Some athletes should watch for heart conditions

Some athletes should watch for heart conditions

Lori NickelMilwaukee Journal Sentinel


Nov. 11–Many assume only those who are aging or overweight must be concerned about the health of their hearts. But in a few unique cases, even competitive, elite athletes need to pay close attention:


Amenorrhea is when a woman, particularly an athlete, misses her menstrual cycle on a regular basis.

“Amenorrhea definitely correlates with having premature heart disease,” said Anne Hoch, a medical doctor and expert in female athletes and cardiovascular health.

She and researchers at the Medical College of Wisconsin began studying athletes at Divine Savior Holy Angels High School in Milwaukee and found amenorrhea and osteoporosis, which is a reduction in bone mass, was very common. But they didn’t have the technology to do the cardiovascular studies on the girls.

They moved on to the Milwaukee Ballet, where they found 64% of the ballerinas had what’s called the female athlete triad — disordered eating, amenorrhea and osteoporosis — or components of the triad and also had early cardiovascular disease.

It might seem shocking — premature heart disease among our most fit and strong women. But the findings didn’t surprise Hoch.

“We kind of expected it because post-menopausal women who are in their 60s and stop having their period, their estrogen levels drop and when it drops, they have an increase in a cardiovascular event rate,” Hoch said. “When young athletes’ periods stop, their estrogen level drops also, but they physiologically have the same hormonal profile as the postmenopausal women.”

The testing went on, with Marquette University, University of Wisconsin-Milwaukee and UW-Parkside runners who were not having their menstrual periods.

“They all had evidence of premature heart disease,” Hoch said.

There is good news: The condition can be treated with folic acid.

Pregnant women take that supplement. It’s also in a plain daily multivitamin with about 0.4 milligrams. But amenorrhea patients need much more: 10 milligrams.

“In a subsequent study, we treated all the dancers with folic acid for their heart disease, and then we retested and their cardiovascular disease normalized,” Hoch said. “So it was reversible. It’s very treatable with folic acid.”

Enlarged heart

When you think of an enlarged heart, you might think of heart disease and risk for cardiac arrest. But an enlarged heart isn’t a disease. It’s a reaction, or a symptom, of other conditions.

And in the case of an athlete, it can be a good thing.

Just as athletes work out and develop their leg, arm and core muscles, the heart — a muscle itself — strengthens and can grow. Duke University professor of medicine William Kraus said there are two stimuli for growing an athletic heart, one good and one bad.

An athlete with a lot of blood flowing through the heart dilates the heart, which forces the heart to thicken to accommodate that dilation.

“Think of a balloon,” Kraus said. “As you’re blowing it up, the wall of the balloon thins. The pressure inside exceeds the pressure outside. What the heart does to accommodate that is thicken the balloon so it can sustain that pressure difference.”

Endurance athletes — marathon runners, triathletes — often have enlarged hearts.

“No medical consequences,” Kraus said. “It’s a good kind of enlarged heart.”

But there is a bad kind — and athletes are at risk.

In those cases, the heart doesn’t widen, it just thickens.

“Eventually you have almost no chamber size, no area where the blood is flowing in,” Kraus said. “Weight lifters, people who do power-type exercise — weightlifting, football — they get that kind of enlarged heart. It can eventually lead to heart failure, is associated with high blood pressure.”

That condition, too, is reversible.

“The heart is a dynamic organ,” Kraus said. “That’s the nice thing about treating high blood pressure. When you have high blood pressure, you’re going to have a thickened heart but if you control that blood pressure, it will regress and normalize. That’s why treating blood pressure is very important; you can undo that damage.”


(c)2012 the Milwaukee Journal Sentinel

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