Doing sport and taking care of your heart: how to do sport safely

Sport, besides being very beneficial, is addictive. When starting a new sporting activity, it would be highly advisable to have a medical check-up that will allow the athlete to practice sport in a safer way, thus avoiding unfortunate cases of sudden death that have so many media repercussions.

Tests for the athlete’s heart

  1. Physical examination and electrocardiogram

    The first thing to do is a physical examination including cardio-pulmonary auscultation. Heart auscultation can detect murmurs and arrhythmias.
    A murmur is an abnormal noise heard when the heart is auscultated. These murmurs can be functional (also called innocent), that is to say, they do not respond to any organic or structural cardiac alteration that justifies it. In this case the athlete can practice sports without any problem; and there are also murmurs of organic origin, caused by a cardiac alteration (narrow valve, valve that does not close, thick heart, congenital heart disease, etc). Here the cardiologist will assess whether or not sport can be done and with what intensity.
    With the auscultation of the lungs, the cardiologist also checks that there is a correct entry of air and can detect noises (rhonchi and wheezing) that may suggest that there is a bronchial obstruction.
    The next step is to perform a 12-lead electrocardiogram, the most basic test in cardiology. It is quick, simple, inexpensive, harmless and painless and is used to make an electrical recording of the heart and diagnose pathologies such as: rhythm disorders (arrhythmias), suspected wall thickening (hypertrophic cardiomyopathy), alterations in the valves (valvulopathies), conduction disorders that can cause malignant arrhythmias (Brugada syndrome, Wolf-Parkinson-White syndrome, etc.), myocardial infarction, electrical conduction block, etc.
    These two tests are what an athlete who does not push his body to the limit would need. When we move on to higher performance athletes, who push their body and heart to the limit, it is advisable to go deeper into the cardiological study.

  2. Echocardiogram

    In high-performance athletes, a transthoracic echocardiogram is usually performed, which allows recreating on a screen the image of the heart in movement in real time. This test does not require special preparation and lasts between 15 and 45 minutes. It is also harmless and has no contraindications.
    The echocardiogram studies the following parameters:

    1. Measurement and thickness of all the chambers of the heart.
    2. Pumping force of the heart
    3. Problems in the heart valves
    4. Fluid inside the sac that surrounds the heart (pericardium).
    5. Blood clots or tumors inside the heart
    6. Congenital heart disease
    7. Sizes of some parts of the aorta.
      Currently, the echocardiogram does not allow to see the coronary arteries, which are the ones that cause myocardial infarction, the most frequent cause of sudden death in athletes over 35 years old, when they are obstructed. For athletes under 35 years of age, the most common problems are congenital heart disease and cardiomyopathies, the most frequent being hypertrophic cardiomyopathy (very thickened heart walls that can cause arrhythmias and sudden death). The performance of an echocardiogram will rule out or confirm whether or not the athlete suffers from these alterations.
  3. Clinical Stress Test

    If the future athlete is over 35 years old and does not practice exercise (the typical sedentary person, smoker who suddenly wants to lose weight and starts exercising), it is advisable to have a clinical stress test. This test must be performed by a cardiologist and consists of walking or running on a treadmill or pedaling a stationary bicycle, but the monitoring is done with a 12-lead electrocardiogram.
    Here the aerobic and anaerobic limits are not monitored. What is studied is the coronary reserve, that is, the probability that the athlete has lesions in the coronary arteries, which are the vessels that carry oxygenated blood to the heart and ensure that it is well irrigated to be able to beat with strength and normal rhythm. The progression of blood pressure every 2 minutes is also observed.
    In cardiology, obstructions of more than 70% are considered significant lesions, since it is above this limit when this obstruction causes irrigation problems to the heart in the event of exercise and produces the famous “exertional angina pectoris”. If the obstructing plaque ruptures suddenly, a clot forms, the artery is suddenly blocked and what is known as acute myocardial infarction occurs, which is an extremely serious clinical condition, with an overall mortality of 30-40%, although once in hospital mortality drops considerably to less than 5-10%. This is why it is so important to go quickly to an emergency department when a person has chest pain to have an electrocardiogram performed.

  4. Stress test with gas consumption

    Patients under 35 years of age without any type of heart disease can undergo a gas stress test. These tests are performed by sports medicine doctors, not cardiologists.
    This test is useful to know very well the body and to know the heart rates from which the metabolism burns fats, sugars in an aerobic and anaerobic way, and to take better advantage of the energetic resources in ultra-endurance tests.
    It involves running on a treadmill without stopping and breathing with a mask that is somewhat uncomfortable but well tolerated. At the beginning of a long-distance race, to obtain energy, carbohydrates are consumed and after about 15 minutes, fats are consumed. The aerobic threshold marks the beginning of lactic acid production (i.e., we begin to obtain energy from glucose partly by consuming via aerobic and partly via anaerobic) but the body, via the liver, is able to “clean it up”. At this level, carbohydrates and fats are consumed at about 50%. Below this threshold, the highest percentage of consumption is fat: 1 kg of fat provides 9,000 calories of energy. Once the anaerobic threshold is reached, the body has a hard time clearing the lactic acid that accumulates in the body, creating a climate of metabolic acidosis (lowering of the blood pH), which it combats with respiratory alkalosis by hyperventilating (breathing very fast). Breathing fast eliminates CO2, which is acidic, and thus maintains the blood pH due to the buffer effect produced. This is the point at which the runner has the sensation of “taking the liver out of the mouth” to keep up the pace. At this time, consumption is mostly carbohydrates and therefore limited.
    The time an athlete endures in acidosis (with a high level of lactic acid) depends on the training and the amount of muscle mass. In any case, the threshold to be taken into account in long exercises is the aerobic threshold (to feel comfortable). It is already known that there are time intervals between thresholds, but above all, the risk lies in exceeding the anaerobic threshold for a long time, since in this case exhaustion is reached sooner. It must be said that these frequencies are approximate, because the variation between measuring them in the laboratory or outdoors can be 5-10%.

Read Now 👉  Arterial hypertension: risk factors and treatment

This article does not seek to alarm anyone, but to make people aware that doing sport is an excellent and healthy practice. It extends life expectancy and the quality of life, and by taking certain precautions, the risks that may arise can be reduced to a minimum.