The athlete’s heart refers to the normal changes that occur in the heart when a person regularly practices intense physical activities. Among these adaptations, cardiac hypertrophy is often observed, meaning an increase in the size or thickness of the muscle.
In most cases, these changes are beneficial and reversible. They demonstrate the heart’s ability to adapt to repeated efforts and to improve its efficiency.
Read more: The Athlete’s Heart – A Normal Adaptation
A trained muscular pump
The heart acts as a muscular pump that propels bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood throughout the body. When stressed regularly and intensively, it can transform—this is the phenomenon of cardiac remodeling.
The analogy with weight training is clear: muscles grow under sustained training. In the same way, the heart strengthens its walls when it must eject bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood against greater resistance. This results in hypertrophy of the left ventricle.
When adaptation exceeds its limits
Although athlete’s heart hypertrophy is generally harmless, certain situations can cause this natural mechanism to shift into a pathological risk:
- Overtraining, which tires the heart muscle and may lead to rhythm disorders or reduced performance.
- Doping, which artificially enhances remodeling and weakens the heart, increasing the risk of severe arrhythmias and even sudden death.
It is therefore essential to distinguish a healthy athlete’s heart, which simply reflects good adaptation, from the excesses linked to inappropriate or dangerous sports practices.
Sports doping – Impact on the heart
This text highlights the cardiovascular consequences of doping in athletes.
Doping
Doping causes particularly concerning remodeling. Under the effect of anabolic steroids, certain hormones, or stimulant products such as amphetamines and decongestants, the heart develops concentric remodeling: its walls thicken rigidly, without proportional dilation of the cavity.
This hypertrophy is accompanied by fibrosis—an abnormal scarring of the heart muscle—that reduces its flexibility. The heart then loses its ability to relax properly between beats. Pressure increases inside the left ventricle and extends into the lungs, causing pulmonary congestion (or “water in the lungs”), even if contraction still appears vigorous… or sometimes already weakened.
This rigid and fibrous remodeling is not only responsible for poor relaxation, it also promotes conduction disorders and arrhythmias. Some can be severe, even fatal, turning a sporting practice that is supposed to be beneficial into a major risk for life.
Often irreversible
Unlike overtraining, the damage caused by doping is often only partially or not at all reversible. Even after stopping the substances, the scars left on the heart may persist and compromise health for the rest of one’s life.
Thus, a brief moment of performance sought for glory or recognition can leave consequences for a lifetime—a very high price to pay for a fleeting success.
A widespread scourge
These substances are far from limited to elite athletes. They are widely available and easily accessible, including to amateur athletes.
What is worrisome is that anti-doping controls are much stricter for professionals than for amateurs, leaving the latter exposed to high risks without real monitoring.
A difficult but necessary admission
Admitting the use of doping substances to one’s doctor is often painful, but essential. The role of the healthcare professional is to prevent and treat, not to judge. In any case, some bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood tests quickly reveal the effects of doping.
The resulting toxic cardiomyopathies can cause permanent damage, including potentially fatal arrhythmias.
Read more: Toxic Cardiomyopathy
Possible arrhythmias
In the context of doping, the risk of developing a rhythm disorder increases significantly.
- Ventricular extrasystoles
Ventricular extrasystoles are premature heartbeats. They are common among athletes but also in the general population. In the vast majority of cases, they are benign and do not compromise health or athletic practice.
- Atrial fibrillation
Atrial fibrillation is an electrical disturbance of the atriaThe atria are the two upper chambers of the heart. They act as reservoirs for blood that will fill the ventricles. that can occur in athletes. It manifests as an irregular and rapid heartbeat. When diagnosed, it requires particular attention, since it may carry a higher risk of being complicated by a bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood clot that can travel to the brain and cause a stroke.
Prevention of this potential complication does not concern all athletes. It is mainly indicated in those who have additional risk factors, such as advanced age or certain medical histories (hypertension, diabetes, heart disease).
- Ventricular tachycardia
A small subgroup of athletes may, however, develop repeated ventricular extrasystoles that evolve into ventricular tachycardia. This arrhythmia is more concerning because it is sometimes associated with extreme remodeling of the heart muscle or enlargement of the cavities. It then reflects a pathological process and may expose the athlete to a life-threatening risk. In such cases, continuing competition becomes dangerous and must be reassessed by the medical team.
Symptoms
The suggestive symptoms may include:
- Palpitations“Palpitation” is a symptom related to an abnormality in heartbeats. There are several types of arrhythmias. This term is like a surname that encompasses several first names.,
- Shortness of breath,
- Unusual fatigue,
- Decreased performance,
- Or chest pain.
Investigations
Faced with these signs, a medical evaluation is essential.
It is based on:
- Electrocardiogram (ECG)
An athlete’s ECG may reveal various abnormalities. Some correspond to normal adaptations to training, while others may raise suspicion of toxic cardiomyopathy linked to the use of doping substances.
One may observe increased electrical activity, reflecting an abnormal thickening of the heart muscle. This exaggerated pattern can be accompanied by signs of slowed electrical conduction in the left ventricle.
The heart rate is sometimes faster than expected, with the presence of extrasystoles (premature beats). In some cases, the ECG also shows other rhythm disorders that require special attention.
- Echocardiography
Cardiac ultrasound allows direct visualization of the heart’s structure. In an athlete’s heart, moderate and generally balanced hypertrophy is seen, with good systolic and diastolic function.
The heart of a doped athlete appears thicker and less flexible. Ultrasound may even suggest the presence of fibrosis, meaning scarring infiltration in the muscle walls.
The contraction of the heart may seem normal or only slightly reduced, but its ability to relax and fill with bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood is clearly impaired. This rigidity leads to elevated pressures inside the heart, which can be transmitted to the lungs and cause pulmonary congestion (“water in the lungs”).
- Magnetic resonance imaging (Cardiac MRI)
Magnetic resonance imaging is a very precise tool for analyzing the heart in detail. It allows accurate measurement of wall thickening, cavity size, and above all, detection of fibrosis (scars in the heart muscle) or any other infiltrating process in the myocardium.
Its main role, in the context of doping, is to help understand the cause of abnormalities already observed on ECG and echocardiography. By confirming that these changes are linked to toxic damage to the heart muscle, MRI becomes an essential tool to establish the correct diagnosis and avoid confusing doping-related effects with another heart disease.
Treatment
The treatment of cardiomyopathy related to doping begins with the immediate and permanent discontinuation of doping substances. As long as these substances circulate, the damage progresses and the risks increase.
Medical management then depends on the consequences observed:
- If the heart’s contraction is weakened, treatment for heart failure may be necessary (medications to support cardiac function, reduce the heart’s workload, and limit symptoms).
- In cases of fluid accumulation in the lungs (“water in the lungs”), diuretics may be prescribed to quickly relieve shortness of breath.
- In the presence of rhythm disorders, close monitoring is essential. Treatment will be adapted according to the type of arrhythmia present in the patient.
Prognosis
The prognosis of cardiomyopathy caused by doping is much more serious than that of overtraining.
The scars left in the heart do not disappear and may cause rhythm disorders or heart failure that last a lifetime, even after stopping the substances.
It remains guarded, since fibrosis and stiffness of the heart muscle do not regress once the products are discontinued. Even if contractile strength may remain stable or improve slightly, the risk of severe arrhythmias and heart failure persists in the long term.
Preventing doping
Doping exposes the heart to serious complications: rigid hypertrophy, fibrosis, impaired relaxation, severe arrhythmias, and even sudden death. These risks, sometimes irreversible, are a reminder that pursuing performance at all costs can turn into a heavy burden for the rest of one’s life.
The best recommendation remains to avoid shortcuts and to rely on natural progression, with balanced training, healthy lifestyle habits, and appropriate medical follow-up.
However, it must be acknowledged that some athletes will nevertheless choose doping. In this situation, it is essential to be transparent with one’s healthcare professional. Speaking about it early makes it possible to quickly detect adverse effects, rather than waiting for complications to appear and permanently compromise health.
Conclusion
Cardiomyopathy linked to doping represents a serious injury to the heart muscle. Unlike the healthy athlete’s heart, the changes induced by doping substances are not an adaptation but a toxic aggression. The rigid hypertrophy and fibrosis that develop impair relaxation, promote rhythm disorders, and expose the individual to severe, sometimes irreversible complications.
The only truly effective treatment lies primarily in the complete discontinuation of doping substances. Depending on the symptoms, medications may then be required to support cardiac function, treat heart failure, or prevent arrhythmias. Prognosis largely depends on the severity of the lesions and how quickly the use of substances is stopped.
Ultimately, by pursuing performance at all costs, the athlete puts their health at risk—sometimes for the rest of their life.
Related articles
Latest articles
