Dores Hélder, Freitas António, Malhotra Aneil, Mendes Miguel, Sharma Sanjay
Hospital das Forças Armadas, Lisboa, Portugal; Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
Centro de Medicina Desportiva de Lisboa, Lisboa, Portugal.
Rev Port Cardiol. 2015 Jan;34(1):51-64. doi: 10.1016/j.repc.2014.07.010. Epub 2015 Jan 7.
Intense and regular physical exercise is responsible for various cardiac changes (electrical, structural and functional) that represent physiological adaptation to exercise training. This remodeling, commonly referred to as 'athlete's heart', can overlap with several pathological entities, in which sudden cardiac death may be the first clinical presentation. Although pre-competitive screening can identify athletes with life-threatening cardiovascular abnormalities, there are no widely used standardized pre-participation programs and those currently implemented are controversial. Data from personal and family history, features of physical examination and changes in the 12-lead electrocardiogram can raise the suspicion of cardiac disease and lead to early detection of entities such as hypertrophic cardiomyopathy. However, interpreting the electrocardiogram is often challenging, because some changes are considered physiological in athletes. Thus, clinical decision-making in such cases can prove difficult: missing a condition associated with an increased risk of life-threatening events, or conversely, mislabeling an athlete with a disease that leads to unnecessary disqualification, are both situations to avoid. This paper provides an up-to-date review of the physiological cardiac effects of exercise training and highlights key points that should be taken into consideration in the assessment of young competitive athletes.
高强度的规律体育锻炼会引起各种心脏变化（电学、结构和功能方面），这些变化代表了对运动训练的生理适应。这种重塑，通常被称为“运动员心脏”，可能与几种病理情况重叠，在这些病理情况中，心源性猝死可能是首发临床表现。尽管赛前筛查可以识别出有危及生命的心血管异常的运动员，但目前尚无广泛使用的标准化参赛前检查项目，而且目前实施的项目也存在争议。个人和家族病史、体格检查特征以及12导联心电图的变化等数据可能会引发对心脏病的怀疑，并有助于早期发现诸如肥厚型心肌病等病症。然而，解读心电图往往具有挑战性，因为有些变化在运动员中被认为是生理性的。因此，在这种情况下进行临床决策可能会很困难：遗漏与危及生命事件风险增加相关的病症，或者相反，将运动员错误地标记为患有某种疾病而导致不必要的取消资格，这两种情况都应避免。本文提供了运动训练对心脏生理影响的最新综述，并强调了在评估年轻竞技运动员时应考虑的要点。
