Once upon a time, in an emergency room far far away, I was called to a patient’s bedside. As I approached his room, I noticed a distinct air of distress among my coworkers. With an anxious voice the nurse said, “The patient’s heart rate is only thirty-eight. He also has a really bad EKG and is complaining of chest pain. The doctor wants an arterial blood gas.”
I gathered my supplies, and approached the patient’s bedside. I was trained to start assessing the patient from the doorway. What I saw was a nineteen year old male. He had a lean muscular build, much like Bruce Lee. There was an expression of pain on his face. The young man obviously didn’t feel well. However, he wasn’t exhibiting the signs of a person with a cardiac emergency.
After all the introductions and explanations, I pulled up a chair and sat down beside him to look for a good site to draw arterial blood. I started talking in order to comfort him, and investigate the conflicting information.
“So, you’re athletic?”
“No, not really,” he shrugged
“You don’t do any sports?” I’m thinking this is ludicrous, and I don’t mean the singer. There is no way he got that athletic build playing video games.
“No, I dropped out of school.”
“So, what kind of work do you do?”
I said, “Big stick”, as I started to draw the blood. “So… what do you do when you get bored?”
A big slow smile came over his face and he says, “I play basketball.”
“Oh, I like basketball. How often do you play?”
“Everyday? How many hours a day?”
“Oh, we start about five p.m. and we play until we can’t see the ball anymore.”
I did some quick math, and started to pick my eyeballs up off the floor. Then I remembered I had a needle in his artery. As I withdrew the needle full of bright red healthy blood, I clarified. “It gets dark around nine p.m. That’s four hours a day. That would be about twenty hours during the week. Do you play on the weekends as well?”
He smiled really big this time, then winced slightly in pain. However the pain didn’t diminish the happiness that basketball brought him. “Sometimes we play all day on Saturday and after church on Sunday. Is my heart OK?”
Now, I’m not licensed to diagnose and such, but as one athlete to another, I felt comfortable saying, “I think so.” Then I analyzed the blood gas and took the results to the Doctor.
As I was approaching the Doctor with the results, he anxiously asked what I thought about the patient?
I smiled almost as big as the patient and said, “He plays over twenty hours of basketball a week.”
The Doctor let out a long slow breath. I could literally see the tension leaving his body. Then he spoke three words, “Athletic Heart Syndrome?”
“Yes, I believe so sir.”
“But, I ASKED him if he was athletic!”
“Sir, to him he’s just playing a game. He has no idea what a phenomenal athlete he is.”
The human body is an amazing feat of architecture. It has the ability to adapt to its environment and daily activity. It will rebuild and recreate itself to meet the demands we place upon it. One of the ways it does that is called Athletic Heart Syndrome. Athletic Heart Syndrome occurs as a result of intense cardiovascular conditioning. The heart undergoes structural changes in order to meet the increased demands of the body. This is generally believed to be a benign condition.
There is an increase in muscle mass, wall thickness, and chamber size of the left ventricle. The amount of blood the heart can pump, is called cardiac output. Cardiac out put increases, causing a lower heart rate and blood pressure. The lower heart rate also reduces the oxygen demands of the heart muscle. When you listen to the athletic heart, you may hear additional heart sounds and a murmur. There are also changes in the electrical activity of the heart. These changes may include but are not limited to findings that look like first and second degree atrioventricular block, atrial fibrillation, T wave inversion, or incomplete right bundle branch block.
Our basketball player’s diagnosis went from a life threatening heart condition to a simple pneumonia. Which was treated at home with antibiotics.
What should we all take from this? Everybody should know their resting heart rate and blood pressure. Also, take the time to actually sit down and have conversations with people. You might actually learn something.
The online Merck Manual is the reference I used for this article. It is a reliable resource used by health care professionals.