Ventricular hypertrophy cured with drugs and diet. The Juventus footballer Federico Bernardeschi This is how he defined in an interview the problem that, around the age of 16, forced him to stop racing for a few months, giving him the determination and strength to become the champion we admire today in stadiums. Following the declarations of the sportsman, however, some sports cardiologists were alarmed, not so much by the specific situation widely followed by specialists, but rather because it is not right that this condition should be underestimated.
The ‘big’ heart
The message from the experts is clear. Anyone with a ‘big’ heart, i.e. suffering from left ventricular hypertrophy, must be careful. And undergo targeted tests, to understand if and how to best control this condition which in most cases can follow an inadequately controlled hypertension but can also be the signal of a real disease such as hypertrophic cardiomyopathy. Or perhaps in those who play sports, be a consequence of training, with adaptation of the heart muscle to intense activity, as happens in the classic athlete’s heart.
“In this situation, the volume and pressure overload of the left ventricle following intense and prolonged training can lead to an increase in the thickness of the left ventricle – reports Ciro Indolfi, President of the Italian Society of Cardiology (Sic) – This is accompanied by an increase in cardiac output, a reduction in heart rate, an increased diastolic filling and, sometimes, a dilation of the heart chambers. Despite these changes, the athlete’s heart pump function remains normal and the subject has no symptoms. “
Don’t underestimate the problem
But be careful: this is not always the case. The enlargement of the heart must not be trivialized and it is necessary to draw attention to this sign that should not be underestimated, which at times may also require the stop of competitive activity, are the experts in cardiology.
It is essential that, despite the complexity of a picture that is difficult to analyze in many cases, the specialist can distinguish between the natural ‘remodeling’ of the heart and the presence of a disease, which can sometimes also have genetic causes and therefore be particularly problematic. to manage in those who play sports.
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Sport changes the heart
“Left ventricular hypertrophy can be a physiological adaptation of the heart to intense physical activity. There are many sports that, over time, can increase the thickness of the heart muscle – confirms Silvia Castelletti, sports cardiologist at the Italian Auxological Institute of Milan. In these cases, obviously, by suspending the stress induced on the heart by repeated efforts related to the sport practiced, a partial or total regression can occur. But in some cases the origin of the situation may be an inherited heart disease that can predispose to sudden death, especially during exertion, such as hypertrophic cardiomyopathy “.
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Hypertrophic cardiomyopathy is among the most common inherited heart diseases: about one in 500 people are affected. “For the latter, unfortunately, as far as we know, a healthy diet and a drug are not enough. Or rather: in hereditary genetic cases, it is not possible to definitively recover from the condition because we do not have a gene therapy capable of modifying the DNA but we do have only of the possibility of preventing complications and sudden death by blocking the athlete from physical activity “, adds the expert.
Cases at risk
In short: for sports cardiologists, as well as for sports doctors, there is a truly thankless task: having to distinguish between pictures that do not create any risk and can be considered almost physiological and hearts that instead have the genetic predisposition to increase thickness. or the volumes of the heart and perhaps to develop very serious arrhythmias already at a young age. “When there is the suspicion of a potentially life-threatening disease, we have the duty to stop the athlete: the news reports stop of internationally renowned sportsmen who have seen competitive activity blocked for situations of this type” , Castelletti reiterates.
More pathologies
The message from the specialists is clear. Before talking about athlete’s heart and specific treatments, we need to make a precise point, sometimes difficult to obtain. “The athlete’s heart must be differentiated from other important pathologies such as hypertrophic cardiomyopathy, dilated cardiomyopathy, ischemic heart disease, non-compact myocardium and arrhythmogenic dysplasia which obviously cannot be cured with diet – insists Indolfi -. between athlete’s heart and real cardiac pathologies it is carried out in the majority of cases as well as with echocardiography which remains the standard screening technique with other methods such as magnetic resonance, stress test, cardiac CT scan “.
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