Aortic valvular disease in active patients: overcoming diagnostic and management challenges

Valvular heart disease in physically active patients can present a diagnostic challenge, because adaptations to exercise may mimic abnormalities. Electrocardiograms may be used to follow asymptomatic or mildly symptomatic athletes but are not very useful for those with valve disorders. Moderate-to-severe aortic insufficiency requires careful follow-up and periodic echocardiograms to monitor changes. Athletes with mild aortic stenosis can participate in all sports if they are asymptomatic and have a normal exercise response. Those with moderate disease should be restricted to sports with low static and dynamic requirements. Symptoms of severe aortic stenosis include exercise-induced syncope, angina, heart attack, and, rarely, sudden death; these athletes should not compete and should have aortic valve replacement.