HEART ENLARGEMENT IN AN ATHLETE - A DIAGN OSTIC CHALLENGE

Endurance training can result in an enlargement of the heart. These at hlete's hearts are rarer than generally assumed. Pathological causes, resulting in an eccentric hypertrophy, have to be considered. We repor t on a 32 year old athlete performing approximately 10 hours of endura nce training weekly. He consulted a physician because of a drop in per formance. The eccentric left ventricular hypertrophy, diagnosed by mea ns of echocardiography, was not interpreted as a solely physiological cardiac adaptation because the ejection fraction did not increase duri ng exercise (stress-echocardiography), the left ventricular diastolic function (maximum E/A-ratio) was impaired at rest, and the ergometric performance was reduced in comparison to the heart size. The invasive diagnostics including myocardial biopsy demonstrate histologically a f ocal fibrosis as the result of former myocarditis. The fibrosis was po ssibly involved in the genesis of the eccentric hypertrophy based on s tructural dilatation through a preferably mesenchymal lesion. It remai ns open whether the long-term endurance training had forced the dilata tion. This case demonstrates that pathological causes must be excluded if in athletes an enlarged heart does not concur together with a clea rly increased ergometric performance. Stress-echocardiography and endo myocardial biopsy can considerably contribute to the differential diag nosis between physiological and pathological cardiac hypertrophy.