A Patient With Athlete's Heart Syndrome: When the Abnormal Is Normal.

Long-term athletic training can result in structural and conduction changes within the heart, leading to Athlete's heart syndrome (AHS). This syndrome is characterized by increased left ventricle (LV) dimensions, thickness, and mass. Dynamic exercise significantly contributes to these alterations, with sinus bradycardia being a common conduction abnormality, often accompanied by first-degree atrioventricular (AV) block. However, higher degrees of AV conduction abnormalities, such as second- and third-degree blocks, though rare, might occur due to parasympathetic hypertonia. Prompt evaluation is necessary to rule out underlying structural or infiltrative heart diseases. We present the case of a 66-year-old lifelong long-distance runner with marked sinus bradycardia, AV dissociation, and junctional escape rhythm, alongside left ventricular hypertrophy (LVH) and T-wave repolarization abnormalities. Subsequent studies ruled out possible pathologies, and the patient was diagnosed with AHS, characterized by cardiac remodeling and bradycardia due to prolonged cardiac loading. This case underscores the importance of clinical assessment, cardiac imaging, and exclusion of pathologic causes to distinguish normal physiological adaptations from potentially concerning conditions.

Measuring provider compliance with ischemic heart disease guidelines.

OBJECTIVES: The purpose of this study was to assess the relationships among provider beliefs, attitudes, and intention to use Veterans Health Administration guidelines for ischemic heart disease (IHD). METHODS: A self-administered written questionnaire was mailed to providers at six Veterans Administration hospitals in a Veterans Integrated Service Network. The questionnaire measured the providers' general impression of the IHD guidelines, factors that influence use of cardiac medications, and barriers to using the guidelines. RESULTS: A total of 170 of 491 eligible providers returned the questionnaire (35% response rate). The top reasons cited for following the guidelines were to decrease mortality, prevent future myocardial infarction, decrease the risk of recurrent events, and provide positive cardiac effects. The authors found that, overall, providers have a positive impression of the IHD guidelines because they provide a standard of care and result in higher quality of care. CONCLUSIONS: The authors' results indicate that providers support the guidelines, but encounter barriers in accessing them.