Sports cardiology in Düsseldorf: expertise for the sports heart with Dr. Bruno

Sports cardiology is the highly specialized discipline that deals with the complex interactions between intensive sporting activity and the cardiovascular system. It is the crucial link between cardiology and sports medicine and requires in-depth knowledge of both disciplines. As a certified sports cardiologist, Dr. Raphael Bruno offers you the highest level of care in his practice in Düsseldorf, which aims to optimize your performance and at the same time ensure the safety of your heart.

What is sports cardiology and who needs a sports cardiologist?

The Sports cardiology goes far beyond a general sports medicine examination. It deals with the specific adaptations of the heart to training, the differentiation of these normal changes from pathological findings and the prevention of the rare but tragic sudden cardiac death in sport. In addition, the sports cardiologist advises athletes with known heart disease in order to define a safe level of sporting activity.

A sports cardiology assessment is particularly essential for the following groups of people:

Competitive and competitive athletes of all age groups.
Ambitious recreational athletes, who train intensively (e.g. for marathons or triathlons).
Athletes with symptoms such as chest pain, dizziness, excessive shortness of breath or palpitations under stress.
People with a positive family history for sudden cardiac death or congenital heart disease.
Patients with known heart disease, who wish to remain active in sport („Return to Sport“).

The „athlete's heart“: normal adaptation or pathological finding?

Regular and intensive endurance training leads to a physiological, i.e. normal, adaptation of the heart. It becomes larger, the heart walls become moderately thicker and the resting heart rate drops. This „athlete's heart“ is a sign of high performance. However, some serious heart diseases, such as hypertrophic cardiomyopathy (HCM), can show a similar picture of wall thickening on ultrasound.

The core competence of Sports cardiology lies in reliably distinguishing between these two conditions. This requires the highest level of expertise in echocardiography and the interpretation of the athlete's ECG.

Differentiation: Physiological athlete's heart vs. pathological hypertrophy

Feature	Physiological athlete's heart	Pathological hypertrophy (e.g. HCM)
Type of thickening	Harmonious, symmetrical, mostly < 13 mm	Often asymmetrical, uneven, > 15 mm
Size of the heart chamber	Mostly enlarged (dilated)	Often normal size or even reduced in size
Diastolic function	Normal or improved (heart fills up well)	Often disturbed (heart is stiff and fills poorly)
ECG changes	Typical, harmless „athlete changes“	Often clearly abnormal ECG patterns
Behavior during a training break	The changes slowly recede	The thickening remains or increases

Sports cardiology screening: prevention of sudden cardiac death in sport

Although very rare, sudden cardiac death in a young, seemingly healthy athlete is a tragic event. The main cause is usually unrecognized congenital heart disease. The aim of sports cardiology screening is to identify athletes with an increased risk through a targeted examination before an emergency occurs.

Such an investigation as part of the Sports cardiology is particularly important if you experience certain warning signals („red flags“):

Dizziness or fainting (syncope) during or shortly after exercise
Unreasonably severe shortness of breath or chest pain on exertion
Unexplained palpitations or stumbling of the heart
Sudden, inexplicable drop in performance
Cases of sudden cardiac death in relatives under 50 years of age

If any of these symptoms are present, an immediate sports cardiology examination is absolutely essential.

Sports cardiology for known heart disease: Staying active safely

In most cases today, a diagnosis of heart disease no longer means the end of sporting activity. On the contrary: targeted exercise is often an important part of therapy. The Sports cardiology plays a decisive role in answering the „return to sport“ question. After a careful analysis of the individual findings, the sports cardiologist can make clear recommendations as to which types of sport are safe and beneficial to health and at what intensity. This applies to patients after a heart attack, with cardiac arrhythmia or with congenital heart defects.

The sports cardiology examination: our procedure

One Sports cardiology examination is more comprehensive than a simple health check. It focuses specifically on the critical aspects of heart health in sport.

The examination in our practice in Düsseldorf typically includes:

Specialized anamnesis: Detailed questioning about sporting activities, family history and any symptoms.
Physical examination: With special attention to possible signs of heart disease.
12-lead ECG at rest: Evaluation according to the internationally recognized, specific criteria for sports ECGs.
Echocardiography (cardiac ultrasound): The central examination to assess the heart muscle, chambers and valves in order to rule out structural anomalies.
Exercise ECG (ergometry): To assess blood pressure, heart rate and rhythm under maximum stress and to detect ischemia.
Summarized assessment and advice: The result is a clear statement on suitability for sport and individual advice.

Frequently asked questions from sports cardiology

Here you will find answers to frequently asked, specific questions in the field of sports cardiology.

What is hypertrophic cardiomyopathy (HCM) and why is it dangerous for athletes?

HCM is a congenital thickening of the heart muscle. It is the most common cause of sudden cardiac death in young athletes. HCM can lead to life-threatening cardiac arrhythmias during intense physical exertion. Differentiation from the harmless athlete's heart is the central task of the Sports cardiology.

I had an inflammation of the heart muscle (myocarditis). When can I do sport again?

After myocarditis, a strict break from sport of at least three, often even six months, is essential. Clearance for a gradual resumption of training may only be given by a cardiologist. A comprehensive Sports cardiology examination with ECG, cardiac ultrasound and stress test is mandatory before readmission to ensure that the inflammation has completely healed.

Is a congenital heart defect always an obstacle to competitive sport?

Not necessarily. This depends heavily on the type and severity of the heart defect. Many simple heart defects that are not hemodynamically relevant allow unrestricted sporting activity. In the case of more complex defects, the sports cardiologist must carry out an individual risk assessment and make clear recommendations for suitable types of sport and intensities.

My resting heart rate is sometimes under 40 - is that still healthy?

A very low resting heart rate (sinus bradycardia) is a typical and usually harmless sign of an economically functioning heart in well-trained endurance athletes. As long as there are no symptoms such as dizziness or poor performance, this is harmless. A Sports cardiology examination can, however, ensure that there are no pathological causes for the slow heartbeat.

What is „commotio cordis“?

Commotio cordis is an extremely rare event in which a blunt but violent blow to the chest (e.g. from a puck or ball) occurs precisely in a vulnerable phase of the cardiac cycle and triggers life-threatening ventricular fibrillation. This is a purely electrical problem in a structurally healthy heart.

I take heart medication (e.g. beta blockers). Can I still do competitive sport?

This must be assessed on an individual basis. Beta blockers lower the maximum heart rate and can limit endurance performance. Depending on the underlying disease and type of sport, however, adapted sporting activity is possible and sensible. Close consultation with the treating sports cardiologist is essential here.

Are cardiac arrhythmias always dangerous during sport?

No. Occasional extrasystoles („palpitations“) also occur in completely healthy athletes and are often harmless. However, persistent palpitations, irregular pulse or rhythm disturbances that lead to dizziness must always be confirmed by a doctor. Sports cardiology examination be clarified in order to rule out dangerous forms.

What does the „Sports Cardiologist (DGK)“ certification mean?

This is an official additional qualification of the German Society of Cardiology (DGK). It is awarded to cardiologists who have completed structured further training and have proven expertise in the care of athletes and cardiac patients in sport. This certificate guarantees the highest level of expertise in the field of Sports cardiology.

Are there age limits for competitive sport from a cardiological point of view?

No, there are no fixed age limits. Impressive performances can also be achieved at Master's level. However, the risk of coronary heart disease increases with age. Therefore, regular Sports cardiology examination all the more important for athletes aged 35 and over.

My ECG was assessed as „abnormal“, but I'm in top shape. What now?

The ECG of competitive athletes very often shows changes that would be considered pathological in a non-athlete. An experienced sports cardiologist can reliably distinguish these training-related adaptations from genuine pathologies. A misinterpretation by an inexperienced doctor can lead to unnecessary uncertainty and false sports bans.

Your heart health in competitive sport - in expert hands

Intense sport places high demands on your heart. To ensure that you can pursue your passion without risk, care from a proven expert is essential. As a certified sports cardiologist, Dr. Raphael Bruno in Düsseldorf offers you the professional expertise you need to assess your sports heart. Make an appointment for a comprehensive Sports cardiology examination.