Road cycling despite heart disease - cardiologist Dr Thomas Kaspar in a TOUR interview

Cardiologist Dr Thomas Kaspar in a TOUR interview

TOUR What does endurance sport do to the heart?

KASPAR Regular endurance training is always beneficial for the cardiovascular system. It promotes blood circulation and strengthens the heart muscle. However, if you have a heart condition, you should only exercise under medical supervision.

Do endurance athletes automatically develop a bigger heart, the so-called athlete's heart?

Not necessarily. The combination of maximum endurance and strength training causes adaptation processes in the heart: the muscle mass grows and the heart cavities enlarge evenly. But cyclists, for example, have to train at least 150 kilometres per week over several years to achieve this. And not every endurance athlete develops a large, muscular heart, not even professionals.

A big heart equals a strong heart?

Unfortunately not. A sports heart can become twice as large as a normal heart. This reduces the resting heart rate, for example. Whether such physiological adaptation processes are harmless or are caused by a heart muscle disease can ultimately only be determined by cardiological examinations: Listening, ECG and cardiac ultrasound. Every performance-orientated athlete should be checked by a cardiologist once a year. In my practice, I also see athletes in whom we detect congenital heart defects - after years of training.

Which heart problems are particularly common among racing cyclists?

The effects of sport are generally positive. A healthy heart can usually withstand long and intensive exertion, such as during road bike training, without suffering any damage. The most common heart diseases in young cyclists, which can lead to sudden cardiac death, are a pathologically thickened heart muscle, also known as hypertrophic cardiomyopathy, and dangerous cardiac arrhythmias such as congenital ion channel diseases. In athletes over 35, circulatory disorders in the coronary arteries, which can also trigger an acute heart attack, are the main cause. The atrium often also dilates in athletes' hearts. This can lead to increased remodelling of heart muscle cells in the connective tissue, which causes atrial fibrillation.

Is atrial fibrillation dangerous?

Due to the arrhythmia, the pumping activities of the atria and ventricles are no longer synchronised, which often manifests itself in palpitations or a decrease in performance. In the worst case, a blood clot forms, causing a stroke.

How do you recognise a defective heart valve?

Depending on which heart valve is affected, this can lead to rapid fatigue, shortness of breath, a feeling of tightness in the chest during exercise or dizziness and even unconsciousness. People who do little sport often do not even notice a severe narrowing of a heart valve. Experienced athletes usually know their bodies very well and realise early on if something is wrong. A narrowing of the aortic valve can be suspected simply by listening with a stethoscope and confirmed with an ultrasound examination of the heart.

Can I then continue to do sport?

This depends on the severity. If the narrowing has been acquired, different training volumes and intensities are possible than in the case of congenital aortic valve disease, for example. I recently had to completely prohibit an athlete's intensive training programme and specify exactly up to what heart rate and wattage she was allowed to exercise. The values were only in the basic endurance range. That was a disaster for her.

Is it safe to exercise again after heart valve surgery?

This is generally possible after an appropriate recovery phase. It depends on the individual case. However, cycling training after heart surgery is only recommended under close medical supervision, especially for intensive exercise.

Info: Common heart disease

Aortic valve stenosisA calcified aortic valve is the most common acquired heart valve disease in Western countries - it usually leads to shortness of breath, loss of performance, later also dizziness or unconsciousness, and in advanced stages often to swelling of the ankles and lower legs.TreatmentA defective aortic valve can be replaced. The operation takes a good 110 minutes. After around eight weeks, the sternum, which had to be partially opened, is stable again and the patient can bear full weight.Mitral valve insufficiencyMitral valve insufficiency, i.e. leakage of the leaflet valve between the left atrium and left ventricle of the heart, is another heart valve defect that particularly often affects athletes under the age of 60. The mitral valve usually becomes leaky when its retaining apparatus ruptures. "Many patients don't notice this until their heart function deteriorates. Here, too, athletes realise much earlier that something is wrong."TreatmentA leaky mitral valve can usually be repaired with a minimally invasive procedure: "In over 90 per cent of cases, we can preserve the patient's own valve," says Bauer. An operation is recommended in any case, even if no symptoms are noticeable yet: "Heart function will definitely deteriorate with a defective mitral valve."