HCM or Athletic Heart Syndrome - Test Results

[Melisa41]

Test results HCM? or Athletes Heart
Thank you for the post on my previous question. Could you reveiw the following info and give me an idea as to whether it is HCM or AHS ? I am a 42 year old male no family history of HCM. Very athletic his entire life. Had 2 episodes of afib 1 month apart 147 and 170 both for approx. 4 hours. Went in for testing. Nuc Stress test and echo. Results as follows.
Aortic Root 3.4 cm - Aortic cusp sep 2.4 cm  - left atrium 4.4 cm  - RV end diastole 2.6 cm  - Septum 1.5 cm  - Posterior wall 1.4 cm  - LV end diastole 5.2  - LV end Systole 3.1- EF 66%  - Fract short 40%  -  LA vol BSA 27.4ml  - LA Volume 27.4ml  - LA Pressure 6.82mm  - LV Mass/ bsa 158g  - LVED vol 70ml  - LVES vol 24ml MITRAL VALVE - E Velocity 48cm  - E/A ratio 0.70 ( 48:69) E/e ratio 3.93 ( 48:12.2)  Nuclear Stress test conclusion - Gated LVEF 57% Normal rest and exercise myocardial perfusion study  - There is no evidence of ischemia  - LV systolic function is normal.

Do these results sound like HCM or Athletic Heart Syndrome? I have been told both. I live a very active life and have been told to hold off on all strenuous activity for 60 days by one Dr. and another tells me I have HCM and not to restrici myself from any activity. I am so confused. How do I know what I really have and should I stop exercising?

[kenkeith]

For some insight there are three types of cardiomyopathy: "hypertrophic", "dilated" and "restrictive". The main feature of hypertrophic cardiomyopathy is an excessive thickening of the heart muscle (hypertrophy literally means to thicken).  The dilated heart type has been discussed.

But the heart muscle may also thicken in normal individuals as a result of high blood pressure or prolonged athletic training. There is a fine line between and athletic heart and a heart with HCM.  In Hypertrophic Cardiomyopathy (HCM), the muscle thickening occurs without an obvious cause. In addition, microscopic examination of the heart muscle in HCM is abnormal. The normal alignment of muscle cells is absent and this abnormality is called "myocardial disarray"  An athelete's heart cells are organized and produce stronger contractions.  The heart is able to pump more efficiently, and almost always will beat at less than 60 bpm at rest.

Cardiomyopathy is a condition in which the muscle of the heart is abnormal in the absence of an apparent cause. While HCM has typically been recognized by its structure ie., hypertrophy, the electrical function of the heart are also adversely affected. Thickening is seen in the ventricular septal measurement (normal range .08-1.2cm), and in weight. In HCM, septal measurements may be in the range of 1.3cm to 6.0+cm.

Dilated heart enlargement usually involves the left ventricle.  The chamber size is increased and walls are stretched and recoils with more force, and that is a normal function when the heart structure is compensating to maintain equilibrium between the left and right side of the heart.  When the heart pathologically overstretches (dilates) it loses its contractility and this leads to heart failure (heart's pumping ability does not meet the system's demand for blood/oxygen).  

Restrictive cardiology happens when the heart's walls are thickened to the extent it crowds out and reduces chamber size compromising the heart's ability to supply enough blood/oxygen with each heartbeat.

The differing comments you have read may be referring to the different pathologies of the 3 different categories of HCM.

[phiras]

hello everybody,

i found out today that i have HCM and i'm still 27 ... I lived alone and stressed most of my life but very healthy and hard working in the same time.... Funny how you live healthy and strong most of your life and in the end your doctor tells you that your heart is big eheheh ... I started laughing at first, i didn't know what to say and i kept on laughing more but this time louder and louder =) ....
In my case what will i do? I have read about it but some articles are different then the others....

[kenkeith]

There are distinquishing features between an athlete's heart syndrome and DCM.  Your doctor should be able assess the differences and make a dx.  Jon makes the point that it is a close call as the metrics are at best borderline, and one metric I identified as an HCD feature from another post of yours is that  E:A is less than one (yours is 0.7)... and another feature LV diastolic less than 6.0 cm indicates AHS...your ESTIMATED value is 5.2.  

But the questions also relate to whether or not to engage in exercise.  If you have A-fib, regardless whether you have AHS or DCM, the risk is the same.  The risk is not heart size, but the fact you experience A-fibs.  With A-fib, the heart rate increases very rapidly when first exercising, and A-fib can reduce your overall capacity to exercise as there is a decrease in the heart's functionality....you should get your A-fib under control before exercising.  An event can quickly remodel (dilate) your LV chamber and cause HF.

[maggiemag]

I agree with Jon.  Just get a repeat echo in a year or so, depending on what your cardiologist wants.

[erijon]

An athlete's heart is not something seen in the normal person that has even a very good exercise routine. Normally, this is only seen in world class athletes in extreme conditioning. From what I read on you results you have a slightly thickened posterior wall which could be a sign of early HCM. You also have an enlarged LA which could be the result of high blood pressure or bouts of afib. I don't think tthese findings are strong enough to call it either HCM or AHS.

Hope this helps,

Jon

[e.r.boy]

I would take it easy until they figure out what you have. My brother was very athletic as well and had undiagnosed HCM. He died of a fatal arrhythmia. His left ventricle wall was measured at 1.5 cm upon autopsy. His enlarged heart was due to CAD which decreased the blood flow to the heart. The heart suffered and remodelled itself into a huge 560 gram beast. Most hearts are around 350 grams in weight. I would err on the side of caution.