HEARTBEATS OF CHAMPIONS: NAVIGATING SMALL CONGENITAL HEART ABNORMALITIES IN YOUTH ATHLETES

HEARTBEATS OF CHAMPIONS: NAVIGATING SMALL CONGENITAL HEART ABNORMALITIES IN YOUTH ATHLETES

Ainash Issayeva

MD, MSc, Senoir lecturer, Al-Farabi Kazakh National University,

Kazakhstan, Almaty

Zhanna Zhalimbetova

MD, MSc, Senoir lecturer, Al-Farabi Kazakh National University,

Kazakhstan, Almaty

Aigul Akimniyazova

MSc, Senoir lecturer, Al-Farabi Kazakh National University,

Kazakhstan, Almaty

ABSTRACT

Despite the risks, many athletes with a small congenital heart abnormalities are able to participate in sports with proper management and precautions. It is important for athletes to work closely with their healthcare team to develop an individualized plan that takes into account their specific condition and level of activity[1].

Keywords: minor cardiac abnormalities, сongenital heart diseases, sudden cardiac events, athletes, pre-participation screening, sudden cardiac death.

Purpose of the study. To determine the long-term effects of exercise on heart health in athletes with small congenital heart abnormalities to prevent sudden cardiac events.

Abstract. Congenital heart abnormalities affect millions of people worldwide, with an estimated prevalence of 1% of all live births. This means that approximately 8 out of every 1,000 babies are born with some form of congenital heart abnormality [2]. In our days with advances in treatment and surgery, nearly 90% patients with congenital heart disease reach adulthood. This achievement form of an ever-growing population of adults with congenital heart disease in our days [3].  These abnormalities can range from mild to severe and can affect the way the heart functions [4]. Small congenital heart abnormalities may limit an athlete's ability to perform at their highest level. This can be frustrating for athletes who may feel like they are not reaching their full potential [5].  

Small congenital heart abnormalities (SCHA) are structural defects of the heart that are present at birth [4]. Minor anomalies of the heart are currently defined as hereditary structural and metabolic changes in the valvular apparatus of the heart and / or its connective tissue framework, including the main vessels, in the form of various anatomical anomalies that are not accompanied by hemodynamically gross and clinically significant disorders [6]. The most common anomalies include false tendons or chords of the left ventricle, considering them as the cause of violations of intracardiac hemodynamics, diastolic function, electrical stability of the heart [7]. The prevalence of mitral valve prolapse (MVP) does not exceed 5% in the population [8]. The SCHA group also should include MVP without thickening of the valve leaflets and significant mitral regurgitation. Single apical false chordae of the left ventricle and abnormal trabeculae are classified by the authors as normal variants or anatomical and physiological features [8].

If we talk about the types of small heart anomalies, they are classified according to localization and form, etiology, and the presence of complications [9].  

I. According to localization: atriums and interatrial septum, tricuspid valve, pulmonary artery, aorta, left ventricle, mitral valve.

II. According to Etiology: dysplasia of the connective tissue structures of the body, unfavorable antenatal factors in the period from the 9th to the 15th week of intrauterine development, changes in postnatal ontogenesis.

III. According to Complications: calcification, fibrosis of the valve leaflets, hemodynamic disturbances, infective endocarditis, pulmonary hypertension, heart rhythm and conduction disorders.

All athletes with congenital heart abnormalities face unique challenges when it comes to participating in sports. However, with proper education and support, many of these athletes can safely engage in physical activity and pursue their athletic goals [10]. While some athletes with more severe abnormalities may be restricted from participating in certain sports, those with small abnormalities may still be able to compete at a high level with proper training modifications, monitoring (electrocardiograms, echocardiograms, cardiac magnetic resonance imaging (MRI) and etc.) [11].  In addition, wearable technology such as heart rate monitors and fitness trackers can provide real-time data on an athlete's heart rate and performance, allowing for adjustments in training and competition to optimize performance while minimizing risk) and medical management as medication (this may include beta blockers, calcium channel blockers, or anti-arrhythmic drugs etc.), or even surgery in some cases [10]. Athletes with small congenital heart abnormalities may be more prone to fatigue and shortness of breath during exercise. As a result, their training regimen may need to be modified to accommodate their condition. This may include shorter workouts or longer rest periods between sets [12]. The key is to work closely with a healthcare provider who specializes in sports cardiology and has experience working with athletes with congenital heart abnormalities. This provider can help develop a personalized care plan that takes into account the athlete's specific condition, as well as their athletic goals and abilities [13]. In recent years, awareness and advocacy campaigns have helped raise awareness about the impact of SCHAs in athletes [14-16].

Athletes with chronic illnesses may also face additional challenges such as medication side effects, doctor appointments, and hospitalizations. These obstacles can be frustrating and demotivating, making it hard to stay on track with physical activity goals [17]. Congenital heart disease is a condition that affects the structure and function of the heart from birth. It can range from mild to severe and can impact an individual's quality of life in various ways. Physical activity is crucial for individuals with congenital heart disease and small congenital heart abnormalities. While it may seem counterintuitive, regular exercise can actually improve their quality of life and overall health [18]. Studies have shown that physical activity can help reduce the risk of complications associated with these conditions, such as arrhythmias and heart failure [18]. It can also improve cardiovascular function and increase endurance, making everyday activities easier to manage [19]. Individuals with congenital heart disease and small congenital heart abnormalities may experience a reduced quality of life due to their condition [20]. They may have to limit their physical activity, which can lead to feelings of isolation and frustration. Additionally, they may require ongoing medical care and monitoring, which can be stressful and time-consuming [21]. However, it's important to note that many individuals with congenital heart disease and small congenital heart abnormalities are able to lead full and fulfilling lives. With proper management and support, they can participate in physical activity, pursue their passions, and achieve their goals. It's important for healthcare providers, family members, and friends to provide encouragement and support to these individuals, helping them to maintain a positive outlook and a strong sense of self-worth [21].

Methodology.  The study will involve a retrospective analysis of medical records and imaging studies of athletes with small congenital heart abnormalities who have been cleared to participate in sports. The study will also include a longitudinal follow-up to evaluate the long-term effects of exercise on their heart health [21, 22].

Expected Outcomes. A better understanding of the prevalence of small congenital heart abnormalities in athletes. Insight into the long-term effects of exercise on heart health in athletes with small congenital heart abnormalities to prevent sudden cardiac events in Athletics with small congenital heart abnormalities.

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