Intense endurance exercise can induce physiological cardiac remodeling, but may also lead to pathological changes including myocardial fibrosis, right ventricular dysfunction, and arrhythmias.
It is crucial to differentiate physiological athlete's heart adaptations from pathological conditions like hypertrophic cardiomyopathy to prevent sudden cardiac death.
Intense exercise may cause heart remodeling to compensate increases in blood pressure or volume by increasing muscle mass. Cardiac changes do not involve only the left ventricle, but all heart chambers. Physiological cardiac modeling in athletes is associated with normal or enhanced cardiac function, but recent studies have documented decrements in left ventricular function during intense exercise and the release of cardiac markers of necrosis in athlete's blood of uncertain significance. Furthermore, cardiac remodeling may predispose athletes to heart disease and result in electrical remodeling, responsible for arrhythmias. Athlete's heart is a physiological condition and does not require a specific treatment. In some conditions, it is important to differentiate the physiological adaptations from pathological conditions, such as hypertrophic cardiomyopathy, arrhythmogenic dysplasia of the right ventricle, and non-compaction myocardium, for the greater risk of sudden cardiac death of these conditions. Moreover, some drugs and performance-enhancing drugs can cause structural alterations and arrhythmias, therefore, their use should be excluded.
Carbone et al. (Sun,) conducted a review in Athlete's heart and exercise-induced cardiac damage. Intense exercise was evaluated. Intense endurance exercise can induce physiological cardiac remodeling, but may also lead to pathological changes including myocardial fibrosis, right ventricular dysfunction, and arrhythmias.