I assume they're talking about the bradycardia?

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The normal athlete's heart is common amongst long term athletes---I have it, I'm pretty sure many other's here do, too. It was first observed in me when I was in my middle 30s (2005 or so). There are lots of cardiologists on here (I'm not a Dr.). It's probably good to rule out HCM, if your wife is concerned, to put her mind at ease. Continuing to train in the face of her anxiety probably isn't going to be a good plan.

Disclaimer here: MD, but not a cardiologist so will just make some general points.
First off, it is really difficult to provide advice without the results of the echocardiogram in particular. There are a number of things that this may have showed which are leading you down the path you are now going. It would really help the other docs on here if you are able to get a copy of the scan report/data as that will govern the general advice.
As GMAN has said, bradycardia is one such potential option but I am not as familiar with when an MRI would be indicated in this situation. Long term endurance activities may cause an increase in the size of your heart and this may be the reason they are steering down that route.
If you can get the echo results in particular it will really help with tailoring any feedback for you as at the moment we would all just be guessing as to what advice to give.

No. Hypertrophic Cardiomyopathy (HCM) is the bad thing---enlarged Left Ventricle. The Athlete's heart looks very similar, except the enlargement is usually to both left and right ventricles. There are other structural differences. Untreated HCM is associated with a risk for Heart Failure (poor pumping function) and sudden cardiac death.

Not really that as I think that just means low heart beat below 60, which I also have. Currently that is in the mid 40's generally per my Garmin.

What is the thing as far as I understand it is the thickness of parts of my heart due to reqular cardiac exercise. I think the low heart rate is part of the equation though.

Anyway I'm no expert for sure but very cusious.

let's talk about the 'athlete's heart'...

I did additional research when I was a fellow in cardiology, just starting out, into this topic as it was near and dear to me even then-which is now ~30 years ago


It is commonly associated with 3 things:
bradycardia, cardiomegaly (a dilated/big heart) and cardiac hypertrophy (a thick heart muscle)

In reality, it can be only 2 of the 3 and usually is-depending on what sport the athlete participates in.

Endurance athletes have big, dilated hearts that are very efficient with training and because of increased blood volume and other reasons, the heart dilates and has a larger stroke volume each beat and the heart rate goes lower as this happens and bradycardia is more likely-especially in males.

Strength athletes get thicker, hearts that respond to resistance training with increased LV thickness and mass.



Runners/cyclists have endurance trained hearts. This leads to eccentric hypertrophy. This seems to me to be more likely to be associated with bradycardia-slow heart rates.
Weight lifters/boxers have strength trained hearts. This leads to concentric hypertrophy.




It is important to distinguish between athlete's heart and hypertrophic cardiomyopathy (HCM), a serious cardiovascular disease characterised by thickening of the heart's walls, which produces a similar ECG pattern at rest. This genetic disorder is found in one of 500 Americans and is a leading cause of sudden cardiac death in young athletes (although only about 8% of all cases of sudden death are actually exercise-related).[ The following table shows some key distinguishing characteristics of the two conditions.



An echocardiogram is usually helpful to differentiate these conditions when it is borderline.

The echo will list the LVs *septal wall, and the LVpw *posterior wall also. Normal is ~1.1-1.2 cm or 11-12 mm, to make the better comparison the the chart above.

I would personally recommend to my patients that a cardiac MRI be done only for patients who have 'in between numbers' of 1.5 cm or higher, for LV thickness.

Hope this helps. I'm off for the weekend, for a change after being on call-Xmas, New Years eve, New years day...cheers!

What he said. That is great stuff.

Good luck and hope you feel confident in your team.

I went thru this when I turned 60 and they ran an EKG with results that my doctor didn’t like and sent me to a cardiologist that didn’t specialize in Endurance athletes hearts. I was put thru the wringer of tests, put on multiple medications and told not to let my heart get above 135 during exercise. My wife also was there at all appointments and tests.

After 6 months nothing had changed to a made the decision to go to the Mayo Sports Cardiology Clinic in Rochester MN. Their diagnosis was you have a huge strong athletic heart, get off meds and get back to training.

The one big outcome from all this is that I now have a tremendous baseline of tests that any follow up issues that come up as I age can be compared too. Recently before a surgery I had a pre op physical where my doctor discovered I was in A- Flutter (upper chambers at 300 beats per minute). BTW….my garmin showed my resting HR was mid 30s so not sure I can truly trust that device when it comes to heart health because of what it measures. So they did a cardioversion for the surgery and an ablation once I had recovered. They used the baseline tests for a comparison to what had changed in their analysis.

So my advice is to get the tests and listen to the results. Seek out cardiologists that understand the endurance athletes heart. If you want to continue to train as you age you will want that baseline and make sure you aren’t risking further damage and for peace of mind for both you and your family.

Thank you so much, I appreciate you replying with such a detailed post. My septal and posterior are both 1.5 cm.

I'm going to get the cardiac MRI. I scheduled the in office visit to get the order for it.

Thank you everyone for the discussion so far on this one.

Having been through a particular heart issue which was not serious I can offer some advice from the perspective of someone who has been doing triathlon for 40 years at all distances. Over a decade ago I experienced a form of tachycardia when pushing up to a higher zone in training. My cardiologist who is a triathlete carried out a battery of tests and recommended I cut out the tempo sessions and try to keep my HR at a reasonable level all the time.

I have followed that advice and at 75 years old I have just completed two 70.3 races where I 'cruised' successfully. I believe that after a certain age, faster is not better if you are seeking longevity in the game.

 



I think this is wise advice, even if you do not have a heart condition.

thanks so much for a super informative post

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maybe she's born with it, maybe it's chlorine
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disclaimer: PhD not MD

10 years ago when I was 46 I had a brief blackout whilst running and ended up in hospital. An MRI showed classic signs of HCM and after an echo the consultant cardiologist told me I had HCM and they would put a pacemaker in. Then it went to the head of his department who knew a bit more about athletes (he was the medical director for the London marathon) who said there was no way someone with HCM would be running the marathon times I was, so it all got looked at again and I went away with no pacemaker. Training and racing got back to normal with no repeat and no symptoms, although I did get an echo and various other tests annually.

None of which may be relevant to your case, other than even experienced cardiologists might not be entirely familiar with the nuances of what older athletes hearts are doing and that sometimes they show things that need to be checked out but not panicked about - get the MRI done and get it looked at by someone who understands athletes.

Now I have cardiac amyloidosis, which is completely unconnected but only diagnosed because I was getting those annual checks. Funny old world.

Do you have high blood pressure? I recall reading somewhere (might have been this forum) about an endurance athlete with a borderline thick septum ~1.5 cm like yourself and it turned out to be exercised induced or chronic blood pressure instead of genetic HCM. With a few life changes his septum went back to normal over a certain period of time.

As per usual, we are lucky to have the likes of dtoce participating in this forum, his post hit the nail on the head comparing athlete's heart with HCM.

My blood pressure if fine and in a healthy range.

Full disclosure... my daughter works as a scribe for the cardiologist whose office did the echo and he sought a second opinion of someone more familiar with 'athlete's heart' as my blood pressure, etc. is healthy. Generally they don't see patients like me in their office. She's been taking my blood pressure around the house and it's normal or maybe a little low at times.

Yes it's amazing to have resources and I'll be getting the cardiac MRI at some point so we will see.

From the workup you posted: Borderline dilated ascending aorta, 4 cm.///

I love these threads, I probably started them over 20 years ago when I had my first issues. I have learned so much just through my misfortunes, and all the bad diagnosis from different doctors. And I also have learned a ton from guys on here like Dale(dtoce) because of their connection to the athletes heart and real world experience..

So something I just recently learned through a freak out, was this ascending aorta thing. I had one of my many calcium scores done, and low and behold, got an emergency call from my general. Apparently I had an aortic aneurism, which can be a really bad thing. But here is the deal, when it becomes dilated over 4 cm, that is just what they call it. Mine is 4.1 now. I went back to my earlier tests and it was 3.9 6 years ago. SO apparently over time it can slowly get wider and wider. After talking with Dale and my Cardio doc, it is one of those normal things in the athlete heart that differs from the general population. But my general had no clue and panicked me to no end..

So after spending 3 days thinking I was going to rupture and die any moment, I got the facts and was able to relax and get back to my normal athlete life. I believe Dale said that he doesnt worry until it is over 5 or so cm. And of course I did some reading up on this, and there are studies that say that 25+% of aging athletes have 4 cm or above.

So just a warning to any who get the news like I did, just one more thing not to stress about while you sit there with your 30 something resting HR...

I'm just a lowly R.N., so not going to dispute the advice of a legit cardiologist. From my very limited knowledge, you just sound like a typical endurance athlete in good shape. As for me, whenever I see a new provider I always make it a point to let them know I'm an endurance athlete.

On a personal note, like many of us here, I'm often brady at rest. A couple years ago I had a minor surgery that kept getting pushed back later in the day. Due to how late in the day they finally got me into surgery, the doc elected to keep me overnight. The night shift nurse came in and woke me up at 3am (scared the crap out of me) just to make sure I was alright. They were watching my telemetry and my heart rate was dropping into the mid 30s in my sleep.

I had the Cardiac MRI and nothing of concern is the summary of findings. My family is more at ease with my athlete's heart condition now. Cardiomegaly... but not for anything concerning.

Also I have a really good baseline I suppose for the future. If someone is interestes I can post the finding which are Greek to me.

Otherwise I've just really been slowing down over the last few years particularly after my last dance with Covid in '22. Lots of questions in my head, but my heart appears to be fine.