Physiological or pathological hypertrophy of athlete’s heart syndrome

Intense physical activity increases the risk of sudden death by 10–17 fold. Some of the most important tasks of modern pathophysiology in sports medicine include searching for factors that allow an athlete’s body to adapt to loads, understanding the line between adaptation and pathology and identifying risk groups of adaptation failure. It is necessary to distinguish between hypertrophic cardiomyopathy and true myocardial hypertrophy in athletes that results from the adaptation of the cardiovascular system to intense physical exertion. In Seattle, the American Medical Society of Sports Medicine together with the European Society of Cardiology proposed standards for the interpretation of electrocardiogram in athletes and considered criteria for the detection of pathological changes. The best functional state of an athlete and the effectiveness of his/her training are noted with high autonomy and high variability of heart rate. This is reflected in rhythmocardiogram data by increases in high frequency and root mean square of successive differences in heartbeats and a decrease in the low-frequency to high-frequency ratio.A promising direction in the study of markers of an athletic heart is the analysis of echocardiographic (EchoCG) images of young and professional athletes. According to EchoСG analysis, nonadaptive remodelling is the loss of the ellipsoid shape of the left ventricle in favour of a spherical one. In athletes, when assessing transmitral flow by EchoCG, a low A peak can be considered a reserve of adaptive capabilities of the heart and not a pathology. For athletes-dischargers, a concentric variant of changing the geometry of the myocardium is characteristic. Upon reaching the qualification of a candidate, master of sportsan eccentric change in the left ventricle cavity prevails.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and design: Y.P. Skirdenko Drafting the article: A.V. Gorbenko, O.V. Zamahina, S.A. SherstyukCritical revision of the article: N.A. NikolaevFinal approval of the version to be published: A.V. Gorbenko, Y.P. Skirdenko, N.A. Nikolaev, O.V. Zamahina, S.A. Sherstyuk, A.V. Ershov