The Murmur or “Don’t go breaking my heart”

I had a bit of a scare back in my early twenties when my doctor sent me for an echocardiogram after detecting a slight murmur in my heart. I had recently moved to Toronto, had very few friends in the city and remember being petrified at the thought of having a heart condition. The procedure – an ultrasound of my heart – was horribly uncomfortable, but reassuringly dull. My heart was fine, despite its little murmur. I could carry on with school, life, work and my regime of evening step classes and cardio boxing, the extent of my (nonetheless quite intense) sports regime at the time.

For reasons that escaped me until I started researching this post, my little murmur then silenced itself and went undetected for well over a decade, only to resurface again last summer at my annual check-up. My doctor didn’t seem all that concerned but given the amount of running I do, she nonetheless referred me to a cardiologist at the Grenoble Sports Medicine hospital.

I knew it was important to go, but I nonetheless wanted to wait until my 2016 season was over (just in case they told me I should stop everything…). My season finished with the SainteLyon race in December. About three weeks ago (yes, mid-March), I decided I really should get going and finally made an appointment.

Joc SainteLyon
Finishing my last race of the 2016 season

So off I went on a fine April morning and met Dr Doutreleau, a smiling and sporty-looking man in jeans and a polo shirt, who even took me in five minutes early. (I haven’t yet mentioned this, but the French healthcare system is phenomenal – we pay high taxes and this is one of the great things they help pay for!)

He asked a few questions about how many hours I run per week, read the referral from my family doctor and asked me to strip from the waist up. We chatted as he hooked me up to a monitor and he confirmed that cardiologists specialized in sports medicine are generally recommended for athletes as they are more accustomed than regular cardiologists to the changes that occur in athletes’ hearts – which can sometimes unnecessarily raise concerns.

Athlete’s Heart

Because yes, “athlete’s heart” – or athletic heart syndrome (AHS) – is a real medical condition tied to changes in the heart that come with intense physical activity, particularly among endurance athletes. AHS is common in people who train more than an hour per day most days. While not serious per se, it is important to examine the symptoms of AHS to ensure they are not masking another, potentially serious heart condition.

Symptoms of AHS include bradycardia, i.e., a lowered resting heart rate, often between 40 and 60 beats per minute (a RHR of 60 to 100 beats per minute is considered “normal” for adults); a slightly enlarged heart, notably in the left ventricle; a systolic murmur; and “extra heart sounds”.

Echocardiogram
This is what the machine looked like (although it’s not the one I tested)

I was much more relaxed going into the appointment this time around, mostly because I’d already heard of AHS and have (knock on wood) never experienced any frightening heart-related issues while running. That said, I mentioned to Dr Doutreleau that my previous echocardiography was quite uncomfortable. He, like my general physician last summer, was surprised and said that an ultrasound of the heart should never be painful. He asked if the doctor was young (I couldn’t remember) and said that new cardiologists sometimes have a habit of pushing too hard when they can’t get a good view of the heart… He noted that this was pointless and told me to let him know if I was uncomfortable. The whole thing was over in about 15 minutes and didn’t hurt in the least. I got to hear and see my heart rocking out on the screen, and he even showed me how it had visibly adapted to the demands of intense physical activity, which was pretty cool.

Hypertrophic Cardiomyopathy

Now, while I am certainly relieved that the cardiologist gave my heart the green light, our sport is not spared of stories about seemingly healthy athletes who up and die suddenly while running or racing on the trails. My virtual superhero David Roche, acclaimed trail runner, coach, dog lover and regular contributor to Trail Runner magazine (yes, I pretend he’s my actual coach and regularly geek out over his and his amazing wife Megan Roche’s feats on Strava) recently wrote an article on “Examining your risk for sudden cardiac arrest while running” in which he described the symptoms and dangers of hypertrophic cardiomyopathy (HCM).

HCM is a relatively common disease that affects about 1 in every 500 people and may cause cardiac arrest, including in seemingly healthy athletes. HCM can cause the heart muscle cells to enlarge and the walls of the ventricles to thicken, which can in turn block blood flow out of the ventricle. The tricky thing about HCM is that many sufferers never know they have it. It is genetic, but may also develop spontaneously. While some people experience symptoms such as shortness of breath, chest pain, hearth arrhythmia or dizziness; others have no symptoms or warning signals whatsoever.

Diagram_of_the_human_heart
The human heart (we learned this in 9th grade science class, remember?)

Without wanting to be alarmist, that is certainly reason enough for me to get an annual check-up at the doctor’s office! Here in France, all races require a recent (less than a year-old) medical certificate from a doctor stating that the competitor is fit to race and presents “no counter-indication to the practice of trail running in a competitive context” (or a copy of the person’s annual FFA licence – which also requires getting the above-mentioned medical certificate signed). While I once thought this was a bit excessive, I’m starting to understand that the logic behind it is indeed driven by concern for athletes’ health at least as much as by what I initially presumed was just race organizers’ fear of being sued should an athlete drop dead in a race (that would be the lawsuit-minded North American side of my brain reasoning, I think).

Love your doctor

Ultimately, nature is always one step ahead of us and I, for one, would rather enjoy life than sit on the side lines worrying about its dangers. But modern medicine is a beautiful thing and, especially as active endurance athletes, it is certainly in our best interests to be proactive about our health. While sometimes a pain in the butt, an annual check-up is an easy way to make sure that everything is in working order. Remember to be honest with your doctor about your training and any concerns you have about your health – better safe than sorry, as your Mom used to say!

Despite the hint of fear in a back corner of my mind, my recent visit to the sports cardiologist was reassuring and confirmed what I expected (…ok, I mean what I desperately hoped). The wonky sounds coming from my heart are simply its way of saying “look how much I love trail running and have adapted to the many hours we spend together outside each week”. But the next time I’m asked to provide a medical certificate for a race, I’ll be grateful to my doctor as she gives my little murmur a listen and, hopefully, sends me on my merry way!

 

The information in this article is drawn from the following sources:

http://www.msdmanuals.com/professional/cardiovascular-disorders/sports-and-the-heart/athlete%E2%80%99s-heart

https://en.wikipedia.org/wiki/Athletic_heart_syndrome

http://www.health.harvard.edu/blog/resting-heart-rate-can-reflect-current-future-health-201606179806

http://www.heart.org/HEARTORG/Conditions/More/Cardiomyopathy/Hypertrophic-Cardiomyopathy_UCM_444317_Article.jsp#.WONoLqKkKUk

http://trailrunnermag.com/training/trail-tips/the-tell-tale-heart.html

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