A cardiologist’s view of hypertrophic cardiomyopathy

Sanjay Sharma

BHF-funded Sanjay Sharma is Professor of Inherited Diseases and Sports Cardiology, a consultant cardiologist at St George’s Hospital and Medical Director of the London Marathon. He was also Lee Mears’s consultant.

“People who exercise a lot can develop a 15–20 per cent increase in the thickness of the left ventricle, the main pumping chamber of the heart,” says Professor Sharma.

“The problem is trying to differentiate between a heart muscle that has become thick because someone has exercised a lot and someone who has a heart problem, such as the inherited condition hypertrophic cardiomyopathy, which also causes thickness, but can increase the risk of sudden death by three- to five-fold.

“You may find a male athlete in the prime of their career has a [heart] wall thickness of 14mm. This could be normal or it could indicate something more serious; it’s critical to get the right diagnosis.”

"The problem is trying to differentiate between a heart muscle that has become thick because someone has exercised a lot and someone who has a heart problem"

If an abnormality is detected in the wall thickness of the heart, Professor Sharma runs a series of additional tests. These include a stress test where he monitors athletes on a treadmill to help determine whether the thickness is the result of intensive exercise, or hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy increases the risk of sudden cardiac death, especially when people do high-intensity exercise; hence the advice is to give this up.

“For most people, a diagnosis of hypertrophic cardiomyopathy means making a series of lifestyle modifications, such as not doing lots of high-risk sport. You can’t take away everything, though – not just because of the psychological implications but because we know that people who take part in moderate-intensity activity are less likely to be overweight, have diabetes or high blood pressure. That sort of benefit can be achieved by walking briskly for 30 minutes every day – you don’t have to run very fast on a rugby pitch to achieve that.”

Read Lee Mears' story

Related publications