Cardiologist Explains Why Heart Wall Thickening Can Occur Despite Regular Exercise and Fitness
Thickened Heart May Signal Problems
A thickened heart muscle is not always a sign of better cardiovascular fitness, even among people who exercise regularly, according to cardiologist Dr Dmitry Yaranov. While intense and sustained exercise can produce normal changes in the heart commonly referred to as “athlete’s heart”, similar thickening can also occur because of hypertrophic cardiomyopathy (HCM), a condition that can affect the heart’s ability to pump blood effectively. Distinguishing between physiological changes caused by exercise and those associated with HCM is important because the two conditions can appear similar but have different implications and may require different approaches to monitoring and treatment.
“Athlete’s heart” describes adaptations that can occur when a person performs strenuous exercise regularly. According to the Cleveland Clinic, exercising for more than an hour on most days of the week can cause the heart muscle to become thicker and the left ventricle to enlarge. These changes are generally considered adaptations to increased physical demand, allowing the heart to pump more blood efficiently during exercise. The extent of these changes can vary depending on factors such as the type, intensity and duration of training. They are commonly seen among endurance athletes and people who undertake high levels of regular physical activity.
HCM, however, involves abnormal thickening of the heart muscle that is not simply an adaptation to exercise. According to the American Heart Association, HCM is often caused by changes in genes affecting proteins in heart muscle cells and can be inherited within families. The thickening may occur in different parts of the heart, with the left ventricle and the wall separating the ventricles frequently affected. In some people, the thickened muscle can interfere with blood flow out of the heart or affect how efficiently the heart relaxes and fills between beats. The condition can occur with or without noticeable symptoms.
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Symptoms associated with HCM can vary considerably. Some people may experience shortness of breath, chest pain, fatigue, dizziness or fainting, particularly during or after physical activity, while others may have few or no obvious symptoms. Because symptoms can overlap with the effects of intense exercise or other cardiovascular conditions, a thickened heart cannot be assessed accurately based only on how physically active a person is. Medical evaluation may involve a physical examination, family and medical history, an electrocardiogram and imaging tests such as an echocardiogram or cardiac MRI, depending on the circumstances.
The distinction becomes particularly important for athletes because a physiological athlete’s heart and HCM can sometimes have overlapping features on cardiac imaging. Doctors may consider the thickness and pattern of the heart muscle, the size of the chambers, the heart’s pumping and relaxation function, symptoms, family history and other clinical findings when assessing the cause. Genetic testing may also be considered in appropriate cases, particularly when HCM is suspected or there is a relevant family history. A specialist assessment can help determine whether the changes represent normal adaptation to training or require further investigation.
Treatment for HCM depends on the individual and the characteristics of the condition. Some people may require only regular monitoring, while others may need medicines to control symptoms or reduce the risk of complications. Certain patients may require procedures or implanted devices depending on their risk profile and the severity of obstruction or abnormal heart rhythms. Because HCM can have a genetic component, doctors may also recommend evaluation of close family members when a diagnosis is confirmed. The key message is that regular exercise does not automatically rule out heart disease: persistent symptoms, unexplained fainting, chest discomfort, unusual breathlessness or a known family history of HCM should be discussed with a healthcare professional rather than being attributed solely to fitness.
