The multifaceted aspects of sports cardiology and exercise

Sports cardiology is devoted to taking care of athletes, differentiating physiological cardiovascular (CV) adaptations from life-threatening pathologies, but also assessing athletes who refer CV symptoms, managing those affected by established CV diseases and providing preparticipation eligibility. A concerted collaboration of a multidisciplinary team is required in complex cases, as the sports cardiologist is expected to pursue medical decision in the best interest of the athlete. Over the years this field has expanded to include not only professional or competitive athletes, but also highly active people, practicing regularly vigorous physical activity for competitive or recreational scope. Repetitive bouts of exercise over time determine morphological and functional changes in an adaptive and healthy CV system, the so-called athlete’s heart. Exercise physiology and exercise-induced cardiac remodeling are essential knowledge to recognize these adaptations during physical examination and diagnostic testing. The initial dicotomy of physiological athletic versus pathological remodeling due to an underlying cardiac disease has evolved over time, in a complex interaction where both the exercise load and the myocardial substrate may result in clinical disease.