Valvular Heart Disease and Sport

Valvular heart disease is usually an age-related degenerative process, predominantly affecting individuals in their fifth decade and onwards. However, there is also a large population of younger individuals with valvular heart disease many of them asymptomatic, who want to engage in sports on a higher level. Unfortunately, little is known about the potential influence of chronic intensive physical activity on the progression of valvular heart disease. In addition, it is theoretically possible that an increased cardiac preload and afterload during exercise could accelerate valvular dysfunction, resulting in adverse cardiac remodeling, pulmonary hypertension and a greater likeliness of cardiac arrhythmias. As a result, the diagnosis of an athlete with valvular heart disease during routine or pre-participation cardiac examination is challenging and often raises the question about on-going participation in competitive sport and the level of permissible physical effort during recreational exercise. Sport disciplines can be divided into groups according to their prevailing load (either endurance or isometric) and their different impact on the cardiovascular system. Dynamic exercise primarily causes an increased volume load to the ventricle, whereas static exercise causes more of a pressure load. Of course, all sports are a combination of these types of effort. Transthoracic echocardiography, ECG and physical examination are the first line investigations to evaluate the diagnosis of valvular heart disease. However, also stress test, stress echocardiography, transoesophageal echocardiography and cardiac magnetic resonance imaging often provide important additional information to quantify the severity of valvular heart disease and to evaluate the recommended degree of allowed exhaustion. The presented manuscript gives an overview about the current literature and provides useful decision guidance to evaluate the recommended level of sports in individuals with valvular heart disease.