Athlete's Heart: A Cardiovascular Step-By-Step Multimodality Approach.

Area of Science:

• Cardiology
• Sports Medicine
• Cardiovascular Imaging

Background:

• Athlete's heart encompasses diverse cardiac adaptations in individuals with intense physical training.
• These adaptations can present similarly to serious cardiac conditions like cardiomyopathies, aortopathies, and channelopathies.
• Distinguishing physiological changes from pathology is crucial to avoid overdiagnosis and ensure early detection of life-threatening disorders.

Purpose of the Study:

• To outline a structured approach for differentiating athlete's heart from underlying cardiac diseases.
• To emphasize the importance of early identification of cardiac pathologies in athletes.
• To highlight the role of cardiovascular imaging in this diagnostic process.

Main Methods:

• A step-by-step, multimodality diagnostic strategy.
• Initial assessment includes personal/family history, clinical evaluation, and resting electrocardiography (ECG).
• Further investigations may involve exercise testing, echocardiography, Holter monitoring, cardiac MRI, CT, nuclear scintigraphy, and genetic testing.

Main Results:

• A systematic approach aids in distinguishing physiological cardiac remodeling from pathological conditions.
• Cardiovascular imaging is vital for identifying subtle structural abnormalities in the 'grey zone' between adaptation and disease.
• Accurate differentiation is key to appropriate management and risk stratification.

Conclusions:

• Athlete's heart requires careful evaluation to differentiate from serious cardiac conditions.
• A comprehensive, stepwise diagnostic pathway is essential for accurate diagnosis.
• Cardiovascular imaging plays a critical role in identifying athletes at risk for sudden cardiac death due to underlying heart disease.