Five deaths in a year—including some as young as 19. Here’s what the evidence reveals about the intersection of performance-enhancing substances, silent heart conditions, and sudden death in the gym.
Sir,does this mean if someone wants to start gymming (for regular exercise not for professional competition) , a cardiac evaluation should be performed ?
Hi Dr , great insights, how should one structure the workouts in these cases considering that there is risk of cardiomegaly, Hypertrophic cardiomyopathy etc. Also heard there are risks Mild/moderate Mitral Regurgitation in athletes due to valsalva etc???
For people with HCM goal is to avoid conditions that increase left ventricular outflow tract (LVOT) obstruction. One hack is to shift resistance training to lower weights + higher reps
Avoid 1 Rep Max (1RM) lifts.
High intensity interval training (HIIT) and explosive sprints can trigger arrhythmias in vulnerable substrates.
Hydration is critical: Dehydration reduces preload. In HCM, a smaller LV cavity increases obstruction. These athletes must stay hydrated to maintain LV filling pressures.
The Valsalva maneuver increases intrathoracic pressure and drastically reduces preload (venous return). Reduced preload shrinks the LV cavity size. This brings the anterior mitral leaflet closer to the septum, worsening systolic anterior motion as a result we get dynamic LVOT obstruction and severe Mitral Regurgitation during the lift.
In healthy hearts, mild MR is often physiological adaptation. In HCM the Valsalva is dangerous as it provokes obstruction and acute MR by reducing the heart of preload
Thanks a lot doc also i guess Trivial MR and Trivial Tricuspid is quite normal amongst aging and athletes. Any thing which can prevent further cardiac issues ??
Thank you for your thoughtful article regarding prehospital cardiac arrest in this subset of athletes. I am curious about one thing though. Has the atherosclerotic plaque buildup been demonstrated to correlate to environmental factors in these individuals? Or is this more of an instance of at risk individuals who fall in the middle of the Venn Diagram?
The answer is both, but there is strong evidence specifically supporting the environmental factor (exercise volume) as an independent driver of plaque accumulation. (Reverse J curve phenomenon)
However the type of plaque generated by this "environmental" stress appears distinct often more calcified and stable compared to the rupture-prone plaque seen in typical at risk patients.
Sir,does this mean if someone wants to start gymming (for regular exercise not for professional competition) , a cardiac evaluation should be performed ?
No. There isn’t one size fits all. Such evaluations aren’t routinely needed in every person.
Young asymptomatic people with no significant family history, who are exercising normally (not going pro bodybuilder route) can continue exercising.
People who are more than 35 should be cautious if they are just starting.
High risk subset is - pro bodybuilders with anabolic steroid abuse and people who have a family history of sudden cardiac deaths
Thanks doc
This is very good stuff doc! Thanks for penning this down.
Glad that you liked it.
Hi Dr , great insights, how should one structure the workouts in these cases considering that there is risk of cardiomegaly, Hypertrophic cardiomyopathy etc. Also heard there are risks Mild/moderate Mitral Regurgitation in athletes due to valsalva etc???
For people with HCM goal is to avoid conditions that increase left ventricular outflow tract (LVOT) obstruction. One hack is to shift resistance training to lower weights + higher reps
Avoid 1 Rep Max (1RM) lifts.
High intensity interval training (HIIT) and explosive sprints can trigger arrhythmias in vulnerable substrates.
Hydration is critical: Dehydration reduces preload. In HCM, a smaller LV cavity increases obstruction. These athletes must stay hydrated to maintain LV filling pressures.
The Valsalva maneuver increases intrathoracic pressure and drastically reduces preload (venous return). Reduced preload shrinks the LV cavity size. This brings the anterior mitral leaflet closer to the septum, worsening systolic anterior motion as a result we get dynamic LVOT obstruction and severe Mitral Regurgitation during the lift.
In healthy hearts, mild MR is often physiological adaptation. In HCM the Valsalva is dangerous as it provokes obstruction and acute MR by reducing the heart of preload
Thanks a lot doc also i guess Trivial MR and Trivial Tricuspid is quite normal amongst aging and athletes. Any thing which can prevent further cardiac issues ??
Thank you for your thoughtful article regarding prehospital cardiac arrest in this subset of athletes. I am curious about one thing though. Has the atherosclerotic plaque buildup been demonstrated to correlate to environmental factors in these individuals? Or is this more of an instance of at risk individuals who fall in the middle of the Venn Diagram?
The answer is both, but there is strong evidence specifically supporting the environmental factor (exercise volume) as an independent driver of plaque accumulation. (Reverse J curve phenomenon)
However the type of plaque generated by this "environmental" stress appears distinct often more calcified and stable compared to the rupture-prone plaque seen in typical at risk patients.