Tomáš Jurko, Alexander Jurko ml., Ján Strachan, Lucia Olexová Bóna, Michal Meštaník, Ingrid Tonhajzerová, Jana Mištinová Poláková
Differential diagnosis of hypertrophic cardiomyopathy and an “athletic heart” is still being discussed and it stands as a sensitive issue of determining the correct diagnosis in clinical cardiology, which is also the issue of the future of top athletes. For this reason, new possibilities and algorithms of non-invasive determination of discrete changes of an “athletic heart” are being constantly sought, as opposed to hypertrophic cardiomyopathy. The objective and purpose of this paper is to point out the problems in distinguishing hypertrophic cardiomyopathy from an “athletic heart” based on causal cases of active athletes using non-invasive methods, including magnetic resonance imaging (MRI). The non-invasive examination algorithm (physical examination, ECG, echocardiography, magnetic resonance) revealed hypertrophic cardiomyopathy in two top-notch athletes, whereas the third athlete was diagnosed with adaptive changes in the “athletic heart” without any signs of HCM. The golden standard of HCM diagnostics – echocardiographic examination – revealed single heart abnormalities in all three cases, but magnetic resonance showed fibrotic changes in the first two athletes. The third athlete with sinus bradycardia showed no pathomorphological changes in the myocardium.
We believe that these case reports have highlighted the significant contribution of magnetic resonance of the heart using an intravenous contrast that can be beneficiary to the diagnostic algorithm in differential diagnostics of HCM and “athletic heart”, as well as the subsequent recommendation of monitoring the athlete throughout his/her peak career.