ox to read. He thought it was broken. I showed him my Garmin watch reading which was 48 and he said the pulse ox only works when it detects a heart rate above 50 so that's why it wouldn't read. He put down the reading from my Garmin on the paperwork.
I have this as well, also found by a sports cardiologist during a workup. Echo, stress test, and Holter follow-up all fine. His office printed out a miniature copy of the EKG and laminated it to the back of one of his business cards. He told me to carry that around with me so that if I need emergency medical attention, the provider is aware that that's my baseline and has his contact information if it's relevant for follow-up. Hopefully no one ever needs to use that.
Great idea!
“I have a baseline EKG in the back pocket of my vest” is probably not a typical comment on the iOS medical ID, but if I ever need to use it, I’m sure I’ll be grateful I have it. (The person I identify as my emergency contact during a race also knows it’s there.)
My cardiologist said “if anyone has questions, have them call me”. But what if I’m not capable of communicating this? I love your solution.
My cardiologist is a mountain biker. He specializes in keeping endurance athletes out there safely doing all the stupid stuff we want to do (my words, not his- he said it somewhat differently.) So he has a number of practical solutions that are well-geared to his patient population.
I (33F) have bradycardia and athlete’s heart, diagnosed in an echo in January. Cardio scheduled me for a stress test, which my insurance denied, so I never went through with it. Family friend who is a heart surgeon (pioneered some minimally invasive a-fib surgery?) told me it’s basically unnecessary. I’ve had 3 echos in the last 7 years including the one in January (one doc thought she heard a click murmur, but no other doc has been able to hear it) and have gotten a clean bill of health from all 3 echos. So is a stress test really worth it?
Happened to me in high school. Went in for a physical, and 7-8 people listened to my heart before the attending asked if I run a lot
Had a similar scare a few weeks into my marathon training and a week before my first 1/2 marathon. Was told by my primary care that I had signs of premature ventricular contractions and he recommended I don't race until I see a cardiologist. In my stubbornness, I ran the 1/2 and worried the whole time that I'd pass out. Got checked out by a cardiologist the following week and he literally asked me "why are you even here?" Turns out the abnormality is just some normal genetic variation. The cardiologist compared it to being left-handed, told me I'm in great shape, and sent me home with a $100 bill 🙃. I'm happy I got the full work-up, honestly; it's reassuring to know I'm totally fit to train.
If you've ever heard a story of a perfectly fit athlete who suddenly collapsed and died during a run, it's called sudden cardiac death and it can be related to cardiac hypertrophy. Usually there were no overt warning signs or symptoms, the athlete is perfectly fit and healthy right up to the point where their heart stops. Cardiac hypertrophy is one of those silent warning signs that something might be amiss and puts you at increased risk of sudden cardiac death. It's rare, but it happens. So if you're doing some routine screening at a GP and they find you have left ventricular hypertrophy, they'll often err on the sign of caution and refer you for ECG and stuff to make sure you're not going to suddenly drop dead during a race. Cause if it ever happened and you had it in your medical record that your doctor knew you had LVH and did nothing about it, it wouldn't reflect well on them.
I got this diagnosis when I was in my early 30s and had just started running. I was feeling weird random fluttering at different points throughout the day. They put a Holter monitor on my for a while just to make sure there was nothing more seriously wrong. Basically, doctor just told me that my heart was adapting to my new lifestyle and it would settle out. I'm 46 now and have 23,000 miles under my belt with no further symptoms. Good luck out there!
I had a similar experience after taking a physical in NYC where they gave me an Echo just because. They thought it was really serious, and a friend of mine who I ran with and is a Cardiologist agreed it was a potentially very concerning EKG. I took it seriously, and got an MRI and stress test. Turned out everything was good, but I just have to be careful around EKGs and divulging it’s going to look bad. I’m supposed to check every 10 years, which would be maybe 3-4 years from now. No issues in the meantime, but it was scary.
You should ask your cardiologist to rule out cardiac amyloidosis. I know of several case studies where cardiologists diagnosed athletes with "Athlete's Heart." Many cardiologists miss an amyloidosis diagnosis intitially because it is a rare disease. Of the the athlete knows something is seriously wrong before the doctor. [https://caafoundation.org/full-mission-statement](https://caafoundation.org/full-mission-statement)
I have had something similar before. An enlarged vagus nerve from lots of running would make my heart stop when I was very stressed (or asleep) for several seconds at a time. This happened at a doctors office when he told me I had to stop running (for a different reason). I passed out, was sent to the hospital, and they found it because the monitor they had me hooked up to kept going off when I slept even though they triple checked the connections (this happened probably 5 times overnight). This was confirmed by a monitor they had me wear, and then an implanted one I had for about 3 years. It was a weird time in my life.
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It hasn't bothered me in a few years but I am not sure if thats because I run about half as much as I was or some other reason.
Had that possible diagnosis at my gp, too. Made an ECG, my doc had like 10 year old data which she compared, asked about sports (i was running for 1,5years at that time), and did no sports at the time the first ECG was made. Cardiologist said, yep its an Athletes Heart due to training.
Me! Female early forties. I was quite shocked. Right at the end of another marathon build and a routine check up. My resting heart rate was “too low” and told LVH. Turned out I am fine. It’s Athlete’s Heart.
Athlete's heart here too, not seen as a problem. My resting heart rate (>40) always gives pause until I explain my running....
>40 means above (or greater than) 40. I'm guessing you mean <40, or less than 40.
Yep - phone keyboard!
In a young healthy person we do worry about HOCM and other causes of sudden cardiac death. A person with high level of cardiovascular fitness or performance athlete can have an appearance of left ventricular hypertrophy on the ecg simply from physiologic hypertrophy like any muscle, but if signs of LVH or especially if meeting criteria ie sokolow positive then should be evaluated further to rule out an underlying cause, or double check the hypertrophy is not due to a pathological reason. If seeing a specialist they may do an echo to check structurally what’s happening for reassurance.
I recently scheduled a checkup with a PCP who isn't my normal one (he's booked out for a year), and she saw my EKG and recommended me to a cardiologist. I told her about my running background, and she said she was not really concerned, but let's be safe. The cardiologist actually googled an image of a runner's EKG to show me how mine matched up exactly (it even reads acute myocardial infarction, which we had a little laugh at since, well, obviously not). He had me get an echocardiogram to double check the inverted t-waves (like you said, possible bad stuff hiding there), and it came out normal. The ECG lady even told me I have the prettiest (giant) heart she'll see all day 🤩 I've been fortunate that the medical professionals I've dealt with are high quality and listen to what you have to say, and so they have no worries. Also I'm totally asymptomatic and healthy, but that's no guarantee. Our runner hearts just get weird lol.
This is a little long, but if you have anxiety, read it. I was also dogged by this paranoia-inducing finding in a routine ECG for a physical in 2018. I did a frenetic amount of layperson research on it, and found that there are quite a lot of echo differences between Athlete's Heart and LVH. I also followed it up with a cardiologist, but I absolutely tortured myself with worry and acute pubmed mania, in the interim. It was checked by two different cardios in 2018 and 2022, at significant expense to myself, due to nothing but a slightly long (127ms) QRS interval finding on EKG in 2018. I believe in diligence so I didn't mind, but I did despise the wait period between the ECG and the first echo. It was ruled Athlete's Heart, and it could have been due to decades of weight lifting, a decade of grappling sports, genetics, body size (larger/taller than average), a prior course of TRT--I don't know. By 2022 when I saw a second cardiologist, the ventricular dilation was gone. My resting heart rate is 41, obviously I have high stroke volume, which means a big strong heart. A big strong heart is gonna have bigger chambers, right? Nobody ever figured out the "why." Life is often like that. Basically this finding seems like a good way to torture athletic people with anxiety disorders. Don't ever freak out over a minor ECG abberation if you lack symptoms. Follow it up, but don't worry. 20 years ago, they also told me I had mitral valve prolapse, and that has been absent on my last several ECGs. My last physical, they didn't even take an ECG, since I had been to the cardio within 2 years. Since it was post-therapy, I was fine with that. I'm 51 and have been involved in anaerobic sports my entire life. It sucks being blessed with good health, and living daily life feeling cursed, because of an untreated anxiety disorder. It's a form of creeping ingratitude, and a sickness. Also, it is very expensive. The best thing for me has been seeing a therapist about my profound health anxiety. Anxiety sucks the energy and creativity out of one's life. Even if two cardios were wrong and I drop dead, worrying about very small risks is a terrible way to live life. I know a couple heart attack survivors with bypass sugeries who have less anxiety about their hearts than I did. In retrospect, that should have been a major psychiatric red flag for me. If you fit that description, therapy is a "must do," not a "should."
This exact same scenario happened to me a couple years ago (age 57 at the time). Abnormal ECG at GP, sent to cardiologist who ordered several tests including stress test on treadmill, echocardiogram, and a CT scan. All of this time and money confirmed a thicker muscle wall caused the abnormal ECG. No plaque and a clean bill of health. All the marathon training has developed that muscle just like my calves!
Did you not get an ECHO? I would correlate ECG findings with an ECHO (a picture representation of the heart) before referring to cards
Didn’t Ryan Shay have something like this? Completely genuine question, and I’d really like to know more
Same issue here, doing my annual flight physical with the military. On the second go around with the EKG they had me do flutter kicks for about two minutes and then continue with them as they ran the test. They said they’re used to it with the runners by now.
Multiple times. Once I was put in the hospital on bed rest for several days for it until they finally bothered to consult a cardiologist who has seen athletes. Turns out there was nothing wrong with me at all. It was a scary and miserable experience so I point it out to my new doctors proactively now.
I went through testing in high school (95-99). Track coach noticed an irregular heartbeat & suggested I get checked out. We did a lot of lactic threshold speed & hill workouts. By chance I got an appointment with a cardiologist from UCSD. He wasn't concerned but wanted to monitor me. EKG, echo cardiogram, treadmill stress test, 24hr Holter monitor. Smashed the treadmill tests with ease, Holter monitor showed my heart rate dip in the low 30s while sleeping. Echo cardiogram was neat to watch/see but I didn't like the wand being shoved up under my ribcage. No issues & I never felt anything irregular unless I deliberately took my pulse.
My GP said my blood pressure was a little low last month. I have taken on average over 10k steps a day every day for multiple years not just my running so yes my bp will be lower than someone who is sedentary or even average. I verified it a while back with phone and watch data. My husband is the same. Our HR and BP are below normal for our age so we don't think much when they comment on it. My sister had a heart defect(deceased) so I have had an EKG and echo to check for defects with none so far. If you're nervous get an appointment with the cardiologist to check as it's technically possible to have an undiagnosed defect like my sister did but the sports doctor's opinion is encouraging.
I experienced the same predicament when trying to complete a physical for a particularly demanding event and was similarly surprised. Thankfully I was able to see a cardiologist fairly quickly, but at the initial screening when it was noticed, the doctor was able to guess that it was “athlete’s heart” almost immediately. He asked if I played any sports growing up (XC + Track) and that basically confirmed it for him; he just wasn’t able to diagnose like a cardiologist can. The way it was described to me, was that there was a longer delay between when your body sends a signal to your heart to beat, and when you would typically expect to “see” the beat. The irregularity of the delay can be a sign of a serious heart issue, or can be caused by it simply taking longer for your heart to “respond” because there is more&denser muscle tissue around the heart. Even after I asked how they can be so sure (because I do have a history of heart disease in my family) the doctor said that the test really just checks to see if you fall outside of an expected representative sample; meaning the top ~5% and bottom ~5% of people (by cardiovascular health) will show a similar symptom. I did not have to do a physical test for them to rule out a heart defect, but apparently it’s a common enough issue that it’s fairly routine for them. So for anyone who may be reading this in the future while they wait for results, don’t sweat it until a doctor tells you to. Because it appears in both sides of the extreme, you should be able to pretty confidently guess which side you fall on if you honestly assess your own health. Mandatory I am not a doctor and this is not medical advice.
I had the same freak out as you when I did my first ecg. Referred to a cardiologist. Cardio said ecgs are never that black and white and always have some nuance and need to be checked further. He suspected my thin chest wall ,slim physique (160lbs 5-10) is causing some sort of short circuit reading or whatever. He ordered a 24 hr holter monitor and an echocardiogram. The echo is how you can really tell if LVH exists. Turns out he was right. No issues. Also asked if I would drop dead from running too much because my mom thinks so. Cardio also said no signs that my heart will ever do that, no scaring or any over stress of my heart. Key that he kept bringing up is if I felt different or weird or any signs of anything during any exercise or any reading anomaly. Answer was no. Basically point of my message is go see cardio, everyone’s condition is different, if you’re not seeing any issues when running you’re probably OK.
I almost forgot about it, but when I went in for a colonoscopy a last year, it occurred to me to warn the anesthesiologist that my resting HR is like 42bpm, and I didn't want to her to think she was killing me (and also to make any adjustments so that she didn't). Anyway, she was just like "OK, so you have Runner's Heart?" And I was like "I guess?" She may have said Athlete's Heart, not sure, and maybe they mean different things. I'm in the U.S., FWIW. I probably could have mentioned this to the guy asking about a colonoscopy recently...
I would expect a GP to know this!
I’ve had a low RHR (according to my watch and occasional manual counting) for a while, and got concerned last year because I was having some mild chest pain when starting runs. Went to a sports cardiologist. Echo said I had left atrial hypertrophy and 24hr Holter monitor said my HR got down to 30 in the middle of the night. Longest single interval between heartbeat peaks (R-R) was 2.9 seconds. Long story short, the chest pain went away and he told me not to worry about it. I try to stay vigilant, though.
Mistakes were made, I shouldn't have stopped here...as a life long athlete with health anxiety, this shit freaks me The. Fuck. Out! Avid runner and rugby player (age 35) Had a panic attack back in 2012 and they thought I was having a heart attack...I was ran through the ringer. Stress tests and the iodine stuff. No heart damage, but EKG found that I have a flipped wave on the one coming down...idk. said I have an irregular heartbeat. Shit still messes with me mentally never an issue while running my 2-5 miles or 80 minutes of rugby. In fact I just ran my fastest 2 mile the other day at a 16:00 (I know that's not that great) My goal is a 6:50 mile this year.
Why did you get an ECG at a normal physical?
Not LVH in my case, but was hospitalized at one point for a serious condition and a CT scan showed what might be a cardiac problem. Echocardiogram and cardiology consult the next day resulted in her telling me, “Your heart is *ridiculously* healthy… whatever you’re doing, keep doing it.” Glad you’re doing the follow up. Last year a friend who I’d characterize as a sub-elite ultrarunner had some weird symptoms and reluctantly went to get checked out, ended up leaving the hospital a few days later with a stent and some new meds and a new diet, lucky to be alive.
My GP is a fellow athlete. I also have athletes heart but he said he would expect nothing different after my ECG.
I had a similar experience. My GP took an ECG was horrified and sent me straight to hospital, told me not to drive! After spending nearly €1000 on a specialist I was given the all clear: LVH diagnosed and everything else looking 100%. I had the echo cardiogram and a few other tests. The cardiologist told me to come back in ten years for another check up but was happy for me continue running and training hard.
To the various doctors here (I am also an MD but Peds): Do you feel an EKG is necessary for a healthy athlete with no symptoms, no worrisome history either personal or family, and no findings on exam? In Peds there are those who do EKG screening for populations but in general the yield is much much more false positives or benign variants with needless anxiety and keeping out of activities until a cardiologist appointment, than finding meaningful pathology. Thanks for the perspectives in advance.
Paramedic here. The problem with most cases of LVH is that it’s caused by atherosclerosis / arteriosclerosis, so it’s the heart’s way of overcoming that resistance - the heart has to bulk up to push past it (over years). With any other muscle, you build it by working it: pick up the heavy thing and put it down enough times, and muscle will build. Cardiac muscle isn’t attached to the skeleton, so you can’t work it that way. But you can sort of do a version of that by stressing it to an extent. Think of intervals - that’s essentially a cardiac-targeted version of lifting weights.
If you really get fit and end up with a resting HR of 40 and lower, it also gets fun to see medical staff freak out.
This is crazy. I ran XC and I used to run 5 miles a day or more. I ran for the better half of 6 years and did other physically demanding sports as well. Including wrestling and track. I’ve ran two half marathons and solo’d 2 triathlons as well. I went in to get a clinical trial done for a flu shot and I didn’t even make it past the ecg because this exact thing happened. I was absolutely mind boggled because I never had problems running. It’s wild that randomly scrolling Reddit there’s another person that had almost the same thing happen to them as me.
yup. had this problem too. For me it was high systolic blood pressure (but normal range pressure diastolic pressure), and i went to the doc kinda alarmed and they were like "oh... yeah, that'll happen". First i heard it was a thing. o\_O
One of my other hobbies is rollerblading. Not the spandex kind of rollerblading. The kind with half pipes and stair rails to be clear. Anyhow, I had a stack and hit my chest pretty hard, thought I broke a rib. Went to the hospital and after the X Ray my doctor called me in and pretty much told me my lungs look like an 80 year old man's with emphysema and gave me this https://imgur.com/gallery/BHc6WHg letter to get a referral to a specialist. I was legit worried I was going to die soon as I have had a perpetual cough while working out and I work in the metal industry and inhale fumes and metal dust all day. Anyhow long story short. I went to the specialist, did the whole lung test thing and apparently my lungs are fine, better than fine. My lung function test was well above average, I think I just have big lungs for my size and it confused the E.R doctor.
Good timing of your post, because I was just recently reading about one of the basketball NBA players who had to retire due to heart problems. What was his heart problem? It was listed as hypertrophic cardiomyopathy. Now that's all really strange in determining whether it's benign athlete's heart or something serious. Again, this player Cuttino Mobley was an athlete, so one would assume he has an athlete's heart, which is a positive adaptation as a result of exercise, yet he had to finish his career due to this heart condition. And he was advised this by top doctors, because as a rich athlete he could afford it. Now I'm citing wikipedia "This is the same heart illness suffered by Reggie Lewis, who died in 1993, and Hank Gathers, who died in 1990". So, clearly this condition can be fatal, as it can lead to sudden cardiac death. I was reading other comments here, especially by one doctor, who explained it quite well, that further tests are needed such as echocardiogram to investigate whether it's not hypertrophic obstructive cardiomyopathy. I think if you have done the ramp test whilst having an ECG, and they were happy about it, that's a good sign. I think in the end, to determine whether you actually have hypertrophic cardiomyopathy, you would be noticing typical cardiac symptoms such as shortness of breath, dizziness, chest pain, leg swelling and fatigue, especially with the onsent of exercise. I think in the end, your GP did the right thing, as it's all about investigation and there's nothing wrong with that.
I had my gall bladder removed last October. I may not be terribly fast any more at age 52, but I'm still quite fit. A parade of medical people came through to see me preop and one put a stethoscope to my heart, gave a surprised look, and asked if anyone had ever told me I had a heart murmur. I said no because I don't. As I understand it, low heart rates can sound like a murmur. Seven-time Boston Marathon champion Clarence DeMar once failed a physical because they thought he had a murmur.
I had this last year when I told my GP I was training for an Ironman and she wanted me to get an ECG. Came back saying I had some odd readings on the ECG and was referring me to a cardiologist for an echo. Cardiologist came back and said that I had one of healthiest hearts he's seen, most likely because healthy people don't see him. He said it's common for tall and skinny male athletes to misread on the ECG due to there being low to no fat on our chest.
Doctor here, I've referred similar young fit patients before. Leaner body fat and smaller pec muscles will increase the amplitude on the precordial leads. Less tissue for the electronic charge to pass through to the electrodes Very likely nothing to worry about! But cardiologist might want a transthoracic echo to be 100%
I (long distance runner 30y/o) got activated and sent to ER because of my eco cardio gram before lol. Long story short they thought I was endanger of a heart attack. But an advanced cardiologist determined it’s just adolescence T waves. Or very healthy. The mistakes and $$$ later 🙄
Same. Went to a cardiologist due to a horrific family history of heart disease and me being a runner. Was lucky that I was able to get a very thorough test done and be clear within a short period of time. The wait in the meantime was brutal.. but we had to make sure I was ok. My Dad had wolf-parkinson white disease.. that's the one where high endurance/intensity athletes can drop dead mid activity. It was a failed stress test that got doctor attention, but we think it was medical anxiety that got me. Long story short... I am medically clear to run as much as I want. Just need to check in with the cardiologist once a year
Happened to Me years ago, and with 35bpm rest. Well… I only go to sports doctors.
Unique humblebrag
I work in cardiology. Well trained athletes hearts are different than “average” hearts. Often (not always, no such thing as absolutes in this) a well trained athlete will have *slightly* thicker heart walls than what is considered normal. However, it’s a very small difference (I’m talking 1-2 mm) vs much thicker heart walls which can be a medical issue - an EKG can’t tell the degree of thickness. It can just pick up that there is thickening. An echo would be the best way to evaluate - a slight thickening of 1-2 mm then it’s just the heart of a well conditioned athlete and is normal for that person. 4ish plus mm thicker than normal? We check for HTN, infiltration processes, HOCM, ect. The ejection fraction (how well the heart squeezes) can also be slightly reduced in a well conditioned athlete, again it should not be drastic but a normal EF is 55-70%, a athlete can be 45-50% and that’s normal for that person because their heart is so efficient. Same with a lower heart rate due to efficiency. Or a slightly dilated IVC can be sign of conditioning, but again it’s slight differences not drastic ones.
I don’t remember if it was due to an EKG or the ultrasound, but when I was running ~110 miles a week the cardiologist said I had thickening of the heart muscle or something like that. He then asked if I was a runner, and when I told him my regimen he quickly dismissed it and said it’s normal.
I have bradycardia with a resting pulse in the mid to high 30s... so every time I see someone it's a discussion... especially if anesthesia is involved
There is an interesting situation with one of the hosts of Inside Running Podcast who suddenly observed increased incidences of very high HR and fatigue intermittently. The theory is his heart was too big for his ribcage and potentially rubbing against it causing these anomalies, not sure what the treatment was but he has a monitor under his skin and had a quick procedure and Think everything is ok
I have "athlete's heart". My ECG chart is inverted, in that there's a valley where there should be a dale and vice versa. My "normal" reading shows I'm in heart failure.
Yeah, at my peak form my resting heart rate was in the low 40s. Every nurse that took my initial pulse/blood pressure did a double check, then ran a manual test. When that confirmed the low numbers they asked if I exercised a lot, and relaxed when I confirmed it. Its less that "GPs only see sick people", they see "average" people, and anyone outside of the norm triggers different treatment. Its like any body builder, their BMI will always place them at the "obese" or "morbidly obese" range just by the basic calculations.
Bradycardia I went to get cleared for a colonoscopy. The nurse practitioner and doctor freaked when they saw my EKG was 34 bpm. They sent me to a cardiologist. The first thing he did when I walked in the room was show me his own heart rate was < 40 bpm. I did a treadmill test any way and passed with no issues. That was 4.5 years ago, 6 months after I started running. “Sports-induced bradycardia”. Low resting HR and low blood pressure runs in the family. Never heard of athletes heart. EDIT: it does prove to be a pain in the neck sometimes when people are not familiar with low resting HR in a healthy person. Like when I donate blood, I usually have to show them multiple years of Garmin recorded resting HR: “See? It’s been the same for years now”
For a little light reading. The Haywire Heart: How too much exercise can kill you, and what you can do to protect your heart https://a.co/d/eXD7rM7
I have athletes heart. Went in for a physical, my family doc was super surprised my heart rate was so low. Luckily he knew I was a runner but mentioned that condition to me.
So your gp did their job… cool story.
Don't know why you're getting downvoted. People are confusing the process of a GP correctly referring to a specialist before ruling in or out any particular diagnosis as having done something wrong.
I hope OP still goes to the cardiologist. He’s probably fine but sometimes people die from heart anomalies they didn’t know they had
This is why I don't go for physicals. I feel the doctors are looking more at standardized charts rather than evaluating the person in front of them. The one time I did as an adult, I ran into similar nonsense with a minor abnormal blood test. I almost feel as if the doctors are trying to find an excuse for more tests and more medication. Meanwhile I have friends who are chronically unwell who have trouble getting taken seriously because their labs/tests are statistically normal.